bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hydrotherapy and acupressure in restless legs syndrome: A randomized, controlled, 3-armed, explorative clinical trial
Authors: Kubasch Julia , Ortiz Miriam , Binting Sylvia , King Ryan , Dietzel Joanna , Nögel Rainer , Hummelsberger Josef , Willich Stefan N. , Brinkhaus Benno , Teut Michael , Siewert Julia 
Published: June 2023

Background:
Restless legs syndrome (RLS) is a common neurological disease that has a significant impact on daily activities and quality of life, for which there is often no satisfactory therapy. Complementary medicine, such as acupressure and hydrotherapy, is used to treat patients with RLS; however, the clinical evidence is unclear. This study aims to investigate the effects and feasibility of self-administered hydrotherapy and acupressure in patients with RLS.

Methods:
This is a randomized, controlled, open-label, exploratory, clinical study with 3 parallel arms, comparing both self-applied hydrotherapy (according to the German non-medical naturopath Sebastian Kneipp) and acupressure in addition to routine care in comparison to routine care alone (waiting list control) in patients with RLS. Fifty-one patients with at least moderate restless-legs syndrome will be randomized. Patients in the hydrotherapy group will be trained in the self-application of cold knee/lower leg affusions twice daily for 6 weeks. The acupressure group will be trained in the self-application of 6-point-acupressure therapy once daily for 6 weeks. Both interventions take approximately 20 minutes daily. The 6-week mandatory study intervention phase, which is in addition to the patient preexisting routine care treatment, is followed by a 6-week follow-up phase with optional interventions. The waitlist group will not receive any study intervention in addition to their routine care before the end of week 12. Outcome parameters including RLS-severity, disease and health-related quality of life (RLS-QoL, SF-12), Hospital Anxiety and Depression Score in German version, general self-efficacy scale, and study intervention safety will be measured at baseline and after 6 and 12 weeks. The statistical analyses will be descriptive and exploratory.

Conclusion:
In the case of clinically relevant therapeutic effects, feasibility, and therapeutic safety, the results will be the basis for planning a future confirmatory randomized trial and for helping to develop further RLS self-treatment concepts.
A case report of thalidomide in the treatment of camrelizumab-induced reactive cutaneous capillary hyperplasia
Authors: Fu Shujuan , Li Cunya , Wang Zhiying , Zhong Zhixian , Zhong Yi 
Published: June 2023

Rationale:
Reactive cutaneous capillary endothelial proliferation (RCCEP) is the most prevalent immune-related adverse event observed in patients undergoing camrelizumab treatment, and there is a lack of effective therapeutic strategies. Thalidomide (THD) has anti-inflammatory, immunomodulatory, antiangiogenic, and antitumor properties, which have led to its use in various autoimmune diseases, hematological malignancies, solid tumors, and other disorders.

Patient concerns:
A 52-year-old male patient with lung cancer developed vascular moles on his face, neck, and back after 3 cycles of chemotherapy comprising pemetrexed and carboplatin combined with camrelizumab immunotherapy. The moles ranged in size (0.1–1.2 cm) and were red or red-black, appearing on the skin’s surface. The patient was advised to avoid scratching or friction, continue monitoring, and apply Yunnan Baiyao powder if a papule ruptured. After the third treatment cycle, papules on the patient’s face, particularly an eyelid vascular mole, ulcerated, causing significant psychological distress.

Diagnosis:
RCCEP induced by camrelizumab was considered.

Interventions:
The patient received 50 mg of THD in the morning and 100 mg in the evening.

Outcomes:
The vascular nevus began to shrivel after 1 week and started disappearing after 2 weeks of THD treatment. After 3 THD treatment courses, RCCEP was alleviated without recurrence, allowing the patient to successfully complete camrelizumab treatment.

Lessons:
During treatment with camrelizumab, if a patient develops moderate or severe RCCEP, and local therapy or anti-infective therapies prove insufficient, THD may be considered as a potential treatment option to improve RCCEP symptoms.
Can stellate ganglion blockage be an alternative treatment for refractory ventricular arrhythmias: Case series
Authors: Küçükbingöz Çağatay , Tepe Ömer , Özmen Çağlar , Özbek Hayri T. , Deniz Ali 
Published: June 2023

Introduction:
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions which increase in frequency over the years. Electrical storm (ES) is defined as the occurrence of 3 or more continuous ventricular arrhythmia. The sympathetic nervous system has an important role in Ventricular arrythmias (VA) and is the target of treatment. Studies show that stellate ganglion blockade (SGB) can reduce cardiac sympathetic tone and is an alternative bridge therapy in VAs.

Patient concerns:
Among the patients who were admitted to the hospital with the complaints of general condition disorder and palpitation.

Diagnosis:
Patients were referred to the Cardiology department and diagnosed VA and ES. Patients who applied to the Cardiology Department with the diagnosis of VA or ES and did not benefit from antiarrhythmic drug therapy were selected and evaluated by a team of 2 anesthesiologists (cardiothoracic and pain specialists) and 2 cardiologists (1 of whom is an electrophysiology specialist).

Intervention:
In our study, ultrasound (USG) guided left SGB was applied to 10 VA and ES patients with implantable cardiac defibrillator (ICD). The 6-month results of the patients were evaluated retrospectively. For blockage, the solution was prepared by adding 8 mg dexamethasone, 40 mg lidocaine and 10 mg bupivacaine to 10 mL with physiological saline. The success of the procedure was evaluated with the development of Horner syndrome in the left eye.

Outcomes:
Resistant VA developed in 2 of 10 patients who had left SGB due to VF/VT ES and were excluded from the study. One (1) month after the procedure it was seen that there was a statistically significant decrease in the number of shocks in 8 patients in the 6th month controls compared to the pre-procedure. The number of VES in the 1st and 6th months of the patients was also statistically significantly decreased compared to the pre-SSD (P = .01, P = .01, P = .01, respectively).

Conclusion:
Unilateral USG-guided SGB application is an effective and safe method in patients with ES and VA. Long-term results can be satisfactory in successful responders in whom SGB is performed with a combination of local anesthetic and steroid.
Effects of traditional Chinese exercise on physiological indicators and quality of life in patients with coronary heart disease: A systematic review and meta-analysis
Authors: Wang Fan , Cai Jingjing , Liu Jihong , Duan Banyan , Yang Yingying , Yang Qianfang 
Published: June 2023

Background:
The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of physiological indicators and quality of life in patients with coronary heart disease (CHD) is controversial.

Method:
Five databases were systematically searched for relevant articles published from inception to February 2023. Controlled trials examining TCE intervention in patients with CHD. The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges g). The categorical and continuous variables were used to conduct moderator analyses. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence based on the Grading of Recommendations Assessment, Development and Evaluation approach. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023401934).

Result:
Ten studies involving a total of 718 participants were included in the final analysis. In the physiological indicators outcomes, the meta-analytic findings revealed large and significant improvements in systolic blood pressure (g = 0.78, 95% confidence interval [CI] = 0.51–1.05, P = .00, I
2 = 98%), diastolic blood pressure (g = 0.90, 95% CI = 0.61–1.20, P = .00, I
2 = 98%) and body mass index (g = 1.05, 95% CI = 0.75–1.34, P = .00, I
2 = 99%), small and significant improvements in heart rate (g = 0.28, 95% CI = 0.01–0.54, P = .04, I
2 = 98%) and ventilatory equivalents/carbon dioxide (g = −1.10, 95% CI = −1.47 to −0.74, P = .00, I
2 = 96%).
In the quality of life outcomes, the findings revealed small and significant improvements in physical functioning (g = −3.01, 95% CI = −3.45 to −2.57, P = .00, I
2 = 96%), bodily pain (g = −2.16, 95% CI = −2.57 to −1.74, P = .00, I
2 = 98%), vitality (g = −3.67, 95% CI = −4.16 to −3.16, P = .00, I
2 = 97%) and mental health (g = −1.23, 95% CI = −1.771 to −0.692, P = .00, I
2 = 99%). The moderator shows that the effects of TCE on physiological indicators and quality of life were moderated by PEDro score, type of exercise, exercise frequency, exercise duration, and number of sessions.

Conclusion:
TCE intervention is a beneficial nonpharmacological approach to improving physiological indicators in patients with CHD, especially in systolic blood pressure, diastolic blood pressure, and body mass index. However, there was no significant effect on quality of life. Our findings require broader clinical trials and higher-quality study designs to strengthen the evidence.
Endoscopic approaches to the management of hemorrhoids
Authors: Kodilinye Syed Matthew , Kalloo Anthony N. 
Published: June 2023

Purpose of review
To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids.

Recent findings
Despite the large burden of hemorrhoidal diseases, research in this area, particularly on endoscopic approaches for treatment, has been slow. Within the last 5 years, data has been published on the novel cap-assisted endoscopic sclerotherapy (CAES), which will continue to gain attention in the future. Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL), demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common. Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES. Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting. Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials. The Goligher classification alone is inadequate for determining the management of symptomatic hemorrhoids and this warrants revision.

Summary
Gastroenterologists are poised to assume a greater role in the management of internal hemorrhoids with flexible endoscopy. Current endoscopic treatment options require further study.
Increased Total Antioxidant Capacity Value Improves Survival of Fat Grafts in Rat Model
Authors: Cinar Fatih , Yalcin Can Ege , Ayas Gorkem , Celik Ugur , Okyay Mehmet Fatih , Demiröz Anil , Bağhaki Semih , Cetinkale Oguz 
Published: June 2023

Background:
Although studies aiming to increase fat graft survival continue, in this study, the authors aimed to investigate the effects of different antioxidants on total antioxidant capacity (TAC) and their effect on graft survival.

Methods:
Thirty-two male Wistar rats were divided into four equally sized groups, including a control group and three antioxidant groups receiving either melatonin (10 mg/kg), zinc (2 mg/kg), or vitamins E and C (100 mg/kg). Autologous fat grafts (1.7 ± 0.4 g) were transferred to the dorsal subcutaneous region, and total antioxidant capacity was measured on days 0 and 1, week 1, and monthly until the third month. Transferred graft volume and mass (1.3 ± 0.4 g) were measured using the liquid overflow method and precision scales at the end of the study. Routine hematoxylin and eosin staining and immunohistochemistry against perilipin were performed for semiqualitative analysis and H-score for viable adipose cells, respectively.

Results:
Collected fat grafts measured significantly less in weight and volume and the survival rate was lower in the control group (P < 0.01). The control group exhibited a reduction in TAC, whereas all groups receiving antioxidants had an increase in TAC during the first week (P = 0.02, P = 0.008, and P = 0.004 for melatonin, zinc, and vitamins, respectively). Immunohistochemistry of the antioxidant group demonstrated a statistically significant excess and reactivity of cells staining with perilipin antibodies.

Conclusion:
In this animal study, the beneficial effect of antioxidants on fat graft survival can be related to the significant increase in TAC following the first week of their administration.

Clinical Relevance Statement:
Antioxidants improve fat graft survival and quality in this rat model, by increasing total antioxidant capacity in the first week of administration.
Upper Eyelid Ptosis Correction with Levator Advancement Using the Levator Musculoaponeurotic Junction Formula in White Patients
Authors: Wong Chin-Ho , Hsieh Michael Ku Hung , Mendelson Bryan 
Published: June 2023

Background:
Upper eyelid ptosis correction is a challenging procedure. The authors report a novel approach to this procedure that is more accurate and predictable compared with conventional approaches.

Methods:
A preoperative system of assessment has been formulated to more accurately estimate the amount of levator advancement required. The levator advancement was referenced from a constant landmark: the musculoaponeurotic junction of the levator palpebrae superioris. The factors considered include the amount of upper lid elevation required, the degree of compensatory brow elevation present, and eye dominance. The preoperative assessment and surgical technique are presented in a series of detailed operative videos. The levator advancement is performed as planned preoperatively with final adjustment made intraoperatively to achieve correct lid height and symmetry.

Results:
Seventy-seven patients (154 eyelids) were analyzed prospectively in this study. The authors found this approach to be reliable and accurate in predicting the required amount of levator advancement. Intraoperatively, the formula correctly predicted the exact required fixation location in 63% of eyelids, and to within ±1 mm in 86% of cases. This may be used for patients with ptosis of varying severity, ranging from mild to severe eyelid ptosis. The revision rate was 4%.

Conclusion:
This approach is accurate in determining the fixation location needed, enabling levator advancement for ptosis correction to be performed with more precision and predictability.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers
Authors: Caiazzo Robert , Bauvin Pierre , Marciniak Camille , Saux Patrick , Jacqmin Geoffrey , Arnoux Raymond , Benchetrit Salomon , Dargent Jerome , Chevallier Jean-Marc , Frering Vincent , Gugenheim Jean , Lechaux David , Msika Simon , Sterkers Adrien , Topart Philippe , Baud Grégory , Pattou François ,   For the SOFFCO-mm Study Group
Published: June 2023

Objective:
To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities.

Background:
While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot’s influence on experienced bariatric laparoscopic surgeons.

Methods:
We conducted a retrospective study using the BRO clinical database (2008–2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance.

Results:
The study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=−0.05, P=0.794), with no difference in the RYGB+SADI group (P=0.322) but a negative trend in the SG group (more complications, P=0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0±9.0 days, P<0.001).

Conclusions:
Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.
What Happens on Call Doesn’t Stay on Call. The Effects of In-house Call on Acute Care Surgeons’ Sleep and Burnout
Authors: Coleman Jamie J. , Robinson Caitlin K. , von Hippel William , Holmes Kristen E. , Kim Jeongeun , Pearson Samuel , Lawless Ryan A. , Hubbard Alan E. , Cohen Mitchell J. 
Published: June 2023

Objective:
We sought to quantify the effects of in-house call(IHC) on sleep patterns and burnout among acute care surgeons (ACS).

Background:
Many ACS take INC, which leads to disrupted sleep and high levels of stress and burnout.

Methods:
Physiological and survey data of 224 ACS with IHC were collected over 6 months. Participants continuously wore a physiological tracking device and responded to daily electronic surveys. Daily surveys captured work and life events as well as feelings of restfulness and burnout. The Maslach Burnout Inventory (MBI) was administered at the beginning and end of the study period.

Results:
Physiological data were recorded for 34,135 days, which includes 4389 nights of IHC. Feelings of moderate, very, or extreme burnout occurred 25.7% of days and feelings of being moderately, slightly, or not at all rested occurred 75.91% of days. Decreased amount of time since the last IHC, reduced sleep duration, being on call, and having a bad outcome all contribute to greater feelings of daily burnout (P<0.001). Decreased time since last call also exacerbates the negative effect of IHC on burnout (P<0.01).

Conclusions:
ACS exhibit lower quality and reduced amount of sleep compared with an age-matched population. Furthermore, reduced sleep and decreased time since the last call led to increased feelings of daily burnout, accumulating in emotional exhaustion as measured on the MBI. A reevaluation of IHC requirements and patterns as well as identification of countermeasures to restore homeostatic wellness in ACS is essential to protect and optimize our workforce.
Diversity and Scale: Genetic Architecture of 2,068 Traits in the VA Million Veteran Program
Authors: Verma Anurag , Huffman Jennifer E , Rodriguez Alex , Conery Mitchell , Liu Molei , Ho Yuk-Lam , Kim Youngdae , Heise David A , Guare Lindsay , Panickan Vidul Ayakulangara , Garcon Helene , Linares Franciel , Costa Lauren , Goethert Ian , Tipton Ryan , Honerlaw Jacqueline , Davies Laura , Whitbourne Stacey , Cohen Jeremy , Posner Daniel C , Sangar Rahul , Murray Michael , Wang Xuan , Dochtermann Daniel R , Devineni Poornima , Shi Yunling , Nandi Tarak Nath , Assimes Themistocles L , Brunette Charles A , Carroll Robert J , Clifford Royce , Duvall Scott , Gelernter Joel , Hung Adriana , Iyengar Sudha K , Joseph Jacob , Kember Rachel , Kranzler Henry , Levey Daniel , Luoh Shiuh-Wen , Merritt Victoria C , Overstreet Cassie , Deak Joseph D , Grant Struan F A , Polimanti Renato , Roussos Panos , Sun Yan V , Venkatesh Sanan , Voloudakis Georgios , Justice Amy , Begoli Edmon , Ramoni Rachel , Tourassi Georgia , Pyarajan Saiju , Tsao Philip S , O’Donnell Christopher J , Muralidhar Sumitra , Moser Jennifer , Casas Juan P , Bick Alexander G , Zhou Wei , Cai Tianxi , Voight Benjamin F , Cho Kelly , Gaziano Michael J , Madduri Ravi K , Damrauer Scott M , Liao Katherine P 
Published: June 2023

AbstractGenome-wide association studies (GWAS) have underrepresented individuals from non-European populations, impeding progress in characterizing the genetic architecture and consequences of health and disease traits. To address this, we present a population-stratified phenome-wide GWAS followed by a multi-population meta-analysis for 2,068 traits derived from electronic health records of 635,969 participants in the Million Veteran Program (MVP), a longitudinal cohort study of diverse U.S. Veterans genetically similar to the respective African (121,177), Admixed American (59,048), East Asian (6,702), and European (449,042) superpopulations defined by the 1000 Genomes Project. We identified 38,270 independent variants associating with one or more traits at experiment-wide (P < 4.6x10-11) significance; fine-mapping 6,318 signals identified from 613 traits to single-variant resolution. Among these, a third (2,069) of the associations were found only among participants genetically similar to non-European reference populations, demonstrating the importance of expanding diversity in genetic studies. Our work provides a comprehensive atlas of phenome-wide genetic associations for future studies dissecting the architecture of complex traits in diverse populations.One Sentence SummaryTo address the underrepresentation of non-European individuals in genome-wide association studies (GWAS), we conducted a population-stratified phenome-wide GWAS across 2,068 traits in 635,969 participants from the diverse U.S. Department of Veterans Affairs Million Veteran Program, with results expanding our knowledge of variant-trait associations and highlighting the importance of genetic diversity in understanding the architecture of complex health and disease traits.