bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Efficacy of Punch Excision Combined With Intralesional Steroid Injection for Keloid Treatment
Authors: Hou Shen , Chen Qian , Chen Xiao-Dong 
Published: April 2023

BACKGROUND
Conservative and nonconservative treatments are available for keloids. However, few studies have explored the effectiveness of punch excision in keloid treatment.

OBJECTIVE
This study aimed to investigate the efficacy and safety of punch excision combined with intralesional steroid injection for keloid treatment.

METHODS
In this prospective, randomized, controlled trial, 81 patients were randomly divided into 2 groups. The patients in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. The patients in the control group received intralesional steroid injection alone. The keloid thickness before and after the punch excision was evaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed.

RESULTS
The mean thickness after punch excision was lower (p < .05), injection treatments were fewer (p < .05), keloid scores were significantly lower (p < .05), and incidence rate of long-term adverse effects was lower in the treatment group than in the control group (p < .05).

CONCLUSION
The combination of punch excision and intralesional steroid injection has a notable therapeutic effect on keloids, shortening the treatment course without evident adverse reactions.
Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study
Authors: Kuenlen Anian , Waked Karl , Eisenburger Michael , Oramary Alan , Alsherawi Abeer , Ninkovic Milomir 
Published: April 2023

Background:
The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps.

Methods:
In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro- and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation.

Results:
The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group.

Conclusions:
VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient’s safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.
Exercise characteristics and blood pressure reduction after combined aerobic and resistance training: a systematic review with meta-analysis and meta-regression
Authors: Schneider Vinícius M. , Domingues Lucas B. , Umpierre Daniel , Tanaka Hirofumi , Ferrari Rodrigo 
Published: April 2023

Objective:
The purpose of this systematic review with meta-analysis was to determine the efficacy of combined aerobic and strength training in adults with hypertension and the influence of exercise training characteristics on blood pressure (BP) reduction.

Methods:
Randomized clinical trials of interventions involving combined aerobic and strength training versus nonexercise control groups (Control) in adults with hypertension were included. The literature search was conducted on PubMed, Cochrane Central, EMBASE, Scopus, and LILACS until December 2021. A random effects meta-analysis was performed using the mean difference in BP changes from baseline, comparing combined aerobic and strength training vs. Control as the effective measure. A multivariate meta-regression analysis was also performed to evaluate the relationship between exercise training characteristics and magnitudes of BP reductions.

Results:
Thirty-seven studies with 41 exercise interventions (1942 participants) were analyzed. The pooled mean differences with a 95% confidence interval (95% CI) showed significant reductions in SBP (−6.4 mmHg; 95% CI, −9.1 to −3.6) and DBP (−3.7 mmHg; 95% CI, −4.9 to −2.4). Meta-regression analysis revealed that greater exercise intensity and a greater number of sets in resistance training were associated with greater reductions in SBP. Greater exercise intensity was also associated with greater decreases in DBP.

Conclusion:
Combined aerobic and resistance training is an effective intervention in reducing both SBP and DBP in adults with hypertension, with greater hypotensive effects expected with higher intensity and more volume.
The Relationship between Cancer and Radiation: A New Paradigm
Authors: Augustine Frank 
Published: April 2023

Abstract
A key concern with the use of radiation sources (including nuclear power) is the health effects of low levels of radiation, especially the regulatory assumption that every additional increment of radiation increases the risk of cancer (linear no-threshold model, or LNT). The LNT model is nearly a century old. There are dozens if not hundreds of studies showing that this model is incompatible with animal, cellular, molecular, and epidemiological data for low-dose rates in the range of both background radiation levels and much of occupational exposure. The assumption that every increment of radiation equally increases the risk of cancer results in increased physical risks to workers involved with actions to reduce radiation exposure (such as risks from welding additional shielding in place or from additional construction activities to reduce post-closure waste site radiation levels) and avoidance of medical exposure even when radiation treatment has a lower risk than other options such as surgery. One fundamental shortcoming of the LNT model is that it does not account for natural processes that repair DNA damage. However, there is no contiguous mathematical model that estimates cancer risk for both high- and low-dose rates that incorporates what we have learned about DNA repair mechanisms and is sufficiently simple and conservative to address regulatory concerns. The author proposes a mathematical model that dramatically reduces the estimated cancer risks for low-dose rates while recognizing the linear relationship between cancer and dose at high-dose rates.
Prediction of Diabetic Retinopathy Severity Using a Combination of Retinal Neurodegeneration and Capillary Nonperfusion on OCT Angiography
Authors: Kim Kiyoung , Kim Eung Suk , Yu Seung-Young 
Published: April 2023

Abstract

Purpose:
To generate a prediction model of diabetic retinopathy (DR) severity stages based on retinal neurodegeneration and capillary nonperfusion area (NPA) detected using optical coherence tomography (OCT) and OCT angiography (OCTA).

Methods:
A total of 155 treatment-naïve eyes were retrospectively included. Macular ganglion cell/inner plexiform layer (mGCIPL) thickness in six macular regions was measured. A custom algorithm was used to calculate capillary NPA from 3x3 mm2 and 12×12 mm2 field OCTA images. The region of interest was selected as circular areas of 3 mm and 12 mm diameter and divided into six subsections. Classification and regression tree analysis identified the best predictors to discriminate between the five DR stages.

Results:
Inferotemporal sector showed the largest mean NPA, and the inferior hemispheric NPA was significantly larger compared with the superior hemisphere. The mean mGCIPL thickness was significantly correlated with NPA of 12×12 mm2 field in participants with early stage DR. Inferior hemispheric NPA of 12×12 mm2 field and mean mGCIPL thickness were the two best variables to discriminate no DR versus mild nonproliferative DR (NPDR) and mild versus moderate NPDR (accuracy: 88.8% and 93.5%). Meanwhile, a combination of NPA of 12×12 mm2 and 3×3 mm2 fields was the best prediction model to discriminate moderate versus severe NPDR and severe NPDR versus PDR (accuracy: 91.8% and 94.1%).

Conclusion:
A combination model of capillary NPA and mGCIPL thickness may be a novel biomarker for predicting DR severity. Capillary nonperfusion seems to initially occurs in midperipheral retina with macular neurodegeneration and progress posteriorly.
Evaluation of vision-related quality of life in patients after vitrectomy following idiopathic epiretinal membrane
Authors: Bajraktari Gentian , Jukić Tomislav , Vukojevic Nenad , Oroz Martin , Bertetić Andrea Radolović , Jashari Fisnik 
Published: April 2023

Abstract

Purpose:
To evaluate the impact of different intraocular tamponades on the visual-related quality of life (VRQOL) after idiopathic epiretinal membrane (IEM) surgery with epiretinal membrane peeling.

Methods:
We prospectively enrolled 50 patients diagnosed with IEM who underwent pars plana vitrectomy (PPV). Patients were consecutively assigned to either the air tamponade (air) group (25 patients) or the balanced salt solutions (BSS) tamponade group (25 patients). The following data were collected before and after surgery and compared between two groups: VRQOL, best corrected visual acuity (BCVA), intraocular pressure (IOP), metamorphopsia, contrast sensitivity (CS), and central macular thickness (CMT).

Results:
PPV was performed in 50 eyes. At baseline, there were no significant differences between the two groups. At 6 months postoperatively, VRQOL (p < 0.001), BCVA (p < 0.001), CMT (p < 0.001), CS (p < 0.001), and metamorphopsia (p < 0.001) improved significantly in comparison to baseline, without significant differences between the air tamponade and BSS groups.

Conclusion:
Removing IEM significantly improved visual function and VRQOL. Despite improvements, our study showed no difference postoperatively whether air or BSS tamponade was used during surgery. As a result, air tamponade may not be a mandatory treatment for IEM surgery and provides no additional advantage compare with BSS tamponade.
Antimicrobial Drug–Drug Interactions in the Treatment of Infectious Keratitis
Authors: Dunster Elianna , Johnson William L. , Wozniak Rachel A. F. 
Published: April 2023

Purpose:Infectious keratitis is a serious disease requiring immediate, intensive, and broad-spectrum empiric treatment to prevent vision loss. Given the diversity of organisms that can cause serious corneal disease, current guidelines recommend treatment with several antimicrobial agents simultaneously to provide adequate coverage while awaiting results of microbiology cultures. However, it is currently unknown how the use of multiple ophthalmic antimicrobial agents in combination may affect the efficacy of individual drugs.Methods:Using a panel of 9 ophthalmic antibiotics, 3 antifungal agents, and 2 antiacanthamoeba therapeutics, fractional inhibitory concentration testing in the standard checkerboard format was used to study 36 antibiotic–antibiotic combinations, 27 antibiotic–antifungal combinations, and 18 antibiotic–antiacanthamoeba combinations against bothStaphylococcus aureusandPseudomonas aeruginosafor synergistic, additive, neutral, or antagonistic drug–drug interactions.Results:We demonstrate that while most combinations resulted in no change in antimicrobial efficacy of individual components, the combination of erythromycin + polyhexamethylene biguanide was found to be antagonistic towardP. aeruginosa. Conversely, 18 combinations towardS. aureusand 15 combinations towardP. aeruginosaresulted in additive or synergistic activity, including 4 with improved activity toward both species.Conclusions:Understanding how drug–drug interactions may affect drug efficacy is critical to selecting the appropriate combination therapy and improving clinical outcomes of this blinding disease.
PaCO2 Levels at Admission Influence the Prognosis of Sepsis Patients: A Nonlinear Relationship
Authors: Qu Zhongkai , Ye Yan , Li Fang , Ren Yinlong , Lu Fan , Li Longzhu , Lyu Jun , Yin Haiyan 
Published: April 2023

ABSTRACT

Background:
Sepsis is a life-threatening organ dysfunction caused by a maladjusted host response to infection (Sequential Organ Failure Assessment [SOFA] ≥ 2). PaCO2 is a blood gas that is commonly tested in hospitalized patients. Few studies have investigated how abnormal PaCO2 levels influence the prognosis of sepsis patients.

Methods:
A retrospective study was applied to data on sepsis patients extracted from the MIMIC-III public database and the results of their first PaCO2 examination after admission. The outcome measure was all-cause death within 90 days of follow-up. The patients were divided into five quintile groups, and the relationship between PaCO2 and all-cause death in sepsis patients was studied using restricted cubic splines (RCSs).

Results:
Our study included 4898 sepsis patients, the hypocapnia (PaCO2 < 31 mmHg) and hypercapnia (PaCO2 ≥ 49 mmHg) groups were associated with the risk of death in sepsis patients using quintile grouping and the multivariate Cox model, with HRs of 1.12 (95% CI = 1.03–1.29) and 1.25 (95% CI = 1.10–1.41), respectively, when compared with the control group (37 ≤ PaCO2 < 41 mmHg). The relationship between PaCO2 and all-cause death in sepsis patients was U-shaped.

Conclusion:
The presence of hypercapnia and hypocapnia at the time of hospital admission will have adverse effects on all-cause death in sepsis patients.
Combination of psoas muscle mass index and neutrophil-to-lymphocyte ratio as a noninvasive prognostic marker in hepatocellular carcinoma patients undergoing radiofrequency ablation
Authors: Hayashi Manabu , Abe Kazumichi , Fujita Masashi , Takahashi Atsushi , Ohira Hiromasa 
Published: April 2023

Aim
The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular carcinoma (HCC). The usefulness of the combination of the PMI and NLR as a prognostic marker in HCC patients undergoing radiofrequency ablation (RFA) is unclear.

Methods
We retrospectively analyzed the PMI and NLR in 112 patients undergoing RFA, including 40 patients aged 75 years and older (36%). The influence of the PMI and NLR on disease-free survival and overall survival (OS) was analyzed.

Results
There were 66 patients with high PMI and low NLR values (58%), 36 patients with a low PMI or high NLR value (32%), and 10 patients with low PMI and high NLR values (9%). The combination of the PMI and NLR did not show a significant association with the disease-free survival rate. For patients aged ≥75 years, those with both low PMI and high NLR values showed significantly shorter OS periods (log-rank: P < 0.001). In the multivariate analysis, the combination of a low PMI value and high NLR value was significantly associated with shorter survival periods (hazard ratio: 19.72; 95% confidence interval, 4.933–78.8; P < 0.001).

Conclusion
In this study, the combination of PMI and NLR was associated with prognosis in patients with early HCC and preserved liver function. The combination of the PMI and NLR may be a useful and noninvasive prognostic marker in HCC patients aged 75 years and older, as well as in younger patients.
Significant clinical outcome using pyrimethamine and clindamycin in cerebral toxoplasmosis with severe edema: a case report
Authors: Basmalah Affan Nadzar , Sugianto Paulus 
Published: April 2023

Introduction and Importance:
Cerebral toxoplasmosis is a complication in HIV/AIDS patients that has recently increased in new cases due to increased HIV/AIDS incidents.

Case Presentation:
An Indonesian male, 26-year old, complained of severe headache, left hemiparesis, and tremors. A brain computed tomography scan with contrast showed a large mass, extensive edema, and a significant midline shift resembling a brain tumor. The HIV test was positive, and CD4 decreased. The patient was treated with dexamethasone, mannitol, and pyrimethamine-clindamycin as therapy. After 2 weeks of treatment, the headache, hemiparesis, and tremor were clinically improved. Two months later, a brain computed tomography scan and MRI showed a good prognosis.

Clinical Discussion:
The diagnosis of cerebral toxoplasmosis is based on a radiological examination and an HIV/AIDS test. Management of cerebral toxoplasmosis using pyrimethamine-clindamycin, while steroids are not recommended unless disproportionate cytotoxic edema is displayed and life-threatening.

Conclusion:
A combination of pyrimethamine-clindamycin, and steroids can improve the prognosis of cerebral toxoplasmosis with severe edema.
Pancreatic solid pseudopapillary neoplasm with concomitant left unilateral renal agenesis and bicornuate uterus: a case report
Authors: Bhattarai Madhur , Shrestha Ayush , Bhandari Suyog , Buha Niravkumar , Baral Rituraj , Shrivastav Shreya , Lakhey Paleswan Joshi 
Published: April 2023

Introduction:
A solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of the pancreas. Concomitant SPN with urogenital anomalies is a very rare presentation.

Case Presentation:
A 16-year-old female presented with a chief complaint of abdominal pain 30 days back. Solid pseudopapillary neoplasm (SPN) of the pancreas was diagnosed with the aid of ultrasonography and contrast-enhanced computed tomography of the abdomen and pelvis. Incidentally, concomitant left unilateral renal agenesis and bicornuate uterus were also detected in radiological findings. The patient underwent spleen-preserving distal pancreatectomy, and SPN was confirmed with the histopathological report.

Discussion:
Symptomatic SPN patients present with an abdominal mass and pain or very rarely jaundice. Most of the SPNs are benign. Complete surgical excision results in more than 95% cure. SPN with concomitant urogenital anomalies is extremely rare, and their concurrent occurrence can be better attributed to Wnt signaling pathway owing to their similar pathogenic mechanism.

Conclusion:
The solid pseudopapillary tumor has an excellent prognosis if timely resected. Proper evaluation of the patient with imaging is necessary to suspect and diagnose SPN who has urogenital anomalies and vice versa.
Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia – Five-Year Follow-Up
Authors: Karlsson Tobias , Mackie Helen , Koelmeyer Louise , Heydon-White Asha , Ricketts Robyn , Toyer Kim , Boyages John , Brorson Håkan , Lam Thomas 
Published: April 2023

Background:
Liposuction for International Society of Lymphology (ISL) late stage II or III limb lymphedema is an established surgical option to remove excessive adipose tissue deposition and has been performed in Australia since 2012 at the Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Macquarie University.

Patients and methods:
Between May 2012 and May 2017, 72 patients with unilateral primary or secondary lymphedema of the arm or leg underwent suction-assisted lipectomy using the Brorson protocol. This prospective study presents 59 of these patients who had consented to research with a five-year follow-up.

Results:
Of the 59 patients, 54 (92%) were women, 30 (51%) had leg lymphedema and 29 (49%) had arm lymphedema. For arm patients, the median preoperative volume difference between the lymphedematous and the contralateral arm was 1061 mL, which reduced to 79 mL one year after surgery and to 22 mL five years after surgery. For leg patients, the median preoperative volume difference was 3447 mL, which reduced to 263 mL one year after surgery but increased to 669 mL five years after surgery.

Conclusions:
Suction-assisted lipectomy is a long-term option for the management of selected patients with ISL late stage II or III limb lymphedema when conservative management can offer no further improvement.
Identification of a novel HIV-1 second-generation circulating recombinant form (CRF136_0107) among men who have sex with men in China
Authors: Zhang Yun-Qi , Li Qing-Hai , Li En-Long , Wang Yi-Ru , Tang Zi-Yan , Gao Xin , Lu Ran-Ran , Liu Si-Yu , Chen Xiao-Hong , Wang Fu-Xiang , Wang Jia-Ye 
Published: April 2023

Objective:
To investigate the molecular epidemiology of HIV-1 in Heilongjiang, China, and try to spot signs of new circulating recombinant form (CRF) in this region.

Design:
A molecular epidemiological study was conducted in Heilongjiang, China during 2011-2020.

Method:
Plasma samples were collected from three HIV-1 positive patients. The near full-length genome sequences (NFLGs) of a novel circulating recombinant form (CRF) were then obtained and subjected to phylogenetic analysis using Mega 7.0.26. Recombination analysis was performed by the jumping profile Hidden Markov Model (jpHMM). Finally, the origin time of this novel CRF was inferred using the Bayesian phylogenetic analysis in Beast v1.10.4.

Result:
The three NFLGs formed a distinct monophyletic cluster in the neighbor-joining (NJ) tree. Recombination analysis revealed that the recombinant genome was composed of five segments derived from CRF01_AE, subtypes B, and C, but further confirmed to be a second-generation recombinant form of CRF01_AE/CRF07_BC by a comparison of genome maps and subregion phylogenetic analysis and therefore designated as CRF136_0107. With Bayesian phylogenetic analysis, CRF136_0107 was estimated to originate around 2010-2011.

Conclusion:
A novel HIV-1 CRF01_AE/CRF07_BC second-generation CRF called CRF136_0107 was identified among men who have sex with men (MSM) in Heilongjiang, a northeast province of China.
Myocardial Contraction Fraction as a Simple Marker of Disease Severity in Hypertrophic Cardiomyopathy
Authors: Jiang Yuqi , Deng Wei , Dai Manyu , Li Yuguo , An Shutian , Qian Yinfeng , Bin Liu  , Yu Yongqiang , Zhao Ren , Li Xiaohu 
Published: April 2023

Purpose:
Myocardial contraction fraction (MCF) of cardiac magnetic resonance (CMR) was used to evaluate myocardial function in patients with hypertrophic cardiomyopathy (HCM), which may represent a proxy marker of disease severity in HCM.

Materials and Methods:
A total of 60 HCM patients and 20 healthy controls were examined with CMR. MCF was calculated by dividing left ventricular stroke volume by left ventricular myocardial volume. The difference in MCF between late gadolinium enhancement (LGE)-positive and LGE-negative patients were compared. The differences in MCF were compared among patients with stages Ⅱ, Ⅲ, and Ⅳ of HCM. Logistic regression analysis was used to detect independent discriminants of more severe HCM. Receiver operating characteristic analysis differentiated HCM with different clinical stages.

Results:
Compared with controls (110.67±20.40%, P<0.001), values for MCF were significantly reduced in HCM (61.40±15.60%). The MCF reduction in LGE detected by CMR was more significant than in HCM patients without LGE (53.15±10.67% vs. 76.72±11.04%, P<0.001). Patients with stage IV of HCM had the lowest MCF (45.36±10.97%, P<0.05 vs. stage II and III). Lower MCF remains an independent discriminator for more severe HCM (Stage Ⅱ vs. Stage Ⅲ, odds ratio: 0.85; Stage Ⅲ vs. Stage Ⅳ, odds ratio: 0.88, all P<0.05). The optimal cutoff value for detecting more severe HCM is MCF under 66.40% (Stage Ⅱ vs. Stage Ⅲ, P<0.05) and 44.75% (Stage Ⅲ vs. Stage Ⅳ, P<0.05).

Conclusion:
MCF may be a useful and simple tool to evaluate myocardial function in patients with HCM and provide an indicator of disease severity in individuals with HCM.