bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmentation Mastopexy: A Five-step Standardized Strategy Approach
Authors: Abdelkader Rasha , Raafat Sarah , Sakr Wael , Abdelaziz Mohamed , ElNoamany Sameh 
Published: June 2022

Introduction:
Planning a combined procedure requires ensuring an optimal fill of the reduced breast skin envelope, which in turn requires a system to quantify skin excess to ensure that the selected implant achieves that optimal fill. This has led us to develop a five-step approach that a surgical team can use to assess patients scheduled to undergo an augmentation mastopexy and arrive at an optimal surgical strategy.

Methods:
This retrospective study included 50 consecutive cases where layered mastopexies combined with augmentation mammaplasties were performed. Step 1 entailed a preoperative examination and evaluation of the breasts. In step 2, the breast volume was assessed. The pocket plane was determined in step 3. The choice of which surgical technique to use was done in step 4, and in step 5, the horizontal skin excess was assessed.

Results:
The average implant size was 300 cm3 (range: 170–350 cm3). The overall revision rate was 4%: on average, revision surgeries were performed 24 months after the first surgery. The average implant size was 300 cm3 (range: 170–350 cm3).

Conclusions:
Early results of single-stage augmentation with mastopexy have shown that the design of this systematic five-step approach demonstrates a great potential for producing reliable results with minimal risk. Using this five-step approach will improve patient and surgeon satisfaction and help to replace the old concept of “fill and re-drape” with a new one of “plan, reduce, fill, and re-drape.”
Conchal Excision Techniques in Otoplasty: A Literature Review
Authors: Mogl Adrian Georg , Palackic Alen , Cambiaso-Daniel Janos , Duggan Robert P. , Vappiani Monica , Giraudi Camilla , Raposio Edoardo , Bertossi Dario , Gualdi Alessandro 
Published: June 2022

Background:
Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons’ insights into current data on outcomes and complications of conchal excision techniques.

Methods:
We conducted a literature search through the MEDLINE, EMBASE, Scopus, and Cochrane databases. Prospective and retrospective studies on otoplasty, including revision surgeries and conchal excision techniques involving concha cartilage resection, were included. Articles with no outcomes data, review articles, case reports, expert opinion or comment, and nonclinical studies were excluded.

Results:
There were a total of four manuscripts that fulfilled our criteria. Three out of four authors preferred posterior access that separates the skin excision from the cartilage excision. Following resection, cartilage edges can be approximated by placing cartilage sutures, or they can be allowed to collapse spontaneously. Although only two authors employed a systematic classification for complications, all the articles reviewed indicated a low complication rate and excellent postoperative cosmetic outcomes.

Conclusion:
Although the techniques and principles stated in the literature varied to some extent, the outcomes of all studies reviewed were comparable.
Women's Health-Related Quality of Life Substantially Improves With Tailored Cardiac Rehabilitation
Authors: Chung Sherrie , Candelaria Dion , Gallagher Robyn 
Published: June 2022

Purpose:
Exercise-based cardiac rehabilitation (EBCR) offers an opportunity to improve women's otherwise poorer outcomes from coronary heart disease compared with men. However, synthesized evidence for the benefits of EBCR for health-related quality of life (HRQL) is lacking for women. The current study addresses this gap.

Methods:
Four electronic databases (PubMed, CINAHL, SCOPUS, and Cochrane) were searched for studies reporting HRQL using validated questionnaires in women attending EBCR. Two reviewers independently screened articles and extracted data. A random effects model was used for meta-analysis, where possible.

Results:
Eleven studies (1237 women) were included, with seven suitable for meta-analyses. Participation in EBCR improved multiple domains of HRQL, with greatest improvements in Role Physical (mean differences [MD] = 19.09: 95% CI, 2.37-35.81), Physical Functioning (MD = 10.43: 95% CI, 2.60-18.27), and Vitality (MD = 9.59: 95% CI, 0.31-18.86) domains of the 12-Item Short Form Health Survey and the 36-Item Short Form Health Survey. Adding psychosocial components tailored for women to traditional EBCR produced further gains in HRQL in Bodily Pain (MD = 9.82: 95% CI, 4.43-15.21), Role Physical (MD = 8.48: 95% CI, 1.31-9.97), Vitality (MD = 8.17: 95% CI, 3.79-12.55), General Health (MD = 5.64: 95% CI, 1.31-9.97), and Physical Functioning (MD = 5.61: 95% CI, 0.83-10.40) domains.

Conclusions:
Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, with added benefits when strategies were tailored to their needs. These benefits should be highlighted to promote EBCR uptake in women.
Can β-blockers influence regular daily physical activity?
Authors: Alimento Marina Luisa , Palermo Pietro , Italiano Gianpiero , Antonioli Laura , Salvioni Elisabetta , Agostoni Piergiuseppe 
Published: June 2022

Background:
In hypertension, β-blockers have a high rate of nonadherence to treatment likely because of fatigue.

Methods:
We evaluate daily physical activity and maximal exercise performance in 56 patients with hypertension (grades I–II), with and without β-blockers (bisoprolol 10 mg or atenolol 100 mg) added to standard treatment; 48 patients completed the study. Study tests were performed after 8 weeks of antihypertensive therapy without β blockers and after the following 8 weeks with β-blockers.

Results:
No significant differences between β-blockers were observed. At office measurement, β-blockers decreased heart rate (HR) from 78 ± 9 to 62 ± 7 bpm (P < 0.01) and SBP from 133 ± 13 to 125 ± 12 mmHg (P < 0.01). No significant changes were observed for DBP. Conversely, at ambulatory pressure monitoring DBP but not SBP decreased with β-blockers (mean-24-h DBP 77 ± 8 vs. 74 ± 7 mmHg, P < 0.01). An overall reduction of daily activities and of estimated kilocalories consumption was observed as measured by a portable armband device. Of note, time with activity more than 3 METS was reduced by β-blockers from 148.1 (83–201) to 117.9 (82–189) min (P < 0.01). Cardiopulmonary exercise (CPE) showed a preserved exercise performance unaffected by β-blockers.

Conclusion:
In hypertension, β-blocker treatment is associated to reduction of daily physical activity but not of maximal exercise performance.
Effect of different treatments for obstructive sleep apnoea on blood pressure
Authors: Kou Chengkun , Zhao Xu , Lin Xin , Fan Xin , Wang Qiongying , Yu Jing 
Published: June 2022

Objective:
Obstructive sleep apnoea (OSA) is a common cause of secondary hypertension. This network meta-analysis (NMA) assessed the effect of different OSA treatments on lowering blood pressure.

Methods:
PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for relevant randomized controlled trials. The search strategies included the concepts of OSA, blood pressure, hypertension, and blood pressure-reducing treatments without language or data restriction (from inception to 1 June 2021). The outcomes included office SBP, office DBP, daytime SBP (dSBP) and DBP (dDBP), and night-time SBP (nSBP) and DBP (nDBP). A Bayesian network meta-analysis was performed, and mean differences with 95% credibility intervals were calculated.

Results: :
We reviewed 49 randomized controlled trials involving 4893 patients and the following interventions: continuous positive-airway pressure (CPAP), mandibular advancement devices, nocturnal supplemental oxygen, surgery, β-blocker, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), renal sympathetic denervation (RDN), mineralocorticoid receptor antagonists (MRAs), calcium channel blockers. MRAs were significantly associated with blood pressure reduction followed by ACEI/ARB. RDN could reduce office SBP, office DBP, 24-h SBP, 24-h DBP, dSBP, and dDBP. CPAP also demonstrated modest blood pressure lowering.

Conclusion:
MRAs and ACEIs/ARBs can reduce blood pressure effectively in patients with OSA. RDN is a novel hypertension treatment that lowered blood pressure in such patients. CPAP was associated with mild but stable blood pressure reduction, and it might be helpful as an adjunctive therapy in OSA patients with hypertension.

Review registration:
This systematic review and meta-analysis was registered in PROSPERO: CRD42021240891.
Inter-individual variations in response to aerobic and resistance training in hypertensive older adults
Authors: Abrahin Odilon , Abrahin Rejane Pequeno , de Sousa Evitom Corrêa , Cortinhas-Alves Erik Artur , Nascimento Dahan da Cunha , Guerreiro João Farias 
Published: June 2022

Background:
Hemodynamic responses to physical training are not homogenous and uniform, and considerable inter-individual variations in the blood pressure of hypertensive individuals are noted in both aerobic and resistance training protocols. In this context, this study aimed to evaluate the effects of resistance and aerobic exercise on the blood pressure responses of hypertensive older adults.

Methods:
Groups were randomly divided into resistance training, n = 20; aerobic training, n = 20; control group, n = 21). After the first intervention period (12 weeks), individuals underwent a washout period (six detraining weeks), followed by a second intervention. This process is called the ‘cross-over’ model, where individuals who performed the aerobic exercise protocol also performed resistance training and vice-versa, constituting another 12 weeks of intervention. Blood pressure, functional performance, glycated hemoglobin and lipid profiles were evaluated preintervention and postintervention.

Results:
Varying responses to resistance training or aerobic training stimuli were observed in the hypertensive older adult participants. Both resistance training (pre 133.2 ± 14.1; post 122.4 ± 7.3; P < 0.05) and aerobic training (pre 134.2 ± 14.4; post 123 ± 9.4; P < 0.0.5) were effective in decreasing SBP, but only aerobic training (pre 9955.3 ± 1769.4; post 8800.9 ± 1316.1; P < 0.05) resulted in a decreased double product, and only the resistance training group improved functional performance.

Conclusion:
Responses to resistance training or aerobic training stimuli varied noticeably between hypertensive older adults and both resistance training and aerobic training were effective in reducing SBP. This knowledge may be useful in providing individually tailored exercise prescriptions for hypertensive older adults.
Campanumoea javanica Bl. activates the PI3K/AKT/mTOR signaling pathway and reduces sarcopenia in a T2DM rat model
Authors: Zuo Xiangyu , Yao Rongfei , Zhao Linyi , Zhang Yinjiang , Lu Binan , Pang Zongran 
Published: June 2022

Abstract

Objective:
Sarcopenia causes loss of skeletal muscle and function, thus seriously affecting the physical function and quality of life in the elderly. This article discusses the specific molecular mechanism and ameliorating effects of Tudangshen (TDS) on sarcopenia in elderly rats with type 2 diabetes mellitus (T2DM).

Methods:
Elderly Sprague-Dawley (SD) rats were randomly selected and fed with a high-fat diet combined with intraperitoneal injection of streptozotocin to establish T2DM model. The model rats were stratified and randomly divided into model group, metformin group, TDS high-dose group, TDS medium-dose group, and TDS low-dose group according to blood glucose combined with body weight, and the same batch of old SD rats were set as normal control group. The effects of TDS in an elderly T2DM sarcopenia rat model were evaluated by observing body positions of the rats, analyzing blood biochemistry, testing exercise capacity, and pathologically staining sectioned gastrocnemius muscle tissues. The molecular mechanisms of the effects were analyzed using quantitative real-time polymerase chain reaction and western blotting.

Results:
TDS has no statistically significant effect on blood glucose, insulin and glycosylated serum protein in aged rats with T2DM, but it can reduce levels of glycosylated serum protein, total cholesterol, triglycerides, and low-density lipoprotein; it improves pathological changes in rat gastrocnemius muscle tissues, and increases muscle cell activity in elderly rats with T2DM and sarcopenia. TDS also promoted the upregulation of the expression of mammalian target of rapamycin (mTOR)/protein kinase B (PKB/Akt)/phosphatidylinositol 3-kinase (PI3K)/ribosomal protein S6 kinase/eukaryotic initiation factor 4E binding rotein1 mRNA in rats and triggered an increase in corresponding protein levels.

Conclusions:
TDS alleviated muscle decline in elderly rats with T2DM by activating the PI3K/AKT/mTOR signaling pathway and regulating the synthesis of corresponding proteins.
Incidence and Predictors of Relapse After Stopping Antiviral Therapy in Pediatric Chronic Hepatitis B
Authors: Upadhyay Piyush , Lal Bikrant Bihari , Sood Vikrant , Khanna Rajeev , Gupta Ekta , Rastogi Archana , Alam Seema 
Published: June 2022

Background:
There are no definite end-points for stopping therapy in pediatric chronic hepatitis B (CHB). The study objective was to evaluate the incidence of relapse after stopping antiviral therapy and to identify its predictors.

Methods:
All hepatitis B surface antigen (HBsAg) positive children presenting to our hospital, who had been on antivirals for at least 2 years with undetectable hepatitis B virus-deoxyribonucleic acid (HBV-DNA) and normal alanine aminotransferase (ALT) on 3 consecutive occasions over last 12 months were included. Antivirals were stopped if liver biopsy showed histological activity index <5 and fibrosis (Ishak) <3. Virological relapse was defined as the elevation of HBV-DNA (>2000 IU/mL) and biochemical relapse as a rise in ALT levels to >2 times the upper limit of normal. Those having biochemical relapse were started on pegylated interferon alpha-2b-based sequential therapy.

Results:
Of the 114 children with CHB screened, 31 HBsAg-positive children fulfilled inclusion criteria and antivirals were stopped in them. Virological and biochemical relapse was seen in 12 (38.7%) and 5 (16.1%) children within 12 months of stopping antiviral treatment. On Cox regression, hepatitis B e antigen (HBeAg) positive status at the time of stopping antiviral therapy (HR: 6.208, 95% CI: 1.630–23.638) and longer time taken for HBV-DNA to become undetectable while on antivirals (HR: 1.027, 95% CI: 1.000–1.055) were the independent predictors of relapse.

Conclusion:
Discontinuation of antiviral treatment in children with CHB resulted in relapse in one-third of the patients. Relapse was frequent in those who were HBeAg-positive at the time of stopping therapy and in those who required longer therapy for HBV-DNA to become undetectable.
Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas
Authors: Salimi Ali , Gauvin Mathieu , Harissi-Dagher Mona , Racine Louis , Cohen Mark , Wallerstein Avi 
Published: June 2022

Purpose:
To investigate the efficacy and safety of phototherapeutic keratectomy (PTK) with topography-guided photorefractive keratectomy (T-PRK) corneal regularization followed by sequential hypo-osmolar riboflavin accelerated corneal crosslinking (CXL) in keratoconic (KC) eyes with <400 μm stromal bed thickness after excimer ablation.

Setting:
Multisurgeon multicenter standardized protocol practice.

Design:
Retrospective multicenter case series.

Methods:
This study included progressive KC eyes that underwent PTK and T-PRK combined with accelerated CXL and had a corneal stromal bed thickness of <400 μm after excimer ablation before administration of hypo-osmolar riboflavin. Demographics and clinical measures were reviewed at baseline and every follow-up visit.

Results:
61 consecutive eyes had a mean corneal stromal bed thickness of 367 ± 21 μm after excimer laser normalization. Postoperatively, uncorrected distance visual acuity (UDVA) improved by 0.29 logMAR (P < .0001), corrected distance visual acuity (CDVA) improved by 0.07 logMAR (P = .0012), and maximum keratometry (Kmax) decreased by 4.67 diopters (P < .0001). The safety index was favorable (1.29 ± 0.56), with stable manifest astigmatism, Kmax, and pachymetry at 12 months. 2 eyes (3%) showed evidence of keratometric progression on topography.

Conclusions:
In KC corneas thinner than 400 μm after excimer ablation, PTK epithelial removal followed by T-PRK and hypo-osmolar accelerated CXL decreases manifest astigmatism and Kmax, improves UDVA and CDVA, and halted disease progression in 97% of eyes at 12 months. These outcomes are comparable with thicker ablated corneas not requiring hypo-osmolar stromal swelling.
Ischemic Preconditioning Is Present in Patients With Non–ST Elevation Myocardial Infarction Screened With Electrocardiogram-Derived Moderate Obstructive Sleep Apnea
Authors: Borczynski Elizabeth , Suba Sukardi , Mackin Lynda A. , Mortara David W. , Badilini Fabio , Rodway George W. , Pelter Michele M. 
Published: June 2022

Background
Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events, including acute coronary syndrome (ACS). There is conflicting evidence that suggests OSA has a cardioprotective effect (ie, lower troponin), via ischemic preconditioning, in patients with ACS.

Purpose
This study had 2 aims: (1) compare peak troponin between non–ST elevation (NSTE) ACS patients with and without moderate OSA identified using a Holter-derived respiratory disturbance index (HDRDI) and (2) determine the frequency of transient myocardial ischemia (TMI) between NSTE-ACS patients with and without moderate HDRDI.

Method
This was a secondary analysis. Obstructive sleep apnea events were identified from 12-lead electrocardiogram Holter recordings using QRSs, R-R intervals, and the myogram. Moderate OSA was defined as an HDRDI of greater than or equal to 15 events per hour. Transient myocardial ischemia was defined as greater than or equal to 1 mm of ST-segment ↑ or ↓, in 1 or more electrocardiogram lead, lasting at least 1 minute.

Results
In 110 patients with NSTE-ACS, 39% (n = 43) had moderate HDRDI. Peak troponin was lower in patients with moderate HDRDI (6.8 ng/mL yes vs 10.2 ng/mL no; P = .037). There was a trend for fewer TMI events, but there were no differences (16% yes vs 30% no; P = .081).

Conclusions
Non–ST elevation ACS patients with moderate HDRDI have less cardiac injury than those without moderate HDRDI measured using a novel electrocardiogram-derived method. These findings corroborate previous studies suggesting a possible cardioprotective effect of OSA in patients with ACS via ischemic precondition. There was a trend for fewer TMI events in patients with moderate HDRDI, but there was no statistical difference. Future research should explore the underlying physiologic mechanisms of this finding.
Coexposure to Solvents and Noise as a Risk Factor for Hearing Loss in Agricultural Workers
Authors: Farfalla Alexandra A. , Beseler Cheryl , Achutan Chandran , Rautiainen Risto 
Published: June 2022

Objective
This study addressed the relationship of hearing loss and coexposure to solvents and noise among farmers and ranchers in central United States.

Methods
The surveillance study included surveys to stratified random samples of operations in 2018 and 2020 (n = 34,146), requesting information on injuries, illnesses, exposures, and preventive measures. Responses (n = 7495) were analyzed using hierarchical multinomial logistic regression, adjusting for personal and work characteristics.

Results
Nearly 60% of respondents exposed to both solvents and noise reported hearing loss. The exposures increased the adjusted odds of moderate/severe hearing loss as follows: solvents alone, (odds ratio [OR], 1.49; 95% confidence interval [CI], 0.93–2.38), noise alone (OR, 4.42; 95% CI, 3.39–5.76), and coexposure to both noise and solvents (OR, 6.03; 95% CI, 4.67–7.78).

Conclusions
Solvent exposure, along with noise, should be considered in hearing conservation programs among farmers and ranchers.
Rates and Predictors of Long-term Clinical Outcomes in Patients With Perianal Crohn’s Disease on Biologic Therapy
Authors: Gubatan John , Frost Spencer , Levitte Steven , Keyashian Kian 
Published: June 2022

Background and Goals:
Perianal Crohn’s disease (pCD) represents an aggressive phenotype with limited studies on long-term outcomes. We evaluated 5-year outcomes of these patients on biologic therapies.

Methods:
We performed a retrospective analysis of patients with pCD at a tertiary medical center. We used Kaplan-Meier curves to estimate rates and multivariate logistic regression to identify predictors of long-term outcomes.

Results:
We included 311 patients with pCD of which 168 patients were started on biologics [138 anti–tumor necrosis factor (TNF) α, 14 vedolizumab, 16 ustekinumab] at the time of diagnosis. Anti-TNF use at the time of diagnosis was associated with decreased rates of perianal abscess recurrence [hazard ratio (HR)=0.48, 95% confidence interval (CI): 0.32-0.74], whereas ustekinumab use was associated with increased rates of perianal fistula closure (HR=3.58, 95% CI: 1.04-12.35) and decreased rates of perianal abscess recurrence (HR=0.20, 95% CI: 0.07-0.56) at follow-up. Among patients who failed their first anti-TNF, switching to another anti-TNF was associated with decreased rates of colectomy (HR=0.20, 95% CI: 0.04-0.90) and permanent diversion (HR=0.16, 95% CI: 0.03-0.94) compared with ustekinumab, whereas vedolizumab use was associated with decreased perianal fistula closure (HR=0.22, 95% CI: 0.05-0.96) compared with ustekinumab. Predictors of colectomy included colonic disease (odds ratio=2.71, 95% CI: 1.36-5.38) and anal stenosis (odds ratio=4.44, 95% CI: 1.59-12.43).

Conclusion:
Type of biologic use at the time of pCD diagnosis or after first anti-TNF failure may be associated with long-term outcomes in patients with pCD.
Phosphate balance during dialysis and after kidney transplantation in patients with chronic kidney disease
Authors: Duque Eduardo J. , Elias Rosilene M. , Moysés Rosa M.A. 
Published: June 2022

Purpose of review
In patients with chronic kidney disease (CKD), hyperphosphatemia is associated with several adverse outcomes, including bone fragility and progression of kidney and cardiovascular disease. However, there is a knowledge gap regarding phosphate balance in CKD. This review explores its current state, depending on the stage of CKD, dialysis modalities, and the influence of kidney transplantation.

Recent findings
Adequate phosphate control is one of the goals of treatment for CKD-mineral and bone disorder. However, ongoing studies are challenging the benefits of phosphate-lowering treatment. Nevertheless, the current therapy is based on dietary restriction, phosphate binders, and optimal removal by dialysis. In the face of limited adherence, due to the high pill burden, adjuvant options are under investigation. The recent discovery that intestinal absorption of phosphate is mostly paracellular when the intraluminal concentration is adequate might help explain why phosphate is still well absorbed in CKD, despite the lower levels of calcitriol.

Summary
Future studies could confirm the benefits of phosphate control. Greater understanding of the complex distribution of phosphate among the body compartments will help us define a better therapeutic strategy in patients with CKD.