bluuebunny/crossref_metadata_2025_split huggingface dataset:
Door to balloon time in primary percutaneous coronary intervention in ST elevation myocardial infarction: every minute counts
Authors: Marcusohn Erez , Reiner Benaim Anat , Ronen Shay , Kerner Arthur , Beyar Rafael , Almog Ronit 
Published: July 2022

Objectives
This study examines relationships between door to balloon (D2B) time and subsequent admissions due to heart failure (HF), acute coronary syndrome (ACS), and mortality for up to 1 year.

Background
Current guidelines set 90-min for D2B time for primary percutaneous coronary intervention (PPCI) as a goal, which has been shown to reduce mortality and adverse events.

Methods
Using the MDclone ADAMS system integrated with our electronic medical records, we conducted retrospective analysis of all patients admitted due to ST-elevation myocardial infarction from home, without any history of HF or coronary disease, and who underwent PPCI during 2013–2019. Data on D2B time, baseline clinical and demographic characteristics, and outcomes of HF, ACS and mortality were collected. Adjusted HR for each of the outcomes was calculated by multivariate Cox model.

Results
A total of 826 patients were included in the final analysis. D2B had no significant effect on incidence of heart failure admissions for up to 1-year follow-up. D2B had a significant effect on mortality at 180 days, showing a 30% increase for each 30-min increase (HR 1.308; CI, 1.046–1.635) as for ACS at 90 days (HR 1.307; 1.025–1.638). The 30-min D2B cutoff showed a significant increase in ACS recurrence throughout the follow-up period at 90 days (HR 2.871, 1.239–6.648), 180 days (HR 2.607, 1.255–5.413), and 1 year (HR 1.886, 1.073–3.317).

Conclusions
Patients with shorter D2B times had significantly reduced mortality and recurrence of ACS, with no effect on heart failure admission incidence.
Bulking agents in gastrointestinal endoscopy: present applications and future advances
Authors: Steinway Steven N. , Singh Anmol , Akshintala Venkata S. 
Published: July 2022

Purpose of the review
Bulking agents are inert materials injected into an organ to affect the physical properties of the organ for a therapeutic purpose. Various agents have been developed to aid in the treatment of diseases like gastroesophageal reflux disease (GERD), fecal incontinence, obesity, malignancy, hemostasis, and tissue dissection. Here, we review the state of the art in bulking agents in gastrointestinal endoscopy, past failures, current limitations, and where we see the field heading in the future.

Recent findings
Though bulking agents have been trialed for various different gastrointestinal diseases, there are currently limited uses in gastrointestinal endoscopy. Though various agents have been trialed for GERD, numerous complications and adverse events have limited its current use. However, for the treatment of fecal incontinence endoscopic bulking agent therapy is a reasonable option. Though in early stages of exploration, bulking agent therapy for enteric protection from radiotherapy may be a promising tool to improve treatment of pancreatic cancer. Bulking agents for tissue dissection have substantially improved lifting agents and complex polyp removal. Bulking agent therapy has not really been explored for endoscopic bariatric therapy or hemostasis but may be a fruitful area for exploration in the future.

Summary
Bulking agent therapy has been trialed for various gastrointestinal diseases with mixed success. There is currently a therapeutic roll in the endoscopic management of fecal incontinence and tissue dissection. A future role in the treatment of GERD, obesity, malignancy, and hemostasis seem feasible.
The Relevance of Airway Resistance in Children Requiring Mechanical Ventilatory Support
Authors: Bruno Francisco , Andreolio Cinara , Garcia Pedro Celiny R. , Piva Jefferson 
Published: July 2022

Objectives:
To describe pulmonary resistance in children undergoing invasive mechanical ventilation (MV) for different causes.

Design:
A cross-sectional study.

Setting:
Two PICUs in the South region of Brazil.

Patients:
Children 1 month to 15 years old undergoing MV for more than 24 hours were included. We recorded ventilator variables and measured pulmonary mechanics (inspiratory and expiratory resistance, auto positive end-expiratory pressure [PEEP], and dynamic and static compliance) in the first 48 hours of MV.

Interventions:
Measurements of the respiratory mechanics variables during neuromuscular blockade.

Measurements and Main Results:
A total of 113 children were included, 5 months (median [interquartile range (IQR) [2.0–21.5 mo]) old, and median (IQR) weight 6.5 kg (4.5–11.0 kg), with 60% male. Median (IQR) peak inspiratory pressure (PIP) was 30 cm H2O (26–35 cm H2O), and median (IQR) PEEP was 5 cm H2O (5–7 cm H2O). The median (IQR) duration of MV was 7 days (5–9 d), and mortality was nine of 113 (8%). The median (IQR) inspiratory and expiratory resistances were 94.0 cm H2O/L/s (52.5–155.5 cm H2O/L/s) and 117 cm H2O/L/s (71–162 cm H2O/L/s), with negative association with weight and age (Spearman –0.850). When we assess weight, in smaller children (< 10 kg) had increased pulmonary resistance, with mean values over 100 mH2O/L/s, which were higher than larger children (p < 0.001).

Conclusions:
Increased pulmonary resistance is prevalent in the pediatric population undergoing invasive MV. Especially in children less than 1 year old, this variable should be considered when defining a ventilatory strategy.
Updated Diagnosis Grouping System for Pediatric Emergency Department Visits
Authors: Fant Colleen , Marin Jennifer R. , Ramgopal Sriram , Simon Norma-Jean E. , Richards Rachel , Olsen Cody S. , Alessandrini Evaline A. , Alpern Elizabeth R. ,   for the PECARN Registry Study Group
Published: July 2022

Objectives
This study aims to update the Diagnosis Grouping System (DGS) for International Classification of Disease, Tenth Revision (ICD-10) codes for ongoing use. The DGS was developed in 2010 using ICD-9 codes with 21 major groups and 27 subgroups to facilitate research on pediatric patients presenting to emergency departments and required updated classification for more recent ICD codes.

Methods
All emergency department discharges available in the Pediatric Emergency Care Applied Research Network (PECARN) database for 2016 were included to identify ICD-10 codes. These codes were then mapped onto the DGS codes originally derived from ICD-9. We used ICD-10 codes from the PECARN database from 2017 to 2019 to confirm validity.

Results
The DGS was updated with ICD-10 codes based on 2016 PECARN data, and this updated DGS was successfully applied to 6,853,479 (97.3%) of all codes from 2017 to 2019.

Discussion
Using ICD-10 codes from the PECARN Registry, the DGS was updated to reflect ICD-10 codes to facilitate ongoing research.
Rehabilitation interventions for improving balance in Parkinson’s disease: a narrative review
Authors: Lena Francesco , Modugno Nicola , Greco Giulio , Torre Monica , Cesarano Simone , Santilli Marco , Abdullahi Auwal , Giovannico Giuseppe , Etoom Mohammad 
Published: July 2022

ABSTRACT

Introduction
Postural instability (PI) is one of the latest clinical manifestations of Parkinson's disease (PD). Due to the limited therapeutic effect of pharmacological therapies, a favorable consideration has now become towards rehabilitation interventions. Thus, this study aimed to synthesize literature evidence to summarize the effects of rehabilitation interventions for improving balance in PD.

Materials and methods
We conducted a narrative review of randomized-controlled clinical trials (RCTs) comparing the effects of interventions, control interventions, and no interventions on balance-related outcomes. A comprehensive search using the MEDLINE database was conducted from January 2000 to September 2021. This review included the following causes of balance-related impairments: inability to control body weight in the base of support, impaired attention and focus on balance, postural deformities, proprioceptive deficiency, sensory-motor integration, and coordination disorders, including visual and auditory-motor coordination.

Results
20 RCTs were included in the review. Various balance-related outcomes were included. The included studies focused on the effectiveness of different rehabilitation interventions, including physical therapy, virtual reality and telerehabilitation, treadmill training, hydrotherapy, action observation training, balance and cues-training interventions, and cognitive rehabilitation.

Conclusions
The results suggest that most of the included rehabilitation interventions have promising therapeutic effects in improving balance in PD.
Current State of Cell Therapies for Genitourinary Malignancies
Authors: Alkhouli Mohammed A. , Bazargan Sarah , Pilon-Thomas Shari , Poch Michael , Chahoud Jad 
Published: July 2022

Abstract
Genitourinary (GU) cancers have greatly benefited from immunotherapy treatments, such as immune checkpoint inhibitors. However, the durable clinical response rate for these agents remains relatively low, calling for more innovative immunotherapy approaches. Adoptive cell therapy has shown a significant advancement in the treatment of cancer in recent years and represents a great potential for the treatment of GU cancers. This review summarizes the current advancements in cellular therapy strategies for the treatment of renal cell carcinoma, bladder cancer, and prostate and penile cancers. Further, current and past clinical trials of adoptive cell therapy in GU tumors are reviewed. Finally, a perspective on the future of cell therapy in GU tumors is discussed.
Surgical Considerations for Tumor Tissue Procurement to Obtain Tumor-Infiltrating Lymphocytes for Adoptive Cell Therapy
Authors: Mullinax John E. , Egger Michael E. , McCarter Martin , Monk Bradley J. , Toloza Eric M. , Brousseau Susan , Jagasia Madan , Sarnaik Amod 
Published: July 2022

Abstract
Adoptive cell therapy with tumor-infiltrating lymphocytes (TILs), an investigational cellular therapy, has demonstrated antitumor efficacy in patients with advanced solid tumors, including melanoma. Tumor-infiltrating lymphocyte cell therapy involves surgical resection of a patient's tumor, ex vivo TIL expansion under conditions that overcome immunosuppressive responses elicited by the tumor and the tumor microenvironment, administration of a lymphodepleting regimen, and infusion of the final TIL cell therapy product back into the patient followed by interleukin 2 administration to support T-cell activity. The surgeon plays a central role in patient identification and tumor selection—steps that are critical for successful outcomes of TIL cell therapy. Commercialization of TIL cell therapy and its broader access to patients will require education and collaboration among surgeons, oncologists, and cellular therapists. This review highlights the unique role that surgeons will play in the implementation of TIL cell therapy and serves as a contemporary report of best practices for patient selection and tumor resection methods.
Current State of Cell Therapies for Gastrointestinal Cancers
Authors: Kooragayala Keshav , Lou Johanna , Hong Young Ki 
Published: July 2022

Abstract
Adoptive cell therapies include multiple cell-based therapies to harness the immune system's power to mount a robust anticancer effect. Early successes in solid tumors with checkpoint inhibition have increased the research and development of immunotherapy. The utilization of cell-based therapy for gastrointestinal malignancies is still in its infancy because of challenges of antigen specificity and access to the tumor microenvironment. In this review, we discuss the current state of adoptive cell therapies in terms of challenges and early successes in preclinical and clinical studies.
Patient Discomfort After Rhinoplasty With and Without Osteotomy Under Conscious Sedation
Authors: Kim Jung Soo , Heo Sung Jae 
Published: July 2022

Objective:
Many rhinoplasty techniques, including dorsum augmentation and tip surgery, could be performed under conscious sedation rather than general anesthesia. However, as osteotomy is an invasive procedure, it is burdensome for surgeons to perform osteotomy under conscious sedation. As patient ratings of pain and satisfaction when osteotomy is performed under conscious sedation are unknown, this study aimed to determine discomfort of osteotomy performed under conscious sedation.

Methods:
Patients who underwent rhinoplasty with conscious sedation were prospectively included in the study. The patients were classified into an osteotomy and a nonosteotomy group. Questionnaires with a visual analog scale ranging from 0 to 10 were utilized to assess patient pain and satisfaction. Patients were also asked whether they would choose conscious sedation for future rhinoplasty operations. To evaluate adverse events, cardiopulmonary vital signs and nausea or vomiting were assessed.

Results:
Forty-five patients with a mean age of 32.7 years were included in the study. The mean patients’ visual analog scale scores for pain and satisfaction were 3.3±2.0 and 7.2±1.9, respectively. Most of the patients [42, (93%)] stated that they would choose conscious sedation again if they had further operations in the future. No significant adverse effects occurred, and there were no significant differences in patients’ ratings of pain and satisfaction between osteotomy and nonosteotomy groups when conscious sedation was used.

Conclusion:
Patients’ ratings of pain and satisfaction, and a lack of significant adverse effects, indicated that rhinoplasty can be performed under conscious sedation, even with osteotomy.
Furlow Palatoplasty and Tonsillectomy for Treating Patients With Submucous Cleft Palate and Tonsillar Hypertrophy: A One-Stage Procedure
Authors: Abdel-Aziz Mosaad , Abdel-Fattah Gamal , Abdel-Aziz Nada M. , Sabry Omar , Elsherbeeny Motaz 
Published: July 2022

Background:
Children with cleft palate are more liable to have obstructive sleep apnea than children with normal palate due to narrow airways. Tonsillar hypertrophy is a common cause of pediatric obstructive sleep apnea; hence, it is not surprising to be encountered during cleft palate repair. The aim of this study was to evaluate the feasibility of tonsillectomy and Furlow palatoplasty performed as a 1-stage operation in patients presenting with submucous cleft palate (SMCP) and tonsillar hypertrophy.

Materials and Methods:
Eleven pediatric patients with SMCP and hypertrophied tonsils were included in this case series study. Furlow palatoplasty and tonsillectomy were performed for the patients in 1 sitting. The evaluation of velopharyngeal function was done preoperatively and postoperatively via auditory-perceptual-assessment, nasometry, and flexible nasopharyngoscopy. In addition, the Epworth sleepiness scale for children/adolescents was administered to the parents to assess daytime sleepiness of their children.

Results:
The speech improved postoperatively. Auditory-perceptual-assessment showed significant reductions in hypernasal speech, nasal air escape, and weak pressure consonants. In addition, nasometry revealed significantly decreased nasalance scores for nasal and oral sentences. A postoperative increased velar movement was observed with a significant improvement in velopharyngeal closure. The preoperative Epworth sleepiness scale for children/adolescents assessment revealed excessive daytime sleepiness in 8 patients, with significant improvement of scores postoperatively.

Conclusions:
Removal of hypertrophied tonsils during the repair of SMCP with Furlow palatoplasty did not negatively affect speech outcome or velar movement postoperatively. It is logical to perform both procedures simultaneously in 1 sitting to avoid postoperative sleep-related breathing disorder, which may necessitate a second stage operation.
A Combination Method of Costal Cartilage Injection Techniques for Augmentation Rhinoplasty
Authors: Gu Tianyi , Li Xin , Yang Xiaoning , Yu Lu , Ma Jiguang 
Published: July 2022

Background:
The multiple toothpick-shaped costal cartilage (MTCC) injection technique was introduced as an improvement based on the free diced costal cartilage (FDCC) injection technique for augmentation rhinoplasty. However, radix irregularities may occur when using the MTCC technique. Considering that the FDCC grafts are easier to shape at the nasal radix, we adopted a combination method of the 2 techniques to achieve natural and smooth contour.

Methods:
Four patients accepted this method for augmentation rhinoplasty. Through a unilateral marginal incision, the costal cartilage grafts were injected for nasal augmentation at the subperiosteal plane. The FDCC grafts and the MTCC grafts were used for nasal radix and dorsum augmentation, respectively. Nasal contour was adjusted by external shaping. The follow-up ranged from 24 to 43 months.

Results:
All patients were satisfied with the surgical outcome. There were no major complications occurred during the follow-up. One patient underwent rasping revision due to her own beauty-appreciation changes.

Conclusions:
The combination method can take advantages of the FDCC and MTCC injection techniques. It can effectively lower the incidence of contour irregularities and graft displacement. Meanwhile, it is easy to perform without special procedure, and is time-saving and cartilage-saving.
Immediate Ear Lobule Reconstruction After Melanoma Resection
Authors: Bushong Elizabeth E. , Komorowska-Timek Ewa 
Published: July 2022

Ear Lobule Reconstruction
Cancer removal from aesthetically vulnerable areas of the face strikes a delicate balance between oncologically appropriate excision and preservation of a unique structure. A 72-year-old male presented with melanoma of the right earlobe requiring complete excision. Partial or complete absence of an ear causes a deformity and is difficult to conceal. Thus, lobule reconstruction postmelanoma excision eliminates deformity and aids in psychological recovery. In this case report, we describe our novel technique of a 2-stage lobule reconstruction immediately after melanoma resection using a direct template of the excised lobule. This template allowed us to sculpt its identical size and shape using harvested contralateral conchal cartilage graft. After the cartilage was banked in a subcutaneous pocket for 8.5 weeks, the second stage liberated the reconstructed lobule. This immediate 2-stage technique eliminated a period of soft tissue contracture and presented a rare surgical opportunity to recreate a structure using its direct template.

Level of Evidence:
Level IV—case report.
Surgical Stress Evaluation of Left Lateral Sectionectomy Based on Skeletal Muscle Catabolism
Authors: Kawasaki Yota , Yamasaki Yoichi , Hozaka Yuto , Oi Hideyuki , Sonoda Tomohiro , Fukuda Kosuke , Idichi Tetsuya , Kurahara Hiroshi , Mataki Yuko , Ueno Shinichi , Ohtsuka Takao 
Published: July 2022

Background:
By examining skeletal muscle catabolism, we aimed to investigate whether laparoscopic left lateral sectionectomy (LLS) is less invasive compared with the open approach.

Methods:
The psoas muscle index (PMI) was measured using computed tomography images before and after surgery. We assessed the relationship between the perioperative PMI reduction rate and the estimation of physiologic ability and surgical stress (E-PASS) score and then compared the PMI reduction rates associated with different approaches.

Results:
Of the 31 patients, 13 and 18 underwent the open and laparoscopic approaches, respectively. A strong correlation was observed between the PMI reduction rates and surgical stress scores (SSS) (r=0.561, P<0.01). The laparoscopic approach was associated with a significantly lower PMI reduction rate (P<0.01) and SSS (P<0.01) than the open approach.

Conclusion:
Laparoscopic LLS should be less invasive than the open approach from the perspective of not only perioperative outcomes but also skeletal muscle catabolism.
The Critical View of Safety in Laparoscopic Cholecystectomy: User Trends Among Residents and Consultants
Authors: Terho Petra , Sallinen Ville , Lampela Hanna , Harju Jukka , Koskenvuo Laura , Mentula Panu 
Published: July 2022

Background:
The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons.

Methods:
Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study.

Results:
The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P<0.001), but not in emergency LCCs (18.4% vs. 15.0%, P=0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P=0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged.

Conclusions:
Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.
Blast-related traumatic brain injury is mediated by the kynurenine pathway
Authors: Zhang Yu , Wang Lei , Ren Wenjie 
Published: July 2022

Objectives
The overactivation of the kynurenine pathway, the major metabolic pathway of tryptophan, induced by inflammation and oxidative stress, might bring about excessive neurotoxic metabolites. This study aimed to investigate whether kynurenine pathway is overactivated in blast-related traumatic brain injury (bTBI) and whether inhibitors of kynureninase and kynurenine-3-monooxygenase (KMO), important enzymes in kynurenine pathway, could alleviate bTBI in rats.

Methods
A shock tube was used to establish the bTBI animal models. Pathological changes in the hippocampus were observed using Nissl, propidium iodide and TdT-mediated dUTP Nick-End Labeling (TUNEL) staining. Immunohistochemistry was used to evaluate the expression levels of kynureninase and KMO. After the establishment of bTBI rat models, they were treated with KMO inhibitor (Ro 61-8048) and kynureninase inhibitor (benserazide hydrochloride), and the animals’ behavioral performance was assessed using an elevated plus maze (EPM).

Results
After blast exposure, the number of neurons decreased, whereas the expression of kynureninase and KMO increased in the CA1 area of the rat hippocampus. In vitro, KMO inhibitor (Ro) and kynureninase inhibitor (benserazide hydrochloride) intervention could reduce the proportion of TUNEL-positive neurons in the hippocampus. In vivo, after Ro treatment, the behavior of the bTBI rats was significantly improved, and more neurons survived in the hippocampus CA1 region; however, following benserazide hydrochloride treatment, the behavior of bTBI rats was not significantly improved, and neuron survival could not be improved in the hippocampal CA1 region.

Conclusion
The expression levels of KMO and kynureninase were increased in the hippocampus of the bTBI rats, suggesting that these factors might mediate the bTBI damage. Furthermore, the KMO inhibitor showed a significant protective effect on bTBI.