bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure Associated Fistula
Authors: Adams Evan D. , Mirocha James M. , Fleshner Phillip R. , Zaghiyan Karen N. 
Published: January 2023

BACKGROUND:
A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure associated fistula is unknown.

OBJECTIVE:
We sought to characterize healing rates and effect of fistulotomy in fissure associated fistula.

DESIGN:
Retrospective study.

SETTING:
Urban tertiary center.

PATIENTS:
Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure. Crohn’s disease, history of lateral internal sphincterotomy, and fistula not amenable to fistulotomy were excluded.

INTERVENTIONS:
Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach.

MAIN OUTCOME MEASURES:
The primary endpoint was healing, defined as resolution of symptoms and both fistula and fissure wounds within one year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) versus fistulotomy involving anal sphincter fibers (group B).

RESULTS:
Twenty-four of 38 patients (63%) patients healed with a median overall follow-up of 6.6 months (4.2—14.1). The overall median time to healing was 4.4 months (2.2—6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were non-statically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72%, (18/25; p = 0.16). There was no difference in time to healing [Subcutaneous fistulotomy 6.7 months (5.2—8.4) vs. Fistulotomy involving sphincter 5.1 months (2.1—7.0); p = 0.36].

LIMITATIONS:
Treatment bias, with increased utilization of chemical sphincter relaxing agents in those who did not heal. Not applicable to complex fistulas, Crohn’s disease, or atypical fissures.

CONCLUSIONS:
Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited non-statistically significant lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145.
Motivations for Seeking Cosmetic Enhancing Procedures of the Face: A Systematic Review
Authors: Martinez Michael J. , Dixit Dhaval , White Michael W. , Rieder Evan A. 
Published: January 2023

BACKGROUND
Cosmetic enhancing procedures continue to grow in demand. Physicians should understand the complex factors that drive patient motivation for seeking such procedures.

OBJECTIVE
In contrast to a lens of psychopathology, this review reveals the driving power of everyday intrapersonal, social, and behavioral factors that motivate interest in elective facial cosmetic procedures.

MATERIALS AND METHODS
The review was conducted according to PRISMA guidelines and included studies with at least 50 adult patients seeking facial cosmetic enhancements between January 1, 2000, and July 1, 2022.

RESULTS
Among 1,239 identified publications, 21 studies with 9,005 participants were selected for inclusion. The review documents everyday factors as patient motivators for pursuing cosmetic enhancements of the face, with the majority of work focusing on intrapersonal factors (17 of 21 studies), such as preventing aging or negative appearance based self-appraisals. For studies reporting social factors (15 of 21 studies), the most common motivators were the patient's social network and a desire to promote social standing. Behavioral factors revealed that social media and media consumption impact patient motivation for cosmetic enhancements (5 of 21 studies).

CONCLUSION
In summary, this review demonstrates that patient motivations for facial cosmetic enhancements may be best understood through everyday intrapersonal, social, and behavioral factors.
Improved Margin Control of Microcystic Adnexal Carcinoma After Mohs Micrographic Surgery Compared With Wide Local Excision
Authors: Yerneni Sharmitha , Murad Fadi , Schmults Chrysalyne D. , Ruiz Emily S. 
Published: January 2023

BACKGROUND
Microcystic adnexal carcinoma (MAC) is a locally aggressive and deeply infiltrative cutaneous tumor primarily treated with excision; however, there are limited data comparing outcomes by surgical approach.

OBJECTIVE
To compare surgical outcomes of MAC treated with Mohs micrographic surgery (MMS) and wide local excision (WLE).

METHODS
A 27-year retrospective cohort study of primary MAC was performed. Surgical (i.e. margin status after resection) and recurrence outcomes (including local recurrence [LR], nodal metastases [NM], and distance metastases [DM]) were analyzed by type of surgical approach (MMS and WLE).

RESULTS
Sixty-nine MACs were included, of which 34 (49.3%) were treated with MMS and 35 (50.7%) with WLE. All MMS-treated tumors had negative margins after the first surgery attempt. Twenty-one (60.0%) tumors treated with WLE had positive margins after the first surgical attempt and required additional procedures. More tumors treated with WLE developed LR, NM, or DM, although this did not meet statistical significance.

LIMITATIONS
Retrospective single institution study.

CONCLUSION
Greater than half of MAC tumors treated with WLE had positive margins after the initial surgery and required multiple procedures for complete removal. Real-time complete margin assessment is important for this locally aggressive and infiltrative tumor.
Adipose Tissue Transfer in Dynamic Definition Liposculpture PART III. The Arms: Biceps, Triceps, and Deltoids
Authors: Hoyos Alfredo E. , Stefanelli Matt , Perez Mauricio E. , Padilla Mauricio 
Published: January 2023

Background:
Arm contouring usually represents a challenge for the surgeon due to zones with high risk of irregularities/asymmetries, the variable degree of skin laxity, and the differences between patient/gender preferences. In men, the bigger and muscular the arms the better, while women tend to prefer a slim and soft silhouette.

Methods:
We performed arm cadaveric dissections and also searched our records for patients who underwent fat grafting of the arm in addition to HD2, from January 2016 to May 2022 at a single center in Bogotá, Colombia.

Results:
Two hundred eighty-nine consecutive patients (275 men and 14 women) underwent high-definition lipoplasty/HD2 plus fat grafting of the biceps (72 muscles), the triceps (46 muscles), the deltoids (426 muscles), or a combination of them. Mean age was 39 and 36 years for men and women, respectively. Range of the fat graft volume was 30–150 ml. No major complications were reported. Follow-up period ranged from 2 to 24 months. Most patients were satisfied with the results.

Conclusions:
Men usually seek an overall well-toned and muscular extremity, while women tend to prefer a slim but also athletic contour. Such outcomes can be achieved through intramuscular fat grafting of the biceps, triceps, and deltoids. The proper recognition of the pedicles and a precise surgical technique will ensure both its safety and the reproducibility of the results.
Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes
Authors: Ash Garrett I. , Nally Laura M. , Stults-Kolehmainen Matthew , De Los Santos Melissa , Jeon Sangchoon , Brandt Cynthia , Gulanski Barbara I. , Spanakis Elias K. , Baker Julien S. , Weinzimer Stuart A. , Fucito Lisa M. 
Published: January 2023

Objective:
Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D).

Design:
Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation.

Setting:
Community-based sample participating remotely with physician oversight.

Participants:
Volunteers aged 18 to 65 years with T1D screened for medical readiness for exercise intervention offerings. N = 20 enrolled, and N = 17 completed all outcomes with 88% to 91% biosensor adherence.

Intervention:
Feedback on personalized data from continuous glucose monitoring (CGM), its intersection with other ecological data sets (exercise, mood, and sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, and self-monitoring diary).

Main Outcome Measures:
Feasibility (use metrics and assessment completion), safety (mild and severe hypoglycemia, and diabetic ketoacidosis), acceptability (system usability scale, single items, and interview themes), and standard clinical and psychosocial assessments.

Results:
Participants increased exercise from a median of 0 (Interquartile range, 0-21) to 64 (20-129) minutes per week (P = 0.001, d = 0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5 ± 5.1 to 29.8 ± 5.4 kg/m2, P = 0.02, d = 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily because of improved exercise management behavioral skills, although derived motivation was transient.

Conclusions:
The intervention was feasible, safe, and acceptable. However, there is a need for more intensive, sustained support. Future interventions should perform analytics upon the digital health information and molecular biomarkers (eg, genomics) to make exercise support tools that are more personalized, automated, and intensive than our present offerings.
Effects of Medicare wellness visits on health promotion outcomes
Authors: Watkins Susan , Astroth Kim Schafer , Kim MyoungJin , Dyck Mary J. 
Published: January 2023

ABSTRACT

Background:
The American older adult population has the highest historical prevalence of chronic disease and underuses wellness visit benefits. Little is known about how Medicare wellness visits (MWVs) affect health outcomes.

Purpose:
The aim of this retrospective case–control study was to examine how MWVs affect health outcomes by measuring two kinds of data for case and control groups at baseline versus 15 months: (1) the differences in blood pressure, fasting lipids, and glucose levels and (2) the completion frequencies for seven screenings and vaccinations.

Methodology:
Informed by Pender's Health Promotion Model, this design used purposively matched samples from a large American Midwestern Medicare population active between January 2013 and January 2016, with a total sample size of 252, consisting of the case group (N = 120) and control group (N = 132). The case and control group samples were matched according to gender, age, marital status, Charlson index scores, smoking status, and pharmaceutical classes. The two groups, case (MWV recipients) and matched control (MWV nonrecipients), were compared at different time points using a doubly multivariate repeated-measures analysis procedure. Descriptive statistics were computed to compare completion frequencies between groups.

Results:
A doubly repeated multivariate analysis of variance (MANOVA) and descriptive statistics revealed significant differences between the case and control group for three of the four health outcomes. The case group had increased completion frequencies in pneumococcal vaccination.

Conclusions:
Additional research controlling for more variables is warranted to better understand MWV efficacy on health outcomes.

Implications:
Primary care providers need to study how MWVs affect longitudinal health outcomes.
Association between monocyte to high-density lipoprotein ratio and coronary heart disease in US adults in the National Health and Nutrition Examination Surveys 2009–2018
Authors: Yan Shaoyi , Sha Shuo , Wang Di , Li Senjie , Jia Yongping 
Published: January 2023

Background
Monocyte to high-density lipoprotein ratio (MHR) is associated with coronary heart disease (CHD) events. The purpose of this study was to analyze the correlation between MHR and CHD in American adults from 2009 to 2018 in the National Health and Nutrition Examination Surveys (NHANES) database.

Methods
A total of 25 862 persons in the NHANES from 2009 to 2018 were included in the cross-sectional analysis. The independent variable was MHR and the outcome variable was CHD. MHR was obtained by dividing the number of monocytes by the high-density lipoprotein concentration, and whether it is CHD is obtained through a questionnaire. Univariate analysis, stratified analysis, and a multivariate linear regression model were used to study the correlation between MHR and CHD.

Results
In each multivariate linear regression model, MHR was positively correlated with CHD, and this positive correlation was stable in both men and women [man odds ratio (OR): 1.54; 95% confidence interval (CI), 1.17–2.03; woman OR: 2.21; 95% CI, 1.40–3.50]. Our results show that the association between MHR and CHD was significant until MHR was less than 0.6 (OR: 7.2; 95% CI, 4.0–13.0); however, in cases where MHR was greater than 0.6, the results were negative but not significantly different (OR: 0.6; 95% CI, 0.3–1.2).

Conclusion
MHR has a clear association with CHD. Our prediction model and validation model show that MHR is highly predictive and robust as a predictor of CHD, therefore it can play an important role in the prediction of CHD.
Can increased intestinal permeability and low-grade endotoxemia be the triggering pathogenesis in isolated coronary artery ectasia?
Authors: Toprak Kenan , Kaplangoray Mustafa , Altiparmak İbrahim Halil , Taşcanov Mustafa Begenç , Güngören Fatih , Fedai Halil , İnanir Mehmet , Biçer Asuman , Demirbağ Recep 
Published: January 2023

Purpose
Isolated coronary artery ectasia (ICAE) is a rare coronary artery disease (CAD) encountered during coronary angiography. Although many mechanisms have been suggested today that may be associated with ICAE, the underlying pathogenesis has not been fully understood. In this study, we aimed to reveal the possible relationship between intestinal permeability and ICAE.

Methods
Of the 12 850 patients who underwent coronary angiography, 138 consecutive patients with ICAE and 140 age- and sex-matched subjects with normal coronary arteries as the control group and 140 subjects with stenotic CAD were included in the study.

Results
Serum zonulin and lipopolysaccharide levels were significantly higher in patients with ICAE than in the control group and CAD group. Additionally, zonulin and lipopolysaccharide levels were significantly higher in the CAD group than in the ICAE group. In the correlation analysis, serum zonulin levels were correlated with the mean diameter and length of the ecstatic segment. In multivariate analysis, zonulin and lipopolysaccharide were identified as independent predictors for ICAE.

Conclusion
These results suggest that there may be a pathophysiological relationship between increased intestinal permeability and ICAE.
Changing epidemiology of dengue fever in children in South America
Authors: Fonseca Silvia Nunes Szente 
Published: January 2023

Purpose of review
Dengue is the most important arthropod-borne viral disease of public health significance. Its geographic distribution includes 128 countries worldwide, affecting 390 million people every year causing significant morbidity and mortality in children and adults everywhere.

Recent findings
In the past, severe dengue affected mostly adults in the Americas; this scenario has changed and now cases of dengue, severe dengue, and dengue deaths have increased in children under 15 years in Brazil and in Colombia. Dengue and COVID-19 co-infections have been reported in South America, with increased hospitalization. A dengue vaccine for 9-year-old children and older children and adults who have serological evidence of previous dengue has been licensed in many countries; a different dengue vaccine trial for 4–16-year-old children has demonstrated decrease in clinical dengue and decrease in dengue hospitalizations.

Summary
There is no specific treatment of dengue, and a changing climate, insecticide resistance and urban expansion have permitted the vector's spread, making the vector control almost impossible. The hope for dengue control relies on vaccine development; there is important research on this area with one vaccine already licensed and another one showing promising results.
The role of cytoreductive nephrectomy in the immuno-oncological therapy era
Authors: Magee Diana E. , Helstrom Emma , Kutikov Alexander 
Published: January 2023

Purpose of review
Cytoreductive nephrectomy has had a variable role in the management of metastatic renal cell carcinoma (RCC) through the different systemic therapy eras. Initially felt to be beneficial with interferon, the utility of cytoreductive nephrectomy was called into question in the tyrosine kinase inhibitor (TKI) era. However, with the advent of immunotherapy for metastatic RCC, the role of cytoreductive nephrectomy continues to be debated. This study sought to evaluate the recent literature and discuss cytoreductive nephrectomy within the context of an improved systemic therapy era.

Recent findings
The literature that exists on the use of cytoreductive nephrectomy with immunotherapy is retrospective in nature and largely derived from large, institutional databases. Although smaller, single-institution articles exist and provide more granular data, issues concerning selection bias and unmeasured confounders persist. Overall, the available studies demonstrate that patient selection is paramount, and cytoreductive nephrectomy should be reserved for patients with no more than one risk factor, those requiring palliation of local symptoms and for those patients with stable, low volume disease or with a complete response following systemic therapy exposure.

Summary
The optimal use of cytoreductive nephrectomy in metastatic RCC remains unclear, but certain subgroups of patients, on evaluation of post hoc and retrospective data, seem to benefit from surgical intervention.
Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection
Authors: Lu Han-Bing , Ma Rui-Chen , Yin Ying-Ying , Song Chun-Yu , Yang Ting-Ting , Xie Jiao 
Published: January 2023

BackgroundCancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients’ perioperative outcomes.ObjectiveTo investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.MethodsOne hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.ResultsPatients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients’ dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.ConclusionFindings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Implications for practiceYoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.
High Interleukin-6 Levels Are Associated With Large-Artery Atherosclerotic Stroke
Authors: Li Cai , Wang Ying , Mei Peina , Tung Tao-Hsin , Wu Gang , Wang Feng , Wang En , Ni Hong , Zhu Xingrong , He Zhidi , Ke Shaofa 
Published: January 2023

Objectives:
Interleukins (ILs) play several critical roles in modulating the occurrence and development of atherosclerosis-related diseases. We aimed to investigate the associations between ILs and the diagnosis, progress, and functional outcome in patients with large-artery atherosclerotic (LAA) stroke.

Methods:
Plasma levels of IL-2, IL-4, IL-6, and IL-10 were measured within 24 hours after stroke in 181 patients with first-time LAA stroke and on admission in 181 age-matched and sex-matched controls. NIHSS scores were recorded at admission and on Day 1, Day 2, Day 3, Day 4, and Day 5 after the stroke. Functional outcome was measured by the modified Rankin Scale at 3 months after stroke. Subgroup analyses were compared based on short-term progress within 5 days (ΔNIHSS ≥3) and 3-month unfavorable outcome (modified Rankin Scale >2). Logistic regression analysis adjusted for relevant confounders was performed.

Results:
IL-6 levels were higher in patients with LAA stroke than in controls [AOR (95% CI), 0.701 (95% CI 0.651–0.748, P<0.001], with an area under the receiver operating characteristic curve (AUC) of 0.701. Higher IL-6 levels were associated with short-term progression [AOR (95% CI), 1.070 (1.009, 1.135), P=0.025], with an AUC value of 0.720. Higher IL-6 levels were associated with unfavorable outcomes [AOR (95% CI), 1.075 (1.002, 1.153), P=0.040], with an AUC value of 0.658. No difference in IL-2, IL-4, or IL-10 was found between the groups.

Conclusions:
Plasma levels of IL-6 are higher in patients with LAA stroke and are independently associated with short-term progression and 3-month functional outcomes after stroke.
A Comparative Study of the Etiology of Intracranial Vertebral Artery Dissection and Carotid Artery Dissection
Authors: Zhang Xingwen , Han Jintao , Wang Jun , Yu Shengyuan 
Published: January 2023

Background:
Both extrinsic (trauma or violent movement) and intrinsic (structural abnormality, atherosclerosis, or hemodynamic instability) factors may result in arterial dissection. The role of these factors in the origin or progression of dissection remains unclear. This study aimed to characterize the clinical features, radiologic features, and outcomes of intracranial vertebral artery dissection compared with carotid artery dissection and to determine the major causative factors.

Methods:
Consecutive patients with craniocervical dissection (n=127) were retrospectively analyzed. Patients with intracranial vertebral artery dissection (n=77) and those with carotid artery dissection (n=35) were compared with respect to patient age, sex, cerebrovascular risk factors, laboratory indices, and radiologic features.

Results:
Intracranial vertebral artery dissection was the most common craniocervical arterial dissection in our cohort (n=77, 60.6%). Body mass index in the intracranial vertebral artery dissection group was significantly greater than that in carotid artery dissection group. Clinical manifestations of intracranial vertebral artery dissection included ischemic stroke (37.7%), dizziness or vertigo (39.0%), and headache or neck pain (44.2%). Two patients had a definite history of trauma. The frontal and lateral tortuosity ratios of the vertebral basilar artery were significantly greater while the vertex angle was smaller in the intracranial vertebral artery dissection group compared with carotid artery dissection group. A positive correlation between the tortuosity ratios and subarachnoid hemorrhage and a significant inverse correlation between the tortuosity ratios and lipid parameters (high-density lipoprotein; apolipoprotein A1) were identified.

Conclusions:
Intrinsic causes may play a more important role in the development of intracranial vertebral artery dissection than carotid artery dissection.