bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchoscopic Laser Interstitial Thermal Therapy
Authors: Casal Roberto F. , Walsh Garrett , McArthur Mark , Hill Lori R. , Landaeta Maria F. , Armas Villalba Aristides J. , Ong Philip , Debiane Labib , Vakil Erik , Grosu Horiana B. , Jimenez Carlos A. , Ost David , Adachi Roberto , Eapen George A.
Published: May 2018

Background:

Population aging and lung cancer screening strategies may lead to an increase in detection of early-stage lung cancer in medical inoperable patients. Recent advances in peripheral bronchoscopy have made it a suitable platform for ablation of small peripheral tumors.

Methods:

We investigated the tissue-ablative effect of a diode laser bronchoscopically applied by a laser delivery fiber (LDF) with wide aperture on porcine lung parenchyma. Laser was tested ex vivo and in vivo to identify the most effective power settings and LDF. Chest computed tomography (CT) were obtained immediately after ablation and after 3 days of observation. At day 3, necropsy was performed.

Results:

On the basis of our ex vivo and in vivo experiments, we selected the round-tip LDF to be activated at 25 W for 20 seconds. Ten ablations were performed in 5 pigs. One ablation resulted in a pneumothorax requiring aspiration. All animals remained stable for 72 hours. CT findings at days 1 and 3 showed an area of cavitation surrounded by consolidation and ground glass. Median size of CT findings (long axis) was 26 mm (range, 24 to 38) at day 1, and 34 mm (range, 30 to 44) at day 3. Necropsy showed an area of central char measuring from 0.8×0.7×0.9 cm to 2.4×3.5×1.2 cm, surrounded by a gray-brown to dark red area. On histology, variable degrees of necrosis were evident around the charred areas.

Conclusion:

Bronchoscopic laser interstitial thermal therapy can achieve relatively large areas of ablation of normal lung parenchyma with a low rate of periprocedural complications.
Nasogastric Tube Syndrome
Authors: Nayak Gyanaranjan , Virk Ramandeep S. , Singh Manvi , Singh Meenu
Published: May 2018

Background:

Nasogastric tubes have been used in the pediatric age group to supplement nutrition in cases of malignancy and failure to thrive due to a variety of causes. Breathing difficulty may occur after the insertion of a nasogastric tube and it can have multiple causes. Here we discuss 2 patients of acute lymphoblastic leukemia (ALL) who developed a rare condition called the Sofferman syndrome (nasogastric tube syndrome). We will also briefly outline a diagnostic algorithm to facilitate its fast and correct diagnosis.

Methods:

We present 2 cases of pediatric ALL who were undergoing chemotherapy in the pediatrics department. They presented with respiratory distress and stridor within a few days of nasogastric tube insertion.

Results:

Two cases of ALL developed stridor within 48 hours of nasogastric tube insertion. The stridor gradually progressed over days. Both the patients required tracheostomy to secure the airway. Removal of the nasogastric tube did not reverse the airway obstruction.

Conclusion:

Nasogastric tube syndrome is a potentially life-threatening condition and has to be considered as a possibility in immune-compromised patients who present with voice change and stridor after nasogastric tube insertion.
Photodynamic Therapy for Bronchial Microscopic Residual Disease After Resection in Lung Cancer
Authors: Mehta Hiren J. , Biswas Abhishek , Fernandez-Bussy Sebastian , Pipkin Mauricio , Machuca Tiago , Jantz Michael A.
Published: May 2018

Background:

The goal of lung cancer surgery is a complete tumor resection (R0 resection) with clear margins. 4% to 5% of resections have microscopic residual disease associated with worse prognosis. Definitive management is resection of residual tumor, which may not be tolerated by many patients, and definitive management is not well studied in these patients. We treated patients with stage I cancer and bronchial mucosal residual disease (MRD) with bronchoscopic photodynamic therapy (PDT).

Methods:

All patients who underwent definitive surgery for early-stage lung cancer were reviewed. Patients with R1 resection, stage I disease with MRD and or carcinoma in situ along the stump site were treated with bronchoscopic PDT. Patient characteristics, histology, type and site of surgery, pattern of recurrence, recurrence status, adverse events, and survival data were evaluated.

Results:

Eleven patients with bronchial mucosal R1 resection were treated with PDT along the stump site. The median age was 67. Three patients had carcinoma in situ and 8 had MRD. One patient (9%) had local recurrence 1 year after PDT treatment and was treated with radiation. Four patients (36%) had no evidence of recurrence to date after a median follow-up of 4 years and the other 6 patients had evidence of regional (16%) or distant (39%) recurrence. The local control rate was 91%. One patient developed pneumonia and other had photosensitivity reaction.

Conclusion:

Bronchoscopic PDT is safe and effective in selected group of patients with non–small cell lung cancer who have MRD along the stump site.
Comparison of Sample Adequacy and Diagnostic Yield of 19- and 22-G EBUS-TBNA Needles
Authors: Chaddha Udit , Ronaghi Reza , Elatre Waafa , Chang Ching-Fei , Mahdavi Ramyar
Published: May 2018

Background:

The 2016 CHEST consensus guidelines recommend use of either 21- or 22-G needles for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We decided to prospectively compare sample adequacy and diagnostic yield of the 19-G with the 22-G EBUS needle, hypothesizing that a larger gauge difference might magnify the differences between 2 needle sizes.

Methods:

Twenty-seven patients undergoing EBUS-TBNA at our institution were evaluated. All cases were performed by a single operator formally trained in interventional pulmonology. Both Olympus 19- and 22-G needles were used at each lymph node station in an alternating manner. Rapid on-site cytology evaluation was used and a separate cell block was prepared for each needle at each station.

Results:

Fifty-six lymph nodes were analyzed. Diagnoses included cancer (36%, including 1 lymphoma), reactive lymphoid tissue (53%), and sarcoidosis (11%). One hundred sixty-two and 163 passes were made with the 22- and 19-G needle, respectively. Sample adequacy was 73% and 46% with the 22 and 19-G needle, respectively (P<0.001). Significantly fewer passes were bloody with the 22-G compared with the 19-G needle (19% vs. 59%; P<0.001). Diagnostic yield was not different between the 22- and 19-G needles (95% vs. 93%; P=0.62).

Conclusion:

In addition to no difference in diagnostic yield, the 19-G needle yielded samples that were frequently less adequate and more often bloody compared with the 22-G needle. Despite the larger caliber lumen, we conclude that the 19-G needle does not confer a diagnostic advantage.
Utility of optical coherence tomography in the evaluation of sellar and parasellar mass lesions
Authors: Al-Louzi Omar , Prasad Sashank , Mallery Robert M.
Published: May 2018

Purpose of review

Anterior visual pathway compression is a common feature of sellar region masses. We review the visual pathway neuroanatomy pertaining to sellar and parasellar lesions and describe recent advances in optical coherence tomography (OCT) imaging that have provided a novel quantitative perspective in the evaluation and management of such patients.

Recent findings

Ultrastructural measurements of optic nerve integrity using OCT, namely peripapillary retinal nerve fiber layer (pRNFL) and the ganglion cell and inner plexiform layer (GCIPL) thicknesses, have been shown to correlate with visual acuity and visual field deficits on perimetry in patients with compressive sellar region masses. In some cases, OCT can visualize early signs of anterior visual pathway involvement in the absence of clinically evident visual field loss or optic disc pallor. OCT is particularly useful when assessing patients who demonstrate less reliable visual field testing. Furthermore, there is growing awareness that pRNFL and GCIPL thinning preoperatively correlate with worse visual recovery following chiasmal decompression, highlighting the prognostic utility of OCT in this patient population.

OCT provides a complimentary, yet critical, role in quantitatively assessing ultrastructural retinal injury in patients with sellar and parasellar lesions compressing the anterior visual pathway and should be incorporated into routine evaluation.
Short article: Recommendations on rectal surveillance for colorectal cancer after subtotal colectomy in patients with inflammatory bowel disease
Authors: Derikx Lauranne A.A.P. , de Jong Michiel E. , Hoentjen Frank
Published: May 2018

Approximately 30% of patients with ulcerative colitis require a colectomy during their disease course. This substantially reduces colorectal cancer risk, although it is still possible to develop colorectal neoplasia in the remaining rectum. Although clear and well-accepted surveillance guidelines exist for patients with inflammatory bowel disease with an intact colon, specific surveillance recommendations following colectomy are less clear. Here, we aim to summarize the prevalence, incidence, and risk factors for developing colorectal cancer in patients with inflammatory bowel disease who underwent subtotal colectomy with a permanent end ileostomy and rectal stump, or with ileorectal anastomosis. Subsequently, gained insights are integrated into a proposed endoscopic surveillance strategy of the residual rectum.
Screening for Sexually Transmitted Infections After Cervical Cancer Screening Guideline and Medicaid Policy Changes
Authors: Parekh Natasha , Donohue Julie M. , Corbelli Jennifer , Men Aiju , Kelley David , Jarlenski Marian
Published: May 2018

Background:

Sexually transmitted infection (STI) screening prevents complications and is cost-effective. Annual screening is recommended in sexually active women below 25 years and older women at increased risk. Cervical cancer (CC) screening guideline changes in 2009 and 2012 recommended less frequent screening, causing concern that STI screening would decrease. Pennsylvania Medicaid implemented a family planning program in 2007 which covered women’s health services (including STI testing) for uninsured women. It is unclear how STI screening was affected by these countervailing forces.

Objective:

The main objective of this study was to assess STI screening before and after CC screening guideline changes and family planning program implementation, and to determine factors associated with STI screening.

Research Design:

This study was an observational cross-sectional study of Pennsylvania Medicaid administrative claims from 2007 to 2013.

Subjects:

Sixteen-year-old to 30-year-old women enrolled in Pennsylvania Medicaid.

Measures:

Annual STI screening, defined as receipt of ≥1 STI test in respective 1-year periods.

Results:

Our population included 1,226,079 women-years for 467,143 women. STI screening increased by 48% between 2007 and 2011, and stabilized by 2013. Odds for STI screening were higher among black compared with white women [adjusted odds ratio (AOR), 2.56; 95% confidence interval (CI), 2.60–3.10]; Hispanic compared with non-Hispanic women (AOR, 1.42; 95% CI, 1.39–1.46); family planning program enrollees (AOR, 1.42; 95% CI, 1.40–1.45); and urban compared with rural residents (AOR, 1.05; 95% CI, 1.03–1.06).

Conclusions:

STI screening dramatically increased between 2007 and 2011. Potential reasons are family planning program implementation, increased urine/vaginal testing, and reporting improvements. It is reassuring that STI screening did not decrease despite CC screening guideline changes. Between 2011 and 2013, rates stabilized at 45% among all women and 60% among sexually active women below 25 years, suggesting opportunities for improvement.
Going Beyond Clinical Care to Reduce Health Care Spending
Authors: Murphy Shannon M.E. , Hough Douglas E. , Sylvia Martha L. , Sherry Melissa , Dunbar Linda J. , Zollinger Raymond , Richardson Regina , Berkowitz Scott A. , Frick Kevin D.
Published: May 2018

Background:

Addressing both clinical and nonclinical determinants of health is essential for improving population health outcomes. In 2012, the Johns Hopkins Community Health Partnership (J-CHiP) implemented innovative population health management programs across acute and community environments. The community-based program involved multidisciplinary teams [ie, physicians, care managers (CM), health behavior specialists (HBS), community health workers, neighborhood navigators] and collaboration with community-based organizations to address social determinants.

Objectives:

To report the impact of a community-based program on cost and utilization from 2011 to 2016.

Design:

Difference-in-difference estimates were calculated for an inclusive cohort of J-CHiP participants and matched nonparticipants. The analysis was replicated for participants with a CM and/or HBS to estimate the differential impact with more intensive program services.

Subjects:

A total of 3268 high-risk Medicaid and Medicare beneficiaries (1634 total J-CHiP participants, 1365 with CM and 678 with HBS).

Outcome Measures:

Paid costs and counts of emergency department visits, admissions, and readmissions per member per year.

Results:

For Medicaid, costs were almost $1200 per member per year lower for participants as a whole, $2000 lower for those with an HBS, and $3000 lower for those with a CM; hospital admission and readmission rates were 9%–26% lower for those with a CM and/or HBS. For Medicare, costs were lower (−$476), but utilization was similar or higher than nonparticipants. None of the observed Medicaid or Medicare differences were statistically significant.

Conclusions:

Although not statistically significant, the results indicate a promising innovation for Medicaid beneficiaries. For Medicare, the impact was negligible, indicating the need for further program modification.
High-Density Infiltration of V-domain Immunoglobulin Suppressor of T-cell Activation Up-regulated Immune Cells in Human Pancreatic Cancer
Authors: Liu Jin'e , Xie Xiaoxue , Xuan Chunxiao , Li Tingting , Wang Lanlan , Teng Lianghong , Liu Jun
Published: May 2018

Objectives

V-domain immunoglobulin suppressor of T-cell activation (VISTA) is constitutively expressed in hematopoietic lineage and is highly up-regulated in tumor infiltrated myeloid cells and regulatory T-cells in animal models. However, its expression in human pancreatic tumor microenvironment remains unknown. In this research, we aimed at the expression of VISTA in human pancreatic cancer samples.

Methods

We performed immunohistochemistry to determine VISTA expression in human pancreatic cancer samples.

Results

We found that 88.46% of the patients showed high-density infiltration of polymorphonuclear neutrophils and mononuclear immune cells with up-regulated expression of VISTA in cancer tissues, especially in the necrotic foci. Interestingly, it was minimally expressed in pancreatic cancerous cells and was not detectable in either normal ducts or islet cells in cancerous or normal pancreatic tissues.

Conclusions

We conclude that VISTA is predominantly expressed and up-regulated in the high-density infiltrated immune cells but minimal in human pancreatic cancerous cells. Our results for the first time highlight pancreatic immunosuppressive tumor microenvironment contributed by VISTA and its potential as a prominent target for pancreatic cancer immunotherapy.
Biliary Stenosis and Gastric Outlet Obstruction
Authors: Sugimoto Motokazu , Sonntag David P. , Flint Greggory S. , Boyce Cody J. , Kirkham John C. , Harris Tyler J. , Carr Sean M. , Nelson Brent D. , Bell Don A. , Barton Joshua G. , Traverso L. William
Published: May 2018

Objectives

Pancreatic duct disruption (PDD) after acute pancreatitis can cause pancreatic collections in the early phase and biliary stenosis (BS) or gastric outlet obstruction (GOO) in the late phase. We aimed to document those late complications after moderate or severe acute pancreatitis.

Methods

Between September 2010 and August 2014, 141 patients showed pancreatic collections on computed tomography. Percutaneous drainage was primarily performed for patients with signs or symptoms of uncontrolled pancreatic juice leakage. Pancreatic duct disruption was defined as persistent amylase-rich drain fluid or a pancreatic duct cut-off on imaging. Clinical course of the patients who developed BS or GOO was investigated.

Results

Among the 141 patients with collections, 33 patients showed PDD in the pancreatic head/neck area. Among them, 9 patients (27%) developed BS 65 days after onset and required stenting for 150 days, and 5 patients (15%) developed GOO 92 days after onset and required gastric decompression and jejunal tube feeding for 147 days (days shown in median). All 33 patients recovered successfully without requiring surgical intervention.

Conclusions

Anatomic proximity of the bile duct or duodenum to the site of PDD and severe inflammation seemed to contribute to the late onset of BS or GOO. Conservative management successfully reversed these complications.
Prevalence of Extrapancreatic Malignancies Among Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Panic Nikola , Macchini Federico , Solito Sonia , Boccia Stefania , Leoncini Emanuele , Larghi Alberto , Berretti Debora , Pevere Sara , Vadala Salvatore , Marino Marco , Zilli Maurizio , Bulajic Milutin
Published: May 2018

Objectives

We conducted a study in order to assess the prevalence of extrapancreatic malignancies (EPMs) in a cohort of patients with intraductal papillary mucinous neoplasms (IPMNs) from northeastern Italy.

Methods

A study was conducted in hospital Santa Maria della Misericordia, Udine, Italy. Hospital records were screened in order to identify newly diagnosed IPMN cases in the period from January 1, 2009, to December 31, 2015. We searched for EPMs diagnosed previous to, synchronous to, or after the IPMN. The ratio of the observed (O) number of patients with EPMs to the expected (E) was calculated.

Results

We identified 72 EPMs in 63 (31.8%) of 198 patients included. Among them, 51 (70.8%) were diagnosed previous to, 17 (23.6%) synchronous to, and 4 (5.6%) after the IPMN. Most frequently diagnosed were colorectal (12 patients [6.1%]), breast (8 patients [6.8%, in females]), renal cell (8 patients [4.0%]), and prostate cancer (7 patients [8.6%, in males]). The O/E ratios for EPMs were significantly increased for cancer in general (3.66; 95% confidence interval [CI], 2.39–5.37), renal cell (9.62; 95% CI, 1.98–28.10), prostate (4.91; 95% CI, 1.59–11.45), and breast cancer (3.16; 95% CI, 1.03–7.37).

Conclusions

We report an increased risk of EPMs in patients with IPMN, especially for renal cell, prostate, colorectal, and breast cancer.
Axis II Personality Disorders Are Linked to an Adverse Course of Bipolar Disorder
Authors: Post Robert M. , McElroy Susan , Kupka Ralph , Suppes Trisha , Hellemann Gerhard , Nolen Willem , Frye Mark , Keck Paul , Grunze Heinz , Rowe Michael
Published: May 2018

The relationship of personality disorder (PD) psychopathology to the course of bipolar disorder remains inadequately described. After giving informed consent, more than 782 outpatients with bipolar disorder rated themselves on the 99-item Personality Disorder Questionnaire, Version 4 (PDQ4) when depressed or euthymic. They also rated six poor prognosis factors (PPFs). The relationships of the PPFs to the total PDQ4 score were examined by a linear regression. Even after correcting for the higher PDQ4 scores observed when patients were suffering depression, the PDQ4 was significantly related to a history of child abuse, early age of onset, an anxiety disorder comorbidity, rapid cycling, and 20 or more previous episodes, but not substance abuse. The data suggest close relationships between the total burden of PD psychopathology and correlates of an adverse outcome of bipolar disorder. The nature of this of association and approaches to treatment of comorbid PD remain to be further explored.
Complexities of the Diagnostic Process
Authors: Schildkrout Barbara
Published: May 2018

The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates. This article uses clinical examples to illustrate and discuss the numerous areas of competence that are involved in coming to a diagnosis. The dual-process cognition model for understanding diagnostic decision making is introduced; the role of creativity is emphasized. Psychiatrists have important contributions to make in understanding the diagnostic process, given the field's long history of valuing self-reflection and conceptualizing clinician-patient dynamics.
Combining Postmortem Vitreous Sodium and Chloride and Lung-Body Ratio in Aiding the Diagnosing Saltwater Drowning
Authors: Tse Rexson , Garland Jack , Kesha Kilak , Morrow Paul , Lam Leo , Elstub Hannah , Cala Allan , Spark Amy , Palmiere Cristian , Stables Simon
Published: May 2018

Diagnosing death due to drowning can be difficult, and several postmortem findings have been postulated to aid the diagnosis. Increased lung weights are often seen in drowning deaths. Lung-body (LB) ratio was described to be the best anatomical lung measurement in diagnosing drowning. Postmortem vitreous humor sodium and chloride (PMVSC) was reported to be a useful biochemical test in diagnosing saltwater drowning when the immersion time is less than 1 hour (SWD1). The presented study compared the diagnostic accuracies between LB ratio, PMVSC, and their combination in diagnosing SWD1 in 20 SWD1 and 50 nonimmersion deaths. Classification tree models were used for analysis and revealed that combination of PMVSC and LB ratio was most accurate in diagnosing SWD1 (misclassification rate, 4%), followed by PMVSC (misclassification rate, 10%) and LB ratio (misclassification rate, 24%). A quantifiable diagnostic improvement was established when both LB ratio and PMVSC were used. After adjusting for interlaboratory variations, the developed tree models can be a reliable way in aiding the diagnosis of SWD1.
Vagal Mediation of Low-Frequency Heart Rate Variability During Slow Yogic Breathing
Authors: Kromenacker Bryan W. , Sanova Anna A. , Marcus Frank I. , Allen John J.B. , Lane Richard D.
Published: May 2018

Objective

Changes in heart rate variability (HRV) associated with breathing (respiratory sinus arrhythmia) are known to be parasympathetically (vagally) mediated when the breathing rate is within the typical frequency range (9–24 breaths per minute [bpm]; high-frequency HRV). Slow yogic breathing occurs at rates below this range and increases low-frequency HRV power, which may additionally reflect a significant sympathetic component. Yogic breathing techniques are hypothesized to confer health benefits by increasing cardiac vagal control, but increases in low-frequency HRV power cannot unambiguously distinguish sympathetic from parasympathetic contributions. The aim of this study was to investigate the autonomic origins of changes in low-frequency HRV power due to slow-paced breathing.

Methods

Six healthy young adults completed slow-paced breathing with a cadence derived from yogic breathing patterns. The paced breathing took place under conditions of sympathetic blockade, parasympathetic (vagal) blockade, and placebo. HRV spectral power was compared under 11 breathing rates during each session, in counterbalanced order with frequencies spanning the low-frequency range (4–9 bpm).

Results

HRV power across the low-frequency range (4–9 bpm) was nearly eliminated (p = .016) by parasympathetic blockade (mean (SD) spectral power at breathing frequency = 4.1 (2.1)) compared with placebo (69.5 (8.1)). In contrast, spectral power during sympathetic blockade 70.2 (9.1) and placebo (69.5 (8.1)) was statistically indistinguishable (p = .671).

Conclusions

These findings clarify the interpretation of changes in HRV that occur during slow-paced breathing by showing that changes in low-frequency power under these conditions are almost entirely vagally mediated. Slow-paced breathing is an effective tool for cardiac vagal activation.
Tackling Ambulatory Safety Risks Through Patient Engagement: What 10,000 Patients and Families Say About Safety-Related Knowledge, Behaviors, and Attitudes After Reading Visit Notes
Authors: Bell Sigall K. , Folcarelli Patricia , Fossa Alan , Gerard Macda , Harper Marvin , Leveille Suzanne , Moore Caroline , Sands Kenneth E. , Sarnoff Lee Barbara , Walker Jan , Bourgeois Fabienne
Published: May 2018

Background

Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes (“OpenNotes”) may help close the safety gap between visits.

Methods

We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes.

Results

A total of 6913 (28%) of 24,722 patients at an adult hospital and 3672 (17%) of 21,579 participants at the children’s hospital submitted surveys. Approximately 75% of patients and parents each reported that reading notes helped them understand the reason for both tests and referrals, and approximately 50% felt that it helped them complete tests and referrals. Roughly 75% of participants were more likely to check and understand test results. Overall, 97% of participants reported that trust in the provider, activation, patient-provider goal alignment, and teamwork were each better or the same after reading 1 note or more. Nonwhite participants and those with high school education or less were 30% to 50% more likely to report that reading notes helped them complete tests compared with white and more educated respondents, respectively.

Conclusions

Overall, the majority of more than 10,000 patients and parents reported reading notes helped them understand and follow through on tests and referrals. As information transparency spreads, OpenNotes can help activate patients and families, facilitate safety behaviors, and forge stronger partnerships with clinicians.
Differential Patterns of Risk and Vulnerability Suggest the Need for Novel Prevention Strategies for Black Bisexual Men in the HPTN 061 Study
Authors: Dyer Typhanye V. , Khan Maria R. , Regan Rotrease , Harawa Nina T. , Nelson LaRon E. , Wilton Leo , Wang Lei , Peng Lili , Ou San San , Shoptaw Steve
Published: May 2018

Background:

Black men who have sex with men (BMSM) and some who also have sex with women (BMSMW) account for over 70% of new HIV infections in the United States representing an elevated HIV risk in this group, also informing risks of HIV transmission to other BMSM and female sexual partners.

Settings:

We examined trajectories of self-reported substance use, HIV-related sexual risk behaviors, and psychosocial vulnerabilities among BMSMW versus BMSM over a 1-year study period.

Methods:

We analyzed baseline, 6-, and 12-month follow-up data from the HIV Prevention Trials Network “BROTHERS” Study (HPTN 061; n = 1126). Categorizing participants by sexual partner type across 3 time points: (1) BMSMO: having male and no female partners across assessments and (2) BMSMW: having sex with male and one or more female partners at least at 1 time point. Using generalized estimating equations, we estimated associations between being BMSMW (versus BMSMO) and changes in psychosocial vulnerability, substance use, and HIV-related sexual risk behaviors.

Results:

Generalized estimating equation models controlling for sociodemographics, time-varying effects, and intervention status showed that BMSMW versus BMSMO had 50% increased odds of crack use, 71% increased odds of alcohol use during condomless anal intercourse (CAI), 51% greater odds of using drugs at last CAI, and twice the odds of receiving goods at last CAI.

Conclusions:

Findings show stable and comparatively elevated illicit drugs, alcohol, and exchange sex during last CAI among BMSMW. Future intervention research should focus on ways to address changes in substance-related HIV-transmission behaviors over time in this population of men.
Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada
Authors: Yanik Elizabeth L. , Hernández-Ramírez Raúl U. , Qin Li , Lin Haiqun , Leyden Wendy , Neugebauer Romain S. , Horberg Michael A. , Moore Richard D. , Mathews W. Christopher , Justice Amy C. , Hessol Nancy A. , Mayor Angel M. , Gill M. John , Brooks John T. , Sun Jing , Althoff Keri N. , Engels Eric A. , Silverberg Michael J. , Dubrow Robert
Published: May 2018

Background:

Cutaneous melanoma incidence may be modestly elevated in people with HIV (PWH) vs. people without HIV. However, little is known about the relationship of immunosuppression, HIV replication, and antiretroviral therapy (ART) with melanoma risk.

Methods:

PWH of white race in the North American AIDS Cohort Collaboration on Research and Design were included. A standardized incidence ratio was calculated comparing risk with the white general population, standardizing by age, sex, and calendar period. Associations between melanoma incidence and current, lagged, and cumulative measures of CD4 count, HIV RNA level, and ART use were estimated with Cox regression, adjusting for established risk factors such as age and annual residential ultraviolet B (UVB) exposure.

Results:

Eighty melanomas were diagnosed among 33,934 white PWH (incidence = 40.75 per 100,000 person-years). Incidence was not elevated compared with the general population [standardized incidence ratio = 1.15, 95% confidence interval (95% CI) = 0.91 to 1.43]. Higher melanoma incidence was associated with older age [adjusted hazard ratio (aHR) per decade increase = 1.50, 95% CI = 1.20 to 1.89] and higher UVB exposure (aHR for exposure ≥35 vs. <35 mW/m2 = 1.62, 95% CI = 0.99 to 2.65). Current, lagged, and cumulative CD4 and HIV RNA were not associated with melanoma incidence. Melanoma incidence was higher among people ART-treated for a larger proportion of time in the previous 720 days (aHR per 10% increase = 1.16, 95% CI = 1.03 to 1.30).

Conclusions:

These results suggest that HIV-induced immune dysfunction does not influence melanoma development. The association between ART and melanoma risk may be due to increased skin surveillance among PWH engaged in clinical care. Associations with age and UVB confirmed those established in the general population.
Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D:A:D Cohort Analysis
Authors: Achhra Amit C. , Sabin Caroline , Ryom Lene , Hatleberg Camilla , Antonella d'Aminio Monforte , de Wit Stephane , Phillips Andrew , Pradier Christian , Weber Rainer , Reiss Peter , El-Sadr Wafaa , Bonnet Fabrice , Mocroft Amanda , Lundgren Jens , Law Matthew G. ,   for the D:A:D Study Group
Published: May 2018

Background:

The relationship between body mass index (BMI) [weight (kg)/height (m2)] and serious non-AIDS events is not well understood.

Methods:

We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non–AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m2.

Results:

Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2–25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23–25, respectively, was as follows: CVD: 1.46 (1.15–1.84) and 1.31 (1.03–1.67); NADCs: 1.78 (1.39–2.28) and 1.17 (0.88–1.54); and “BMI-NADCs”: 1.29 (0.66–2.55) and 1.92 (1.10–3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12–2.89) and 1.21 (0.97–1.50); and in females: 1.60 (1.30–1.98) and 1.02 (0.74–1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001).

Conclusions:

Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23–25 and 25–30. High BMI was also associated with risk of diabetes.
Improved Cognitive Performance and Reduced Monocyte Activation in Virally Suppressed Chronic HIV After Dual CCR2 and CCR5 Antagonism
Authors: D'Antoni Michelle L. , Paul Robert H. , Mitchell Brooks I. , Kohorn Lindsay , Fischer Laurent , Lefebvre Eric , Seyedkazemi Star , Nakamoto Beau K. , Walker Maegen , Kallianpur Kalpana J. , Ogata-Arakaki Debra , Ndhlovu Lishomwa C. , Shikuma Cecilia
Published: May 2018

Objective:

To evaluate changes in neuropsychological (NP) performance and in plasma and cell surface markers of peripheral monocyte activation/migration after treatment with cenicriviroc (CVC), a dual C-C chemokine receptor type 2 (CCR2) and type 5 (CCR5) antagonist, in treatment-experienced, HIV-infected individuals.

Setting:

Single-arm, 24-week, open-label clinical trial.

Methods:

HIV-infected individuals on antiretroviral therapy ≥1 year with plasma HIV RNA ≤50 copies per milliliter and below-normal cognitive performance [defined as age-, sex-, and education-adjusted NP performance (NPZ) <−0.5 in a single cognitive domain or in global performance] were enrolled. Changes over 24 weeks were assessed for global and domain-specific NPZ scores, plasma markers of monocyte/macrophage activation [neopterin, soluble (s)CD14, and sCD163] quantified by ELISA, and CCR2 and CCR5 expression on monocytes, and T cells measured by flow cytometry.

Results:

Seventeen of 20 enrolled participants completed the study. Improvements over 24 weeks were observed in global NPZ [median change (Δ) = 0.24; P = 0.008], and in cognitive domains of attention (Δ0.23; P = 0.011) and working memory (Δ0.44; P = 0.017). Plasma levels of sCD163, sCD14 and neopterin decreased significantly (P's < 0.01). CCR2 and CCR5 monocyte expression remained unchanged; however, CCR5 levels on CD4+ and CD8+ T cells and CCR2 expression on CD4+ T cells increased (P's < 0.01).

Conclusions:

CVC given over 24 weeks was associated with improved NP test performance and decreased plasma markers of monocyte immune activation in virally suppressed, HIV-infected participants. These data potentially link changes in monocyte activation to cognitive performance. Further study of CVC for HIV cognitive impairment in a randomized controlled study is warranted.
Human Papillomavirus Genotypes in Invasive Cervical Carcinoma in HIV-Seropositive and HIV-Seronegative Women in Zimbabwe
Authors: Mudini Washington , Palefsky Joel M. , Hale Martin J. , Chirenje Michael Z. , Makunike-Mutasa Rudo , Mutisi Fiona , Murahwa Alltalents , Mario Altini
Published: May 2018

Background:

Invasive cervical carcinoma (ICC) accounts for 23% of all cancer-related deaths in Zimbabwean women. Trials for a national program of genotype-specific human papillomavirus (HPV) vaccines are underway to prevent cervical carcinoma, but the distribution of HPV types among women with ICC according to HIV status is unknown.

Methods:

To determine prevalence and distribution of high-risk HPV genotypes by HIV status in women with ICC, we performed a cross-sectional study on women referred for ICC testing at 4 urban referral hospitals in Zimbabwe from June 2014 to December 2015. Cervical biopsies were obtained for histology and HPV genotyping. HIV serology testing was performed. HPV testing was performed using MY09/MY11 polymerase chain reaction followed by typing using dot-blot hybridization.

Results:

Of 107 participants with histologically proven ICC, HIV prevalence was 49.5% (53/107). HIV-positive women tended to be younger (median age 44 years) than HIV-negative women (median age 59 years). HPV prevalence was 94% (101/107), ranging from 1 to 5 genotypes per participant. HPV 16 (81.5%), 18 (24%), 33 (13%), 35 (11%), 56 (9%), and 45 (7.4%) were the most prevalent genotypes among HIV-negative participants; HPV 16 (67.9%), 18 (43.4%), 56 (18.9%), 45 (15.1%), 33 (11.3%), and 58 (9.4%) were the most prevalent among HIV-positive participants. Eighty-three percent of women were infected with either HPV-16 or HPV-18.

Conclusions:

Effective vaccination programs against HPV 16 and HPV 18 could prevent up to 83% of cases of cervical cancer in Zimbabwe. HIV may influence distribution of some HPV genotypes given the significant increase in prevalence of HPV 18 among HIV-positive participants.
Influenza vaccine strategies for solid organ transplant recipients
Authors: Hirzel Cédric , Kumar Deepali
Published: May 2018

Purpose of review

The aim of this study was to highlight recent evidence on important aspects of influenza vaccination in solid organ transplant recipients.

Recent findings

Influenza vaccine is the most evaluated vaccine in transplant recipients. The immunogenicity of the vaccine is suboptimal after transplantation. Newer formulations such as inactivated unadjuvanted high-dose influenza vaccine and the administration of a booster dose within the same season have shown to increase response rates. Intradermal vaccination and adjuvanted vaccines did not show clear benefit over standard influenza vaccines. Recent studies in transplant recipients do not suggest a higher risk for allograft rejection, neither after vaccination with a standard influenza vaccine nor after the administration of nonstandard formulation (high-dose, adjuvanted vaccines), routes (intradermally) or a booster dose. Nevertheless, influenza vaccine coverage in transplant recipients is still unsatisfactory low, potentially due to misinterpretation of risks and benefits.

Annual influenza vaccination is well tolerated and is an important part of long-term care of solid organ transplant recipients.
Repairing a Facial Cleft by Polyether–Ether–Ketone Implant Combined With Titanium Mesh
Authors: Deng Yuan , Tang Weiwei , Li Zhengkang
Published: May 2018

The Tessier Number 4 cleft is one of the rarest, most complex craniofacial anomalies that presents difficulties in surgical treatment. In this article, we report a case of simultaneous facial depression, eye displacement, and medial canthus deformity. In this case, the maxillary bony defect was reconstructed using computer-assisted design computer-assisted manufacturing (CAD-CAM) polyether–ether–ketone (PEEK) material, and the orbital floor defect was repaired with AO prefabricated titanium mesh. Additionally, the medial canthus was modified with canthopexy and a single Z-plasty flap. Owing to its relative rarity and varied clinical presentations, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. This study presents the combination of CAD-CAM manufactured PEEK material and titanium mesh as an alternative approach for reconstructing the bony defect of Tessier No. 4 facial clefts.
Proptosis Correction in Pre-Adolescent Patients With Syndromic Craniosynostosis by Le Fort III Distraction Osteogenesis
Authors: Gibson Travis L. , Grayson Barry H. , McCarthy Joseph G. , Shetye Pradip R.
Published: May 2018

Le Fort III distraction osteogenesis may be indicated in the treatment of syndromic craniosynostosis with severe midface retrusion and proptosis. This study assesses the stability of proptosis correction over 10-years.

A retrospective review identified 15 patients with syndromic craniosynostosis treated by Le Fort III distraction prior to age 10 (9 males, 6 females; age 4.9 ± 1.5 years). Untreated, non-craniosynostotic age- and gender-matched controls were obtained from historical growth records. Lateral cephalometric tracings at pre-surgery (T1), immediate (T2), 1 year (T3), 5 years (T4), and 10 years (T5) (n = 11) post-distraction were superimposed using the best-fit of cranial base. Proptosis severity was defined as the horizontal distance between the Ant. Globe cephalometric point and orbital rim landmarks Orbitale and Lat. Orbit.

The orbital rim advanced 10.54 ± 3.78 mm (P < 0.001) at Orbitale and 9.73 ± 4.54 mm (P > 0.001) at Lat. Orbit from T1 to T2; Ant. Globe advanced 3.13 ± 3.02 mm (p 0.001). Proptosis decreased 7.41 ± 5.29 mm (P < .001) from Orbitale and 6.60 ± 6.50 mm (p 0.002) from Lat. Orbit. Comparison to controls demonstrated phenotypic correction. In craniosynostotic patients from T2 to T5, the bony orbital rim demonstrated non-significant remodeling posteriorly and inferiorly. Anterior Globe moved 3.79 ± 1.47 mm anteriorly (P < .001), which did not differ significantly from controls. Proptosis increased by 4.18 ± 2.94 mm in craniosynostotic patients from T2 to T5.

Le Fort III distraction was stable, with no significant anteroposterior relapse of the maxilla or bony orbit. Phenotypic relapse of proptosis to pre-treatment levels occurred through deficient growth of the midface, surface resorption at the orbital rim, and preservation of normal forward movement of Ant. Globe.
Educational Exposure to Transgender Patient Care in Otolaryngology Training
Authors: Massenburg Benjamin B. , Morrison Shane D. , Rashidi Vania , Miller Craig , Grant David W. , Crowe Christopher S. , Velasquez Nathalia , Shinn Justin R. , Kuperstock Jacob E. , Galaiya Deepa J. , Chaiet Scott R. , Bhrany Amit D.
Published: May 2018

Objective:

Gender dysphoria is estimated to occur in over 1 million people in the United States. With decreasing stigma regarding the transgender population, it is likely more patients will seek medical and surgical gender transition as parts of their treatment. However, otolaryngologists may lack training in gender-confirming surgery. This study aims to determine the current state of transgender-related education in the United States otolaryngology training programs and to evaluate trainee perceptions regarding the importance of such training.

Methods:

A cross-sectional survey was performed among the United States otolaryngology training programs. A representative sample of 22 training programs divided within 4 US Census regions completed a cross-sectional 9-question survey between March and May 2017. Respondents were queried regarding demographics, transgender curricular exposure (didactic and/or clinical), and perceived importance of training in transgender patient care.

Results:

A total of 285 trainees responded (69.3% response rate). Thirty percent of respondents reported education on or direct exposure to transgender care during residency. Among those with experiences in gender-confirming surgery, more than half were exposed to facial (masculinization or feminization) or pitch alteration surgery. Overall, the majority of respondents believed training in gender-confirming surgery is somewhat important and 63.2% supported incorporation of transgender patient care in existing subspecialty fellowship training.

Conclusion:

Less than one-third of otolaryngology trainees are exposed to transgender patient care. The majority of trainees endorsed the importance of residency and subspecialty fellowship training in gender-confirming surgery. To better serve the transgender population, formal didactics on gender-confirming surgery should be offered.
The Arterialized Facial Artery Musculo-Mucosal Island Flap for Post-Oncological Tongue Reconstruction
Authors: Moro Alessandro , Saponaro Gianmarco , Doneddu Piero , Cervelli Daniele , Pelo Sandro , Gasparini Giulio , Garagiola Umberto , D’Amato Giuseppe , Todaro Mattia
Published: May 2018

Background:

In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection.

Method:

From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection.

Results:

Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications.

Conclusion:

The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.

The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.
Family Functions and Life Quality of Parents of Children With Cleft Lip and Palate
Authors: Aslan Belma I. , Gülşen Ayşe , Tirank Şadiye B. , Findikçioğlu Kemal , Uzuner F. Deniz , Tutar Hakan , Üçüncü Neslihan
Published: May 2018

Objective:

This study was designed to identify variables affecting family functions and life quality of parents with cleft lip and/or palate children.

Materials and Methods:

Family Assesment Scale (FAS) and short form of World Health Organization quality of life (WHOQOL-BREF-TR) were used to measure family functions and life quality of parents. Questionnaire Forms were given to 146 parents: 74 having cleft lip and/or palate children (cleft-group), and the other 72 with healthy children (control-group). Parents were divided into 3 subgroups according to children's age as 0 to 6, 7 to 12, and 13 to 18 years. Kruskal-Wallis and Mann–Whitney U tests were used to evaluate differences between the groups.

Results:

Behavior of cleft patients’ parents was found to be problematic in behavioral control, required attention and role areas at 0 to 6 years, required attention area at ages 7 to 12 and 13 to 18 years. When compared to control group, significant differences were detected in required attention at ages 0 to 6 years, problem-solving, and communication areas at 7 to 12 years. Findings of life quality were found to be over medium level in physical, social, psychological and environmental areas in cleft group at all age groups; however, life quality was found better in control group in physical, psychological, and social subtests at age 13 to 18 years.

Conclusion:

Cleft children influence family functions in behavioral control, required attention and role areas at early childhood, and continue to affect required attention through adolescence. Also social, physical, and psychological fields of life quality were found lower in cleft parents compared to control group at adolescence.