bluuebunny/crossref_metadata_2025 huggingface dataset:
Adipose Stromal Vascular Fraction Gel Grafting: A New Method for Tissue Volumization and Rejuvenation
Authors: Yao Yao , Cai Junrong , Zhang Pan , Liao Yunjun , Yuan Yi , Dong Ziqing , Lu Feng
Published: May 2018

BACKGROUND

The clinical outcomes of fat grafting vary and are technique-dependent. Stromal vascular fraction (SVF) gel is a novel, mechanically processed fat product with high concentrations of adipose tissue–derived stem cells and other SVF cells. This study evaluated the volumization and rejuvenation effects of SVF-gel.

OBJECTIVE

This study evaluated the volumization and rejuvenation effects of SVF-gel.

METHODS

This retrospective, single-center study included 126 patients who underwent SVF-gel grafting and 78 who underwent conventional lipoinjection for various indications from March 2015 to February 2017. Patient satisfaction and secondary surgery rates were evaluated. Samples of transferred SVF-gel were harvested and examined histologically.

RESULTS

All patients showed improvements in facial augmentation and contour. Patients in the SVF-gel group experienced mild postoperative swelling and a low secondary surgery rate (10.9%). Assessment of patient-rated satisfaction on a 5-point Likert scale found that 77.3% of patients in the SVF-gel group were satisfied (54.5%) or very satisfied (22.8%) with their outcomes. By comparison, 53.8% of patients who underwent conventional lipoinjection were satisfied (48.7%) or very satisfied (5.1%). Moreover, SVF-gel showed effective antiwrinkle and skin rejuvenation effects. Hematoxylin–eosin staining showed a normal adipose tissue structure in transferred SVF-gel.

CONCLUSION

Stromal vascular fraction gel is effective for both volumization and rejuvenation, and may be superior to conventional lipoinjection for facial recontouring.
Health Outcomes of Medically and Economically Vulnerable Adults
Authors: Cooley Morgan E. , Thompson Heather M. , Murray Heather
Published: May 2018

Medically and economically vulnerable adults experience various challenges that can impact their health. Within this vulnerable population, there may be individuals who are even more vulnerable, those who have a history of involvement with the foster care system. The purpose of this study was to evaluate the difference of reported health-related problems between adults with previous foster care experience and other vulnerable adults. Physical, mental, and relational health was evaluated in this study. Practice and policy implications for mental health and medical professionals are discussed.
Development of a Community Health Worker–Delivered Cognitive Behavioral Training Intervention for Individuals With Diabetes and Chronic Pain
Authors: Andreae Susan J. , Andreae Lynn J. , Cherrington Andrea L. , Lewis Marquita , Johnson Ethel , Clark Debra , Safford Monika M.
Published: May 2018

Cognitive behavioral therapy (CBT) programs have the potential to improve quality of life in individuals with chronic pain and diabetes. Rural communities often lack the infrastructure necessary to implement such programs. CBT traditionally requires trained therapists, who are rarely available in these areas. An alternative may be programs delivered by community health workers (CHWs). We present an iterative developmental approach that combined program adaptation, pretesting, and CHW training processes for a CBT-based diabetes self-care program for individuals living with diabetes and chronic pain. Collaborative intervention refinement, combined with CHW training, is a promising methodology for community-engaged research in remote, underresourced communities.
Stable Upper Eyelid after 2 Successive Tarsoconjunctival Flaps
Authors: Liu Catherine Y. , Putterman Allen M.
Published: May 2018

A 70-year-old male with history of multiple cutaneous squamous cell carcinoma throughout the body presented with a left lower lid margin squamous cell carcinoma. The lesion was excised via Mohs surgery elsewhere, and the defect was reconstructed with a tarsoconjunctival flap (Hughes flap). The lesion recurred, and the patient had a second Mohs surgery for excision. For reconstruction, a second tarsoconjunctival flap spanning the entire horizontal distance of the upper lid was done. The remaining 2–3 mm of upper tarsus provided good support of the upper lid. Careful planning may allow for successive tarsoconjunctival flaps if needed in the future.
Modeling the Skeleton Weight of an Adult Caucasian Man
Authors: Avtandilashvili Maia , Tolmachev Sergei Y.
Published: May 2018

The reference value for the skeleton weight of an adult male (10.5 kg) recommended by the International Commission on Radiological Protection in Publication 70 is based on weights of dissected skeletons from 44 individuals, including two US Transuranium and Uranium Registries whole-body donors. The International Commission on Radiological Protection analysis of anatomical data from 31 individuals with known values of body height demonstrated significant correlation between skeleton weight and body height. The corresponding regression equation, W
skel (kg) = −10.7 + 0.119 × H (cm), published in International Commission on Radiological Protection Publication 70 is typically used to estimate the skeleton weight from body height. Currently, the US Transuranium and Uranium Registries holds data on individual bone weights from a total of 40 male whole-body donors, which has provided a unique opportunity to update the International Commission on Radiological Protection skeleton weight vs. body height equation. The original International Commission on Radiological Protection Publication 70 and the new US Transuranium and Uranium Registries data were combined in a set of 69 data points representing a group of 33- to 95-y-old individuals with body heights and skeleton weights ranging from 155 to 188 cm and 6.5 to 13.4 kg, respectively. Data were fitted with a linear least-squares regression. A significant correlation between the two parameters was observed (r
2 = 0.28), and an updated skeleton weight vs. body height equation was derived: W
skel (kg) = −6.5 + 0.093 × H (cm). In addition, a correlation of skeleton weight with multiple variables including body height, body weight, and age was evaluated using multiple regression analysis, and a corresponding fit equation was derived: W
skel (kg) = −0.25 + 0.046 × H (cm) + 0.036 × W
body (kg) − 0.012 × A (y). These equations will be used to estimate skeleton weights and, ultimately, total skeletal actinide activities for biokinetic modeling of US Transuranium and Uranium Registries partial-body donation cases.
PROGNOSTIC VALUE OF SHAPE-DESCRIPTIVE FACTORS FOR THE PROGRESSION OF GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Pfau Maximilian , Lindner Moritz , Goerdt Lukas , Thiele Sarah , Nadal Jennifer , Schmid Matthias , Schmitz-Valckenberg Steffen , Sadda SriniVas R. , Holz Frank G. , Fleckenstein Monika ,   for the Fundus Autofluorescence in Age-Related Macular Degeneration Study Group
Published: May 2018

Purpose:

To systematically compare the prognostic value of multiple shape-descriptive factors in the natural course of the disease.

Methods:

A total of 296 eyes of 201 patients (female patients 130; mean age: 72.2 ± 13.08 years) with a median follow-up of 2.38 years from 2 prospective, noninterventional natural history studies (Fundus-Autofluorescence-in-Age-related-Macular-Degeneration [clinicaltrials.gov identifier NCT00393692], Directional-Spread-in-Geographic-Atrophy [NCT02051998]) were included in the analysis. Serial fundus autofluorescence images were annotated using semiautomated image analysis software to determine the lesion area, circularity, perimeter, and caliper diameters. These variables and the fundus autofluorescence phenotype were evaluated for prediction of the future square root progression rates using linear mixed-effects models.

Results:

For the combined model, leave-one-out cross validation on patient level (Scenario 1: previously unknown patient) resulted in a goodness-to-fit (R2 value) of 0.244 and leave-one-out cross validation on visit level (Scenario 2: previous observation of the patient) in a R2 value of 0.391. This indicated that shape-descriptive factors could explain 24.4% of the variance in geographic atrophy progression in previously unknown patients and 39.1% in patients with previous observation.

Conclusion:

These findings confirm the relevance of shape-descriptive factors and previous progression as prognostic variables for geographic atrophy progression. However, a substantial part of the remaining variation in geographic atrophy progression seems to depend on other variables, some of which are visible in optical coherence tomography.
Osteo-Odonto-Keratoprosthesis in Severe Thermal and Chemical Injuries
Authors: Vasquez-Perez Alfonso , Zarei-Ghanavati Mehran , Avadhanam Venkata , Liu Christopher
Published: May 2018

Purpose:

To report the results of osteo-odonto-keratoprosthesis (OOKP) surgery in patients who sustained severe chemical and thermal injuries.

Methods:

This is a noncomparative retrospective case series of 14 patients who underwent OOKP surgery between 2001 and 2016 at the Sussex Eye Hospital, Brighton, UK, because of severe chemical and thermal injuries

Results:

OOKP surgery was performed in 14 eyes of 14 patients. Eight patients (57%) sustained thermal injuries and 6 patients (43%) chemical injuries. Every eye had previously undergone adnexal or ocular surgery, including 2 cases that underwent synthetic keratoprosthesis implantation. One case had choroidal hemorrhage during stage 2. Laminar retention was observed in 11 cases (85%) at the end of the study. The Kaplan–Meier curve showed a probability of 81% of laminar retention at 5 years and a decrease at 15 years to 61%. Functional visual success was observed in only 7 patients (50%) because of end-stage glaucomatous optic neuropathy in 4 cases and macular scar in 1 case. Two cases developed endophthalmitis. Two cases required removal of laminae, one because of endophthalmitis, bone resorption and aqueous leak and the other because of development of a retroprosthetic membrane. Glaucoma was the most frequent complication (79%) and required surgical intervention with tube shunts in 5 cases. Six cases (43%) required buccal mucosal repair, which included two cases that developed endophthalmitis.

Conclusions:

Anatomic success was achieved in 11 of 13 cases in this series of OOKP surgery after severe chemical and thermal trauma; 8 of these cases had at least 5 years of follow-up and thus qualified as long-term.
Repeatability and Intersession Reproducibility of Pentacam Corneal Thickness Maps in Fuchs Dystrophy and Endothelial Keratoplasty
Authors: Mingo-Botín David , Arnalich-Montiel Francisco , Couceiro de Juan Ana , Ortiz-Toquero Sara
Published: May 2018

Purpose:

To assess intrasession repeatability and intersession reproducibility of Pentacam corneal thickness maps in patients with Fuchs endothelial corneal dystrophy (FECD) before and after endothelial transplantation.

Methods:

In this observational diagnostic evaluation, 20 healthy subjects along with 81 consecutive patients were examined. Patients were classified into 4 groups: FECD without corneal edema, FECD with corneal edema, Descemet stripping automated endothelial keratoplasty, and Descemet membrane endothelial keratoplasty. Three consecutive scans of each eye were obtained at 2 different sessions. Raw pachymetry data were used to calculate average values of 4 concentric annular zones, which were also divided into 8 sectors. Repeatability and reproducibility coefficients (CR), coefficient of variation (CV), intraclass correlation coefficient, and 95% limits of agreement were calculated.

Results:

The intrasession repeatability CV was ≤1% in the central 6 mm for all groups, with an intraclass correlation coefficient ≥0.97. It was better at the central zone than the periphery in all groups. Intersession reproducibility tended to be worse in the central area than the periphery in FECD without edema (CR ≤ 24.37; CV ≤ 1.48) and FECD with edema (CR ≤ 36.74; CV ≤ 2.03), whereas it was better in the central area in healthy eyes (CR ≤ 20.11; CV ≤ 1.32) and improved after Descemet stripping automated endothelial keratoplasty (CR ≤ 21.93; CV ≤ 1.31) and Descemet membrane endothelial keratoplasty (CR ≤ 30.83; CV ≤ 1.94).

Conclusions:

Pentacam corneal thickness maps showed good repeatability and intersession reproducibility in virgin and grafted corneas with FECD, which makes it a valid tool for monitoring these patients. Central areas showed the highest variability between sessions in diseased groups.
Quantitative sensory testing in patients with migraine: a systematic review and meta-analysis
Authors: Nahman-Averbuch Hadas , Shefi Tom , Schneider Victor J. , Li Dan , Ding Lili , King Christopher D. , Coghill Robert C.
Published: May 2018

Quantitative sensory testing (QST) is widely used to assess somatosensory function by application of controlled stimuli across a variety of modalities. The aim of the present meta-analysis is to synthesize QST results across a wide array of studies of patients with migraine to identify the QST parameters that are reliably different between patients with migraine and healthy controls. In addition, we aimed to determine whether such differences vary according to stimulus location. A comprehensive literature search (up to January 2017) was conducted, which included studies comparing QST parameters between patients with migraine and healthy controls. For each QST modality, we calculated up to 3 meta-analyses for combined (combined data from multiple testing locations), local (head and neck), and nonlocal (outside the head or neck) locations. A total of 65 studies were included in the meta-analyses. Lower heat and pressure pain thresholds were observed in patients with migraine compared with healthy controls in the combined locations. Importantly, lower pressure pain threshold in patients with migraine was found in local areas but not in nonlocal areas. In addition, patients with migraine had higher pain ratings to cold suprathreshold stimuli for combined and nonlocal areas, and higher pain ratings to electrical suprathreshold stimuli for nonlocal areas. This meta-analysis indicates that the alterations in nociceptive processing of patients with migraine may be modality, measure, and location specific. These results provide researchers and clinicians the evidence to choose QST parameters optimally suited for differentiating patients with migraine and healthy controls.
Involvement of the VGF-derived peptide TLQP-62 in nerve injury–induced hypersensitivity and spinal neuroplasticity
Authors: Skorput Alexander G. J. , Zhang Xijing , Waataja Jonathan J. , Peterson Cristina D. , Riedl Maureen S. , Kitto Kelley F. , Truong Hai , Huffman Cecilia , Salton Stephen R. , Fairbanks Carolyn A. , Honda Christopher N. , Vulchanova Lucy
Published: May 2018

Neuroplasticity in the dorsal horn after peripheral nerve damage contributes critically to the establishment of chronic pain. The neurosecretory protein VGF (nonacronymic) is rapidly and robustly upregulated after nerve injury, and therefore, peptides generated from it are positioned to serve as signals for peripheral damage. The goal of this project was to understand the spinal modulatory effects of the C-terminal VGF-derived peptide TLQP-62 at the cellular level and gain insight into the function of the peptide in the development of neuropathic pain. In a rodent model of neuropathic pain, we demonstrate that endogenous levels of TLQP-62 increased in the spinal cord, and its immunoneutralization led to prolonged attenuation of the development of nerve injury–induced hypersensitivity. Using multiphoton imaging of submaximal glutamate-induced Ca2+ responses in spinal cord slices, we demonstrate the ability of TLQP-62 to potentiate glutamatergic responses in the dorsal horn. We further demonstrate that the peptide selectively potentiates responses of high-threshold spinal neurons to mechanical stimuli in singe-unit in vivo recordings. These findings are consistent with a function of TLQP-62 in spinal plasticity that may contribute to central sensitization after nerve damage.
Closing the Referral Loop
Authors: Davidow Stephen L. , Sheth Jignesh , Sixta Constance S. , Thomas-Hemak Linda
Published: May 2018

More than 105 million referrals of Medicare beneficiaries to specialists occur annually. Different settings and electronic health records have made care coordination complex. PCPI (formerly American Medical Association-convened Physicians Consortium for Performance Improvement) and The Wright Center for Graduate Medical Education sponsored the Closing the Referral Loop pilot project. Twelve dyads of primary care and specialist physicians sought to improve ambulatory referrals by mapping the referral process, and using care compacts, metrics, and electronic health records. Referrals closed on time increased from 40% to 70%. Clinical questions answered increased from 50% to 75%. Adoption of the change package and lessons from this project may significantly improve ambulatory referral management.
Dermatology Emergencies
Authors: Kellen Roselyn , Berlin Joshua M.
Published: May 2018

Dermatology is primarily an outpatient specialty. However, it is important to recognize certain conditions that require referral for inpatient management as well as for healthcare professionals to appreciate the types of patients who need to be triaged appropriately in the emergency room or urgent care setting. This article will serve to summarize some of the diagnostic features and management of these patients.
Intestinal Fatty Acid Binding Protein as a Marker of Necrosis and Severity in Acute Pancreatitis
Authors: Kupčinskas Juozas , Gedgaudas Rolandas , Hartman Hannes , Sippola Tomi , Lindström Outi , Johnson Colin D. , Regnér Sara
Published: May 2018

Objectives

The aim of this study was to study intestinal fatty acid binding protein (i-FABP) as a potential biomarker in predicting severity of acute pancreatitis (AP).

Methods

In a prospective multicenter cohort study, plasma levels of i-FABP were measured in 402 patients with AP. Severity of AP was determined based on the 1992 Atlanta Classification.

Results

Admission levels of plasma i-FABP were significantly higher in patients with pancreatic necrosis, in patients having systemic complications, in patients treated invasively, in patients treated in the intensive care unit, in patients with severe AP, and in deceased patients. Plasma i-FABP levels on admission yielded an area under curve (AUC) of 0.732 in discriminating patients with or without pancreatic necrosis and AUC of 0.669 in predicting severe AP. Combination of levels of i-FABP and venous lactate on the day of admission showed higher discriminative power in severe AP—AUC of 0.808.

Conclusions

Higher i-FABP levels on admission were associated with pancreatic necrosis, systemic complications, and severe AP. Low levels of i-FABP had a high negative predictive value for pancreatic necrosis and severe AP. Combination of levels of i-FABP and venous lactates on admission were superior to either of markers used alone in predicting severe AP.
Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis After Double-Guidewire Biliary Cannulation in an Average-Risk Population
Authors: Krill Joseph T. , DaVee Tomas , Edwards Jade S. , Slaughter J. Chris , Yachimski Patrick S.
Published: May 2018

Objectives

Double-guidewire cannulation (DGC) for selective biliary access has been associated with increased risk of post-ERCP pancreatitis (PEP) in patients who have had pancreatic duct (PD) contrast injection. The objective of this study was to determine whether DGC increases PEP risk in standard risk individuals when controlling for procedural aspects such as PD contrast injection.

Methods

Consecutive adults with native papillae who underwent endoscopic retrograde cholangiopancreatography from 2009 to 2014 were retrospectively identified, and clinical data were collected.

Results

There were 879 subjects who met inclusion criteria. Increased incidence of PEP was observed after DGC (18% with DGC vs 4% without DGC, P < 0.005). Additional factors associated with increased PEP risk included the following: PD contrast injection, PD wire cannulations, and biliary stent placement. The association between DGC and increased PEP risk remained significant in a multivariate model controlling for age, sex, PD contrast injection, biliary sphincterotomy, biliary stent placement, and rectal indomethacin administration (odds ratio = 2.87, 95% confidence interval = 1.23–6.36).

Conclusions

Double-guidewire cannulation is associated with increased risk of PEP when controlling for confounding variables. Prospective studies should be undertaken to assess whether prophylactic interventions reduce risk of PEP after DGC in an average-risk population.
STRONGkids
Authors: da Cruz Gouveia Mara Alves , Tassitano Rafael Miranda , da Silva Gisélia Alves Pontes
Published: May 2018

Objectives:

The aim of the study is to assess STRONGkids as a tool for predicting weight loss and length of hospital stay in children and to determine whether the anthropometric diagnosis of nutritional status at the time of admission was associated with weight loss and length of hospital stay.

Methods:

A methodological study recruiting 245 children age between 1 and 10 years of age admitted to a tertiary hospital. The participants were weighed daily until discharge. Validation of the STRONGkids tool for the identification of patients sustaining weight loss at the end of hospitalization involved the calculation of sensitivity, specificity, and positive and negative predictive values, and anthropometric assessment.

Results:

A total of 129 (52.7%) children lost weight at the end of hospitalization. Of these, 73 (56.6%) lost over 2% of their weight on admission. The tool had a sensitivity of 55.8%, a specificity of 38.8% and a positive predictive value of 50.3% in identifying children who lost weight. The anthropometric assessment had a sensitivity of 26.5%, a specificity of 75.9%, and a positive predictive value of 49.1%.

Conclusions:

The model used to develop the STRONGkids tool incorporated clinical evaluation to a greater extent than the assessment of nutritional status. The tool, however, had a low sensitivity and a high percentage of false positives. Therefore, it should be considered as a preliminary evaluation tool and its use should be complemented with clinical data.
Efficacy and Safety of Direct Acting Antiviral Therapy for Chronic Hepatitis C in Thalassemic Children
Authors: Padhi Shivadatta , Maharshi Sudhir , Gupta Gaurav K. , Garg Kapil , Nijhawan Sandeep
Published: May 2018

Objectives:

There is limited data on the efficacy and safety of directly acting antiviral therapy (DAA) for chronic hepatitis C in pediatric population. The aim was to assess the efficacy and safety of DAA in chronic hepatitis C β-thalassemic major pediatric patients.

Methods:

Prospective study was conducted from September 2015 to January 2017. All β-thalassemic major chronic hepatitis C pediatric patients with age between 5 and 14 years were included in this study. Data related to demography, laboratory parameters, hepatitis C viral load, genotype and outcome of antiviral therapy was analyzed. DAA was planned according to EASL guidelines 2015 for chronic hepatitis C therapy in adults.

Observations:

Fourteen β-thalassemic major patients (median age was 9.5 y, 12 male) were studied. All patients were of genotype 3, received DAA (sofosbuvir 400 mg+daclatasvir 80 mg) for 12 weeks. The median viral load was 2.5×103 IU/mL. End of treatment response and sustained virological response at 12 weeks was achieved in all the patients. Serum alanine aminotransferase, aspartate aminotransferase, ferritin, and albumin significantly reduced after DAA.

Conclusions:

DAA in adult dosage are safe and effective for treatment of chronic hepatitis C (genotype 3) in pediatric β-thalassemic major population.
Cold Pressor Pain Response in Children With Cancer
Authors: Jenkins Brooke N. , Roemer Ryan J. , Martinez Ariana , Torres Tara K. , Fortier Michelle A.
Published: May 2018

Objective:

The goal of this study was to examine pain responses in pediatric patients with cancer.

Method:

Children (ages 6 to 18) undergoing treatment for cancer (N=68) completed the cold pressor task.

Results:

Average pain tolerance was 118.22 seconds (SD=101.18) and 40% of the children kept their hand in the water the entire 4-minute ceiling. On a 0 to 10 numeric rating scale, children reported a pain severity of 5.07 (SD=3.47) at their first report of pain, a pain severity of 5.94 (SD=3.54) at their maximum report of pain, and a pain severity of 5.33 (SD=3.72) at the time they reached pain tolerance. Children receiving chemotherapy agents (N=56) with possible neuropathic effects exhibited higher pain tolerance compared with children not receiving such treatments (N=10), β=0.84, SE=0.38, Wald χ2
1=4.88, P=0.027, hazard ratio=2.33, 95% confidence interval (1.10-4.92).

Conclusions:

This study provides data on experimental pain responses in a sample of children undergoing cancer treatment and suggests that pain experience may be moderated by cancer treatment type.
Upshaw-Schulman Syndrome With c.2728C>T Mutation in ADAMTS13 Gene
Authors: Resham Shahzadi , Fadoo Zehra , Moiz Bushra
Published: May 2018

Congenital thrombotic thrombocytopenic purpura is a rare autosomal recessive disorder presenting with hemolytic anemia, thrombocytopenia, micro vascular thrombosis, and end organ damage. Here, we present a case of a 7-year-old girl having recurrent neonatal hemolysis, developmental delay, frequent seizures, and thrombocytopenia. Characteristic clinical picture and gene sequencing of a disintegrin and metalloproteinase with thrombospondin motifs 13 confirmed the diagnosis of Upshaw-Schulman syndrome. She was treated successfully with plasma infusion. The patient is alive at 6-month post follow-up, and on regular plasma therapy. Congenital thrombotic thrombocytopenic purpura should be considered in the differential diagnosis of thrombocytopenia with hemolytic anemia in infants.
Psychological Community Integration of Individuals With Serious Mental Illness
Authors: Pahwa Rohini , Kriegel Liat
Published: May 2018

As different facets of community integration as well as psychological and social integration are important dimensions of recovery for individuals with serious mental illness (SMI). The primary aim of the study was to explore psychological integration for individuals with SMI into the mental health and mainstream (i.e., non–mental health) communities and its association with their social integration into both communities. The study used self-report and egocentric social network data from 60 individuals with SMI receiving community-based mental health services. The primary findings indicated that social integration connected to service providers was associated with psychological integration in both mental health and mainstream communities. Our data suggest that in addition to providing services, providers are doing something meaningful to impact their clients' lives well beyond mental health services. The study supports a bifurcated conceptualization of psychological integration and provides a more complex understanding of the community integration concept.
Differential Association of Stigma with Perceived Need and Mental Health Service Use
Authors: Wong Eunice C. , Collins Rebecca L. , Breslau Joshua , Burnam M. Audrey , Cefalu Matthew , Roth Elizabeth A.
Published: May 2018

This study examined the role of stigma at two stages of the treatment-seeking process by assessing associations between various types of stigma and perceived need for mental health treatment as well as actual treatment use. We analyzed cross-sectional data from the 2014 and 2016 California Well-Being Survey, a telephone survey with a representative sample of 1954 California residents with probable mental illness. Multivariable logistic regression indicated that perceived need was associated with less negative beliefs about mental illness (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.95) and greater intentions to conceal a mental illness (OR = 1.47; 95% CI = 1.12–1.92). Among respondents with perceived need, treatment use was associated with greater mental health knowledge/advocacy (OR = 1.63; 95% CI = 1.03–2.56) and less negative treatment attitudes (OR = 0.66; 95% CI = 0.43–1.00). Understanding which aspects of stigma are related to different stages of the help-seeking process is essential to guiding policy and program initiatives aimed at ensuring individuals with mental illness obtain needed mental health services.
Electrolytes and Biochemical Changes in Cerebrospinal Fluid in Drowning
Authors: Paulis Melad G. , Hasan Eman I.
Published: May 2018

The diagnosis of drowning is still a difficult task in forensic science. Biochemical changes in different body fluids have been examined for the identification of drowning. However, none of them alone gives accurate results in the diagnosis of drowning and differentiation of saltwater and freshwater drowning. This study aimed to examine cerebrospinal fluid changes in drowned rabbits. Six groups of rabbits were used including immersed dead rabbits in freshwater or saltwater (as control groups), alive fully conscious rabbits drowned in freshwater and saltwater, and anesthetized rabbits drowned in freshwater and saltwater. Cerebrospinal fluid electrolytes except for potassium levels were significantly higher in rabbits drowned consciously in saltwater than their level in the control group. In rabbit drowned in freshwater, the examined electrolytes decreased significantly. In addition, urea, creatinine, uric acid, glucose, and tumor necrosis factor were different in cases of freshwater and saltwater drowning from those of control rabbits. Electrolytes and biochemical changes of unconscious rabbits drowned in water showed no significant difference from those of control rabbits. Cerebrospinal fluid examination in drowning gives promising results in the diagnosis of drowning. In addition, the differentiation between freshwater and saltwater drowning was possible.
Cost of Integrating Noncommunicable Disease Screening Into Home-Based HIV Testing and Counseling in South Africa
Authors: Golovaty Ilya , Sharma Monisha , Van Heerden Alastair , van Rooyen Heidi , Baeten Jared M. , Celum Connie , Barnabas Ruanne V.
Published: May 2018

Introduction:

Integrated HIV–noncommunicable disease (NCD) services have the potential to avert death and disability but require data on program costs to assess the impact of integrated services on affordability.

Methods:

We estimated the incremental costs of NCD screening as part of home-based HIV testing and counseling (HTC) and referral to care in KwaZulu-Natal, South Africa. All adults in the households were offered integrated HIV–NCD screening (for HIV, diabetes, hypertension, hypercholesterolemia, obesity, depression, tobacco, and alcohol use), counseling, and linkage to care. We conducted comprehensive program microcosting including ingredient-based and activity-based costing, staff interviews, and time assessment studies. Sensitivity analyses varied cost inputs and screening efficiency.

Results:

Integrating all-inclusive NCD screening as part of home-based HTC in a high HIV prevalence setting increased program costs by $3.95 (42%) per person screened (from $9.36 to $13.31 per person). Integrated NCD screening, excluding point-of-care cholesterol testing, increased program costs by $2.24 (24%). Furthermore, NCD screening integrated into HTC services reduced the number of persons tested by 15%–20% per day.

Conclusions:

Integrated HIV–NCD screening has the potential to efficiently use resources compared with stand-alone services. Although all-inclusive NCD screening could increase the incremental cost per person screened for integrated HIV–NCD services over 40%, a less costly lipid assay or targeted screening would result in a modest increase in costs with the potential to avert NCD death and disability. Our analysis highlights the need for implementation science studies to estimate the cost-effectiveness of integrated HIV–NCD screening and linkage per disability-adjusted life year and death averted.
Brief Report: Point of Care Cryptococcal Antigen Screening: Pipetting Finger-Prick Blood Improves Performance of Immunomycologics Lateral Flow Assay
Authors: Wake Rachel M. , Jarvis Joseph N. , Harrison Thomas S. , Govender Nelesh P.
Published: May 2018

Background:

Cryptococcal antigen (CrAg) screening at the point of care could improve cryptococcal meningitis prevention where laboratory resources are limited. We evaluated the accuracy of Immunomycologics (IMMY, Norman, OK) CrAg lateral flow assay (LFA) using different techniques at point of care.

Setting:

Two tertiary-level hospitals in Johannesburg and a community health clinic in Soweto, South Africa.

Methods:

A case–control diagnostic validation study and a prospective clinic-based implementation study using the IMMY CrAg LFA on finger-prick blood. Accuracy, using direct application of LFA to sample, or pipette to transfer sample to diluent, and reading after 10 and 20 minutes, was compared with laboratory-based plasma testing.

Results:

The validation study tested 64 CrAg-positive and 152 CrAg-negative patients with no symptoms or signs of meningitis, identified by routine laboratory screening, recruited by convenience sampling. Consecutively diagnosed HIV-infected adults (n = 654) were included in the implementation study. Sensitivity was 82% and 20% when the LFA was read 10 minutes after direct application to finger-prick blood in the validation and implementation studies, respectively. Using a pipette to transfer blood and reading after 20 minutes improved sensitivity to 100%, while retaining 100% specificity, in both studies.

Conclusions:

Although the IMMY CrAg LFA performs well when applied directly to finger-prick blood for diagnosing cryptococcal meningitis, this technique may not provide adequate volume to detect low concentrations of CrAg when screening asymptomatic patients. Using a pipette to transfer larger volumes of blood to diluent before CrAg LFA testing and reading results after 20 minutes is a more reliable point-of-care method.
Cytomegalovirus-Specific CD4+ T-cell Responses and CMV-IgG Levels Are Associated With Neurocognitive Impairment in People Living With HIV
Authors: Ballegaard Vibe , Pedersen Karin Kaereby , Pedersen Maria , Brændstrup Peter , Kirkby Nikolai , Buus Anette Stryhn , Ryder Lars P. , Gerstoft Jan , Nielsen Susanne Dam
Published: May 2018

Background:

Mechanisms leading to neurocognitive impairment (NCI) in people living with HIV (PLWHIV) on stable combination antiretroviral therapy (cART) remain unknown. We investigated the association between immunity against cytomegalovirus (CMV), HIV-specific variables, and NCI in PLWHIV on stable cART and with low comorbidity.

Methods:

Fifty-two PLWHIV on stable cART and 31 HIV-uninfected controls matched on age, sex, education, and comorbidity were tested with a neurocognitive test battery, and CMV-immunoglobulin G (CMV-IgG) levels were measured. In PLWHIV, CMV-specific (CMV-pp65 and CMV-gB) CD4+ and CD8+ T-cell responses were measured using intracellular cytokine staining and flow cytometry. NCI was defined as a global deficit scale score (GDS score) ≥0.5. GDS scores and domain-specific scores defined severity of NCI. Logistic and linear multivariable regression analyses were used.

Results:

NCI was detected in 30.8% of PLWHIV, and HIV was associated with an adjusted odds ratio (aOR) of 5.18 [95% confidence interval (CI): 1.15 to 23.41, P = 0.033] for NCI. In PLWHIV, higher CMV-specific CD4+ T-cell responses increased the probability of NCI with an aOR of 1.68 (95% CI: 1.10 to 2.57) for CMV-pp65 or an aOR of 3.73 (95% CI: 1.61 to 16.98) for CMV-gB, respectively. Similar associations were not found with CMV-IgG or CMV-specific CD8+ T cells, but when assessing severity of NCI, higher CMV-IgG (per 100 U/mL) was associated with worse GDS scores (β = 0.08) (0.01–0.16), P = 0.044), specifically in the domain of speed of information processing (β = 0.20 (0.04–0.36, P = 0.019).

Conclusions:

PLWHIV had increased risk of NCI. Excess risk may be associated with CMV-specific CD4+ T-cell responses and CMV-IgG. Larger longitudinal studies investigating the impact of immunity against CMV on risk of NCI are warranted.
Extended-release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living with HIV and Alcohol use Disorders Transitioning to the Community: Results From a Double-Blind, Placebo-Controlled Trial
Authors: Springer Sandra A. , Di Paola Angela , Barbour Russell , Azar Marwan M. , Altice Frederick L.
Published: May 2018

Objective:

To determine whether extended-release naltrexone (XR-NTX) would improve or maintain viral suppression (VS) among incarcerated individuals with HIV and alcohol use disorders (AUDs) transitioning to the community.

Design:

A randomized, double-blind, placebo-controlled trial was conducted among incarcerated individuals with HIV and AUDs transitioning to the community from 2010 through 2016.

Methods:

Eligible participants (N = 100) were randomized 2:1 to receive 6 monthly injections of XR-NTX (n = 67) or placebo (n = 33) starting at release and continued for 6 months. The primary and secondary outcomes were the proportion that maintained or improved VS at <200 and <50 copies per milliliter from baseline to 6 months, respectively, using an intention-to-treat analysis.

Results:

Participants allocated to XR-NTX improved VS from baseline to 6 months for <200 copies per milliliter (48.0%–64.2%, P = 0.024) and for <50 copies per milliliter (31.0%–56.7%, P = 0.001), whereas the placebo group did not (<200 copies/mL: 64%–42.4%, P = 0.070; <50 copies/mL: 42.0%–30.3%, P = 0.292). XR-NTX participants were more likely to achieve VS than the placebo group at 6 months (<200 copies/mL: 64.2% vs. 42.4%; P = 0.041; <50 copies/mL: 56.7% vs. 30.3%; P = 0.015). XR-NTX independently predicted VS [<200 copies/mL: adjusted odds ratio (aOR) = 2.68, 95% confidence interval (CI) = 1.01 to 7.09, P = 0.047; <50 copies/mL: aOR = 4.54; 95% CI = 1.43 to 14.43, P = 0.009] as did receipt of ≥3 injections (<200 copies/mL: aOR = 3.26; 95% CI = 1.26 to 8.47, P = 0.010; <50 copies/mL: aOR = 6.34; 95% CI = 2.08 to 19.29, P = 0.001). Reductions in alcohol consumption (aOR = 1.43, 95% CI = 1.03 to 1.98, P = 0.033) and white race (aOR = 5.37, 95% CI = 1.08 to 27.72, P = 0.040) also predicted VS at <50 copies per milliliter.

Conclusions:

XR-NTX improves or maintains VS after release to the community for incarcerated people living with HIV and AUDs.
Willingness to Donate Organs Among People Living With HIV
Authors: Nguyen Anh Q. , Anjum Saad K. , Halpern Samantha E. , Kumar Komal , Van Pilsum Rasmussen Sarah E. , Doby Brianna , Shaffer Ashton A. , Massie Allan B. , Tobian Aaron A.R. , Segev Dorry L. , Sugarman Jeremy , Durand Christine M.
Published: May 2018

Background:

With passage of the HIV Organ Policy Equity (HOPE) Act, people living with HIV (PLWH) can donate organs to PLWH awaiting transplant. Understanding knowledge and attitudes regarding organ donation among PLWH in the United States is critical to implementing the HOPE Act.

Methods:

PLWH were surveyed regarding their knowledge, attitudes, and beliefs about organ donation and transplantation at an urban academic HIV clinic in Baltimore, MD, between August 2016 and October 2016. Responses were compared using Fisher exact and χ2 tests.

Results:

Among 114 survey respondents, median age was 55 years, 47.8% were female, and 91.2% were African American. Most were willing to be deceased donors (79.8%) or living donors (62.3%). Most (80.7%) were aware of the US organ shortage; however, only 24.6% knew about the HOPE Act, and only 21.1% were registered donors. Respondents who trusted the medical system or thought their organs would function adequately in recipients were more likely to be willing to be deceased donors (P < 0.001). Respondents who were concerned about surgery, worse health postdonation, or need for changes in HIV treatment because of donation were less likely to be willing to be living donors (P < 0.05 for all). Most believed that PLWH should be permitted to donate (90.4%) and that using HIV+ donor organs for transplant would reduce discrimination against PLWH (72.8%).

Conclusions:

Many of the PLWH surveyed expressed willingness to be organ donors. However, knowledge about the HOPE Act and donor registration was low, highlighting a need to increase outreach.
Comparison of Adults With Polyarticular Juvenile Idiopathic Arthritis to Adults With Rheumatoid Arthritis
Authors: Feger Danielle M. , Longson Nicholas , Dodanwala Hiranda , Ostrov Barbara E. , Olsen Nancy J. , June Rayford R.
Published: May 2018

Background/Objective

Many individuals with juvenile idiopathic arthritis (JIA) have persistent disease into adulthood. Polyarticular JIA (pJIA) is often mislabeled as rheumatoid arthritis (RA) in adult rheumatology clinics, and treatment for adult pJIA patients is not well defined. We aimed to describe clinical features and medication use in the adult pJIA population in relation to an RA control cohort.

Methods

We performed a cross-sectional study of 45 adults with pJIA and 94 with RA seen from 2013 to 2017. Clinical characteristics including RA classification criteria were compared using χ2and McNemar tests. Medication use was analyzed focusing on tumor necrosis factor inhibitor (TNFi) survival, and an accelerated failure-time model was developed for time to methotrexate initiation.

Results

Polyarticular JIA patients were less likely to be rheumatoid factor or cyclic citrullinated peptide antibody positive; fewer than half of pJIA subjects met the RA 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria. Time from diagnosis to methotrexate initiation was associated with longer disease duration in both groups (p< 0.01). Current TNFi use was more prevalent in pJIA patients (49% vs. 18%,p< 0.01), and TNFi use, particularly for etanercept, was sustained longer with a median drug survival of 4.41 years compared with 0.70 years in RA patients (p< 0.01).

Conclusions

Although often considered together in adult rheumatology practice, adults with pJIA are distinct from patients with RA. Medication use markedly differed between the 2 populations with greater prevalence and duration of TNFi use in pJIA patients. Further study is needed to improve outcomes in this unique population.
Quality and Safety in Health Care, Part XLIII
Authors: Harolds Jay A.
Published: May 2018

To compare outcome results from different institutions in a registry, it is necessary to have a way to take into account differences in the risk characteristics of the patients. This model has been constructed for the Implantable Cardioverter Defibrillator (ICD) Registry, and the most important variables have been identified. In another study, it has also been found that many of these patients have comorbidities, and the mortality rate 60 months after a replacement ICD was 41.2%. In a third study, it was determined that for individuals at least 65 years of age, 60 months after ICD placement, 50.9% of the recipients used hospice services or were dead.
Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity
Authors: Mattos David , Diamond Shawn , Chattha Anmol S. , Riesel Johanna N. , Iorio Matthew L.
Published: May 2018

Background

Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer.

Methods

All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors.

Results

Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m2 was a predictor for both flap complication (P = 0.025) and partial flap loss (P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis.

Conclusions

The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.
Complex Scalp and Calvarium Defects After Giant Basal Cell Carcinoma Excision: Management, Challanges, Outcomes
Authors: Ozcan Utku , Akyurek Mustafa , Arslan Emrah
Published: May 2018

Giant basal cell carcinoma (GBCC) is defined as a tumor ≥5 cm in diameter. GBCC of scalp usually requires extended resection of soft tissues, calvarium, and dura. In this study, we present 5 patients with GBCC of head, who underwent a single-stage combined scalp, calvarium, and dural reconstruction. Herein, we aim to discuss reconstruction methods, cerebrospinal fluid (CSF) leakage, duration of hospital stay, and tumor recurrency. Peroperative and postoperative follow-ups, defect areas, and performed calvarium reconstruction methods of 5 patients, who underwent complex scalp and calvarium reconstruction after GBCC between year 2010 and 2017, were retrospectively maintained. We studied reconstruction methods, CSF leakage, duration of hospital stay, and tumor recurrency. All patients undergone single-stage reconstruction. Avarge duration of hospital stay was 15 days. Titanium mesh was used in 3 patients and methyl methacrylate was used in 2 patients for calvarium reconstruction. CSF leakage was seen in patients who underwent calvarium reconstruction with titanium mesh. Tumor recurrence occured next to calvarium in 1 patient who undergone calvarium reconstruction with methyl methacrylate. CSF leakage and duration of hospital stay may induce morbidity of this oncoplastic procedure. The fact of longer hospital stay of patients reconstructed with titanium mesh might be a new data presented in this study. These parameters can be related with the method of calvarium reconstruction.