bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of TLR4 gene 2026A/G (rs1927914), 896A/G (rs4986790), and 1196C/T (rs4986791) polymorphisms and cancer susceptibility: Meta-analysis and trial sequential analysis
Authors: Wang Fengzhen , Wen Xianming , Wen Ting , Liu Ziyou 
Published: February 2023

Background:
This study was performed to assess the association of TLR4 gene 2026A/G (rs1927914), 896A/G (rs4986790), and 1196C/T (rs4986791) polymorphisms and cancer susceptibility based on published case-control studies.

Methods:
Web of Science, PubMed, Embase, CBM, WanFang Data, CNKI, and VIP database were used for article retrieving. Then, these articles were screened according to the study inclusion and exclusion criteria. The data was extracted, and the study quality was evaluated according to the principle of Newcastle-Ottawa Scale. Meta-analysis was performed by RevMan 5.4 and Stata MP-17 software. Trial sequential analysis was performed by TSA 0.9.5.10 Beta software.

Results:
Eighty-seven case-control studies including 25,969 cases and 32,119 controls were included in the meta-analysis. The diseases involved in case groups include prostate cancer, lung cancer, gastric cancer, hepatocellular carcinoma, colorectal cancer, etc. A versus G model of rs1927914, A versus G model of rs4986790 and C versus T model of rs4986791 showed that odds ratio (OR) = 1.08, OR = 0.85, and OR = 0.74 respectively. All the 3 comparisons were statistically significant. Sensitivity analysis showed that the results were stable. Publication bias analysis and trial sequential analysis showed that no significant publication bias was found in the results of the meta-analysis, and the probability of false positives was small.

Conclusion:
People with A allele of rs1927914, G allele of rs4986790, or T allele of rs4986791 have higher risks of cancer. The results of meta-analysis are stable and have less probability of false positives.
Hemodynamic response related to the Airway Scope versus the Macintosh laryngoscope: A systematic review and meta-analysis with trial sequential analysis
Authors: Nagumo Takumi , Hoshijima Hiroshi , Maruyama Koichi , Mihara Takahiro , Mieda Tsutomu , Sato (Boku) Aiji , Shiga Toshiya , Nagasaka Hiroshi 
Published: February 2023

Background:
It is important to reduce the hemodynamic response during tracheal intubation. We performed a systematic review and meta-analysis of the Airway Scope and Macintosh laryngoscope to determine whether they reduce the hemodynamic responses of heart rate (HR) and mean blood pressure (MBP) after tracheal intubation under general anesthesia.

Methods:
We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim of our meta-analyst is to determine if the Airway Scope reduces hemodynamic responses (HR and mean MBP) 60 seconds after tracheal intubation compared to the Macintosh laryngoscope. We expressed pooled differences in hemodynamic responses between the 2 devices as weighted mean differences with 95% confidence intervals. We conducted trial sequential analysis. Secondarily, we investigated the ability of the Airway Scope and Macintosh laryngoscope to reduce hemodynamic responses at 120 seconds, 180 seconds, and 300 seconds after tracheal intubation.

Results:
We identified clinical trials comparing hemodynamic response via a comprehensive literature search. Of 185 articles found in the search, we selected 8. In comparison to the Macintosh laryngoscope, the Airway Scope significantly reduced HR and MBP at 60 seconds after tracheal intubation (HR; weighted mean difference = −7.29; 95% confidence interval, −10.9 to −3.62; P < .0001; I
2 = 57%, MBP; weighted mean difference = −11.5; 95% confidence interval, −20.4 to −2.65; P = .01; I
2 = 91%). At the secondary outcome, the Airway Scope significantly reduced the fluctuation of HR after 120 seconds and 180 seconds of tracheal intubation. However, the Airway Scope did not significantly reduce MBP 120 seconds, 180 seconds, and 300 seconds after tracheal intubation. Trial sequential analysis suggested that the total sample size reached the required information size for heart rate.

Conclusions:
Our finding suggested that the Airway Scope attenuated hemodynamic responses at 60 seconds after tracheal intubation in comparison with that of the Macintosh laryngoscope. However, the MBP sample size is small and further research is needed.
Systemic immune-inflammation index in predicting non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer
Authors: Tang Yun-he , Ren Lin-lin , Yu Ya-Nan , Zhang Shao-hua , Tian Zi-Bin , Mao Tao 
Published: February 2023

Background and purpose
Although endoscopic submucosal dissection (ESD) is considered standard treatment for early gastric cancer (EGC), patients with non-curative resection (NCR) of ESD may still require gastrectomy. The systemic immune-inflammation index (SII) showed great potential in predicting the prognosis of gastric cancer patients. This study aims to investigate the predictive validity of SII of NCR in EGC patients.

Methods
We reviewed data from EGC patients who underwent ESD in the past. The relationship between SII and clinicopathologic features was investigated. We used Receiver operating characteristic curves to compare the predictive values of NCR between SII and other inflammation indices. Binary logistic analysis was used to identify independent risk factors for NCR. These factors were then used to construct a predictive nomogram.

Results
SII was associated with larger tumor size, male gender, older age, submucosal invasion, and a greater risk of NCR. SII showed better predictivity of NCR than platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). SII [odds ratio (OR) = 1.003, P = 0.001], NLR (OR = 1.520, P = 0.029), PLR (OR = 1.009, P = 0.010), upper stomach tumors (OR = 16.393, P < 0.001), poorly differentiated type (OR = 29.754, P < 0.001), ulceration (OR = 4.814, P = 0.001), and submucosal invasion (OR = 48.91, P < 0.001) were independent risk factors for NCR. The nomogram model based on these factors exhibited superior concordance and accuracy.

Conclusion
SII could be considered a simple and effective predictor of NCR of ESD in EGC patients.
Variability of estimated glomerular filtration rate and 99mTc-DTPA glomerular filtration rate: implications for a single time-point sampling regime
Authors: Bonney Lara M. , McGowan Daniel R. 
Published: February 2023

Background
This work aimed to determine the implications of the variability in estimated glomerular filtration rate (eGFR) for the prediction of measured GFR (mGFR) for selection of sampling time-point in single-sample 99mTc-diethylene–triamine–pentaacetate (DTPA) mGFR.

Methods
Patient studies were used to compare eGFR and mGFR (n = 282). The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration 2009 equation, from serum creatinine values measured in the laboratory (n = 27) or using a point-of-care testing device (n = 255). The mGFR was taken as the true value, and the root mean square error (RMSerr) in eGFR was calculated. Receiver operator characteristic curves were generated comparing the sensitivity and specificity of eGFR for the prediction of mGFR within the British Nuclear Medicine Society (BNMS) 2018 guideline ranges.

Results
The overall eGFR RMSerr was 19.3 mL/min/1.73 m2. Use of eGFR to predict mGFR in the ranges specified in the BNMS 2018 guidelines (25–50; 50–70; 70–100; and >100) achieved the following specificity and sensitivity for each individual range (97%, 71%; 92%, 47%; 81%, 48%; and 74%, 90%). For the middle ranges (50–70 and 70–100) the sensitivity is very low, less than 50%; more studies are classified incorrectly on the basis of eGFR in these ranges than correctly.

Conclusion
This work shows that serum creatinine eGFR is not sufficiently accurate to predict the optimum single-sample time-point for 99mTc-DTPA mGFR prior to measurement. It is the recommendation of this study that a single sampling time-point should be chosen for studies eGFR > 40 ml/min/1.73 m2 as opposed to the use of eGFR to determine the sampling time-point.
Increasing Nurse-Physician Family-Centered Rounds Communication
Authors: Kulesa John T. , Tyris Jordan N. , McQuiston-Lane Keira , Herstek Jessica , Rush Margaret L. 
Published: February 2023

Background:
High-quality nurse-physician communication during family-centered rounds (FCRs) can increase patient safety.

Local Problem:
In our hospital, interdisciplinary team members perceived that nurse-physician communication during FCRs declined during the COVID-19 pandemic.

Methods:
Using quality improvement methodology, we measured nurses' perceived awareness of components of the shared mental model, nurses' attendance during FCRs, compliance with completing FCR summaries, and average time spent per FCR encounter.

Interventions:
A structured resident huddle took place prior to an FCR. Residents used a tool to send individualized alerts to bedside nurses to prepare them for an FCR. Residents developed comprehensive summaries after each FCR encounter and sent a summary text to nurses who were unable to attend the FCR.

Results:
We assessed 40 FCRs over 16 weeks. Nurses' perceived awareness increased from 70% to 87%. Nurse attendance increased from 53% to 75%.

Conclusions:
We successfully piloted multiple interventions to improve nurse perceived awareness after an FCR.
Comparing Experiences of Women Who Were Direct Breastfeeding and Women Who Used Expressed Breast Milk to Feed Their Infants
Authors: Anders Lisa A. , Robinson Karen , Ohlendorf Jennifer M. , Hanson Lisa 
Published: February 2023

Abstract

Purpose:
To provide understanding about feeding experiences of women who provide breast milk through direct breastfeeding and exclusive expression and to compare these experiences.

Study Design and Methods:
A qualitative study was conducted to gather experiences from the perspectives of women who had given birth to a healthy, term infant within the past 12 months and exclusively fed breast milk for at least 2 weeks. The sample was recruited from motherhood and breastfeeding support groups on Facebook. Groups had state- or national-based memberships. Interviews were examined for themes that were compared between feeding groups using thematic analysis.

Results:
Fifteen new mothers participated. Under the primary themes of Similarities and Differences, seven subthemes were identified: Fatigue, Importance of Support, Finding Joy in a Common Goal, Mixed Feelings, Trusting versus Tracking, Latching versus Body Failure, and Pumping in Isolation.

Clinical Implications:
Mothers who provide breast milk share common experiences and feelings of satisfaction. Expressed breast milk feeding offers some mothers a way to provide the benefits of breast milk while preserving a balance between maternal and infant physical and mental health needs. Understanding the different ways in which women manage breast milk feeding while balancing maternal and infant needs can prepare nurses to discuss various methods of breast milk feeding and provide individualized support.
A Multimodal Protocol to Limit Opioid Exposure and Effectively Manage Postoperative Cesarean Birth Pain
Authors: Harden Ronda , Dawkins Denise , Stallings-Saints Keya , Hampton Michelle DeCoux , DeLilly Carol 
Published: February 2023

Abstract

Purpose:
To evaluate the impact of implementing a multimodal plan of care in treating the pain of the postoperative cesarean birth patient that limited opioid exposure.

Study Design and Methods:
A retrospective medical record review was conducted to evaluate a pain management protocol implemented for postoperative cesarean patients before and after a practice change. Sample included term postoperative cesarean patients ≥ 37 weeks of gestation, who had spinal or epidural, were 18 years or older, gave birth to a singleton newborn, admitted to the maternal child health department, and were prescribed opioids as a postoperative pain management treatment plan. Participants (N = 150) were evaluated based on two groups: n = 75 in the preimplementation group and n = 75 in the postimplementation group.

Results:
There was a significant difference in the total oral opioid milligrams administered between the pregroup (M = 27.13) and postgroup (M = 8.43), after the practice change (p < .001). There was an increase of nonopioids administered to treat and manage postoperative cesarean pain, Motrin PO (p = < .001) and Tylenol PO (p = .002).

Clinical Implications:
Fewer milligram equivalents of morphine were administered when postoperative cesarean patients were placed on scheduled nonopioids to treat pain.
Defense Mechanisms and Parenting Styles in Patients With Anorexia and Bulimia
Authors: Craba Ambra , Mazza Marianna , Marano Giuseppe , Crosta Maria Luigia , Moroni Federica , Di Pietro Salvatore , Balocchi Marta , Della Casa Silvia , Rinaldi Lucio , Janiri Luigi , Sani Gabriele 
Published: February 2023

Abstract
Dysfunctional parenting styles are risk factors for eating disorders (EDs). In this observational study, we examined 57 women with ED, a psychiatric control group (n = 26), and healthy participants (n = 60). Several instruments were administered: Defense Style Questionnaire (DSQ-40) to examine the type of defense mechanism used, Parental Bonding Instrument (PBI) to investigate the perception of the relationship with parents, Eating Disorder Examination Questionnaire and Eating Disorder Inventory-3 to assess the severity of the ED, and Body Shape Questionnaire to investigate the perception of their body shape. In patients with anorexia and bulimia, neurotic factor (p = 0.007) and immature factor (p = 0.002) are associated with perception of relationship with their own parents. In the PBI, maternal care was associated with higher scores in the DSQ-40 in the immature factor (p = 0.012), whereas paternal overprotection was associated with lower scores in the DSQ-40 in the mature factor (p = 0.016). Patients with anorexia and bulimia overutilize more neurotic and primitive defense mechanisms compared with nonclinical subjects, and this use is associated with greater severity of eating symptomatology. This can be related to diversified ego forces, can inform about the nature and severity of disease, and can characterize prognostic and psychotherapeutic value.
Neuropathologic Features in Chronic Methamphetamine Use
Authors: Persons Jane E. , Conway Kyle S. 
Published: February 2023

Abstract
Methamphetamine is a psychostimulant that exerts its euphoric and stimulant effects by increasing cytosolic monoamine concentration at the nerve terminal. In addition to its known systemic cardiovascular effects, there is compelling evidence to suggest a direct neurotoxic effect of methamphetamine; however, the existing body of literature includes very few human tissue studies. This exploratory analysis used postmortem human brain specimens to examine histologic and immunohistochemical features associated with chronic methamphetamine use. This retrospective cohort study included 60 decedents who were autopsied at the University of Iowa Hospitals and Clinics between the years 2015 and 2021. Logistic regression models demonstrated no definite pathologic changes in the hippocampi of individuals with a history of chronic methamphetamine use. Decedents with a history of methamphetamine use had a marginally increased odds of basal ganglia arteriosclerosis, which did not reach statistical significance (odds ratio, 3.33; 95% confidence interval, 0.6–19.2; P = 0.17), which may be independent of the systemic hypertensive effects of methamphetamine. Future studies that include targeted examination of brain regions of interest, such as the basal ganglia and specifically the striatum, may prove revealing.
The Impact of Alar Flare Reduction Goes Beyond Just the Ala
Authors: Gordon Alexandra R. , Patel Anmol , Schreiber Jillian E. , Layke John C. , Tepper Oren M. 
Published: February 2023

Introduction:
Alar flare reduction (AFR) is a widely utilized technique in rhinoplasty. While the impact of AFR on the alar base has been well studied, its effect on the surrounding tissues is largely unknown. This study aims to elucidate the potential effect of AFR on the overall nasal and peri-nasal anatomy.

Methods:
AFR was performed on cadavers (n=7) with sequential crescent shaped alar excisions of 2, 4 and 6mm. 2D and 3D-photographs were obtained at baseline and subsequent intervals. Analysis was performed with Adobe Photoshop and Vectra. Standardized landmarks were placed at the nasal tip point (NTP) and alar base point (ABP) to quantify NTP vector distances, NTP surface distances, and alar crease angle.

Results:
The surface and vector distances between the NTP and ABP decreased for increasing AFR intervals. AFR created a surface decrease of 1.90±1.60, 3.54±1.85, and 4.91±1.89mm respectively. AFR created a vector decrease of 1.50±1.14, 2.83±1.37, and 3.97±1.38mm respectively. NTP projection decreased by 0.54±0.31mm for 6mm excision. AFR led to cheek elevation of 0.87±0.70, 1.25±0.60, and 1.96±0.48mm respectively. This alar crease elevation blunted the transition between the cheek and upper lip skin at the level of the alar rim with the angle of this transition increasing 26.62±12.78 degrees from baseline to 6mm.

Conclusions:
3D-analysis demonstrates the influence of AFR on the alar base and surrounding peri-nasal contour. AFR results in nasal tip de-projection, alar crease elevation, and alar flare width narrowing. Further investigation into the impact of modifying the alar base on surrounding structures is warranted.
’Implant-based and DIEP flap breast reconstruction: a comparison of breast sensation and quality of life within a singular patient sample’’
Authors: van Rooij Joep A.F. , Bijkerk Ennie , van der Hulst René R.J.W. , van Kuijk Sander M.J. , Tuinder Stefania M.H. 
Published: February 2023

Background:
In this cohort study we compared breast sensation and quality of life (QoL) after replacement of an implant-based breast reconstruction (IBBR) with a deep inferior epigastric perforator (DIEP) flap reconstruction in a singular sample of women.

Method:
Women with IBBR prior to their DIEP flap were included. Women formed their own control. Breast sensation was measured using Semmes-Weinstein monofilaments (SWM). QoL was evaluated using BREAST-Q questionnaires. Preoperative (T0) sensation and QoL was compared to postoperative at 6 (T1), 12 months (T2) and maximum follow-up (Tmax, sensation only). A linear mixed effects regression was used for SWM measurements, a paired samples t-test for BREAST-Q scores. Most women chose replacement of their implant by a DIEP flap due to implant-related complaints.

Results:
Postoperative sensation decreased significantly compared to preoperative sensation after T1 (mean 5·1 months), T2 (mean 14·6), and Tmax (mean 17·6) for the total breast but recovers to preoperative levels for the native skin after an average of 1.5 years. Nerve coaptation positively influenced recovery of sensation. BREAST-Q scores increased significantly after 6 and 12 months over the domains satisfaction with breast, psychosocial wellbeing, physical wellbeing of the chest, and sexual wellbeing. Scores decreased significantly in physical wellbeing of the abdomen after 6 months.

Conclusions:
Replacing an implant with a DIEP flap initially causes a decrease in overall breast sensation, gradually recovering to preoperative levels for native skin, and can significantly increase QoL with the right indication. Superior recovery of sensation and QoL may be obtained by accompanying the DIEP flap with nerve coaptation.
Autologous Breast Reconstruction in Massive Weight Loss Patients: Understanding Risks in a Growing Population
Authors: Sinik Lauren M , Elver Ashlie A , Egan Katie G , Johnson Braden M , Cullom Melissa E , Limpiado MarcArthur , Nazir Niaman , Lai Eric C , Butterworth James A 
Published: February 2023

Background:
Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rise of obesity and bariatric surgery, more MWL patients will be presenting for breast reconstruction. We hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared to patients without a history of MWL.

Methods:
A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Patients with a history of bariatric surgery or >50-pound weight loss were identified and compared to non MWL patients. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores.

Results:
Of 916 patients who underwent 1465 flaps, 39 MWL patients (4.3%) underwent 68 flaps (4.6%) and 877 non MWL patients underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively (p=.005). MWL patients experienced more surgical site infections (p=.02), wound healing complications of flap (p=.007) and donor sites (p=.03), and late partial flap losses (p=.03). More revisional surgeries for flap (p=.009) and donor sites (p=.01) were required. BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial (p=.01) and sexual well-being (p=.04).

Conclusion:
Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in MWL patients. These patients should be counseled on the possibility of more postoperative complications and need for revisional surgeries.
Does the Type of Reconstruction Matter? A Propensity Score Matched Analysis of Immediate Post-mastectomy Implant and Flap Reconstruction
Authors: Jung Wooram F. , Pollie Meridith P. , Ho Kaylee K. , Mauer Elizabeth A. , Newman Lisa A. , Otterburn David M. 
Published: February 2023

Background:
No randomized controlled trials have compared implant and flap reconstruction. Recently, worse longitudinal outcomes have been suggested for flap reconstruction. We compared long-term oncologic outcomes of post-mastectomy breast reconstruction using propensity score matching.

Methods:
A retrospective study of post-mastectomy reconstruction was achieved using the Weill Cornell Breast Cancer Registry between 1998 and 2019. Patients were matched using propensity scores based on demographic, clinical, and surgical characteristics. Kaplan-Meier estimates, Cox-regression models, and restricted mean survival times (RMST) were used to evaluate patient outcomes.

Results:
Before matching, 1395 implant and 586 flap patients were analyzed. No difference in overall survival and recurrence were observed. Multivariable models showed decreased survival for Medicare/Medicaid (HR: 3.09; 95% CI: 1.63, 5.87; P <.001), pathological stage II (HR: 2.98; 95% CI: 1.12, 7.90; P = .028), stage III (HR: 4.88; 95% CI: 1.54, 15.5; P = .007), 11 to 20 lymph nodes positive (HR: 3.66; 95% CI: 1.31, 10.2; P = .013), >20 lymph nodes positive (HR: 6.41; 95% CI: 1.49, 27.6; P = .013). RMST at 10 years post-flap reconstruction showed 2 months of decreased survival time compared to implants (9.56 vs 9.74 years; 95% CI: -.339, -.024; P = .024). After matching, 563 implant and 563 flap patients were compared. Reconstruction was not associated with overall survival and recurrence. RMST between implant and flap reconstruction showed no difference in each 5-year interval over 20 years.

Conclusions:
Post-mastectomy breast reconstruction was not associated with a difference in long-term oncologic outcomes over a twenty-year period.