bluuebunny/crossref_metadata_2025_split huggingface dataset:
UVEITIS TREATED WITH DEXAMETHASONE IMPLANT
Authors: Mathis Thibaud , Cerquaglia Alessio , Weber Michel , Guillarme-Sallit Rébecca , Malclès Ariane , Voirin Nicolas , Servant Marion , Sudhalkar Aditya , Bilgic Alper , Denis Philippe , Sève Pascal , Bodaghi Bahram , Kodjikian Laurent 
Published: June 2020

Purpose:
To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis.

Methods:
This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score.

Results:
Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection.

Conclusion:
This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
Pharmacological therapies to address obesity in type 1 diabetes
Authors: Casu Anna , Bilal Anika , Pratley Richard E. 
Published: June 2020

Purpose of review
Obesity is increasing in prevalence among patients with type 1 diabetes (T1D) and is associated with insulin resistance and increased cardiovascular risk. The management of obesity in this population is complicated by defects in pancreatic islet hormone secretion and the effects of exogenous insulin treatment. Here, we review the effects of antiobesity medications and adjunct-to-insulin medications on body weight in T1D.

Recent findings
There is a profound evidence gap around the use of drugs for the treatment of obesity in T1D since systematic studies have not been performed in this population. Adjunctive-to-insulin therapy with certain antihyperglycemic agents leads to modest weight loss and reductions in insulin dose in T1D. However, only pramlintide has been approved in the United States for clinical use as adjunctive therapy in T1D.

Summary
The growing prevalence of obesity in T1D has created an unmet need for safe and effective therapies to treat overweight and obesity in this population. Currently, antiobesity medications are used off-label for the treatment of patients with T1D. Additional studies are needed to understand the role of these medications in the management of obesity in patients with T1D.
Traumatic Axonal Injury
Authors: Szecsi Andras , Danics Krisztina , Kondracs Agoston , Szollosi Zoltan 
Published: June 2020

Abstract
A 17-year-old prisoner was found unconscious during a morning check. The previous night, he had been struck on the chin multiple times by one of the other inmates. The patient remained unconscious and eventually died after nearly 1.5 months of care. The primary task of the forensic pathological examination was to investigate the events leading to his death; therefore, it was necessary to examine whether there was a connection between the abuse and eventual death. In our case, the key element was the repetitive, mild-to-moderate force in abuse, resulting in grade I traumatic diffuse axonal damage. Due to progressive brain edema, aspiration subsequently developed, which eventually resulted in irreversible hypoxic damage of the brain.
Unexpected and Sudden Death Due to Undiagnosed Moraxella catarrhalis Meningoencephalitis in a 40-day-old Infant
Authors: Ventura Francesco , Barranco Rosario , Buffelli Francesca , Fulcheri Ezio , Bandettini Roberto , Palmieri Antonella 
Published: June 2020

Abstract
Acute bacterial meningitis in infants and newborns represents a medical emergency and a significant cause of mortality and morbidity worldwide. Moraxella catarrhalis has been considered a microorganism with low pathogenic potential, and only in exceptional cases has it been found to cause meningitis in infants and immunocompetent people. We will now document an unusual case of an unexpected and sudden death of a 40-day-old infant due to acute meningitis from M. catarrhalis, apparently asymptomatic and subsequently diagnosed by an autopsy. According to our knowledge this is the first case of unexpected infant death due to undiagnosed M. catarrhalis meningitis.
The suggested case, as well as for the rarity of such a fatal event, should be considered a caution to pediatrics and neonatologists for M. catarrhalis can cause paucisymptomatic meningoencephalitis in infants which can be potentially fatal.
From a forensic point of view, an autopsy accompanied by a multidisciplinary assessment is always necessary in cases of unexpected infant deaths to identify the causes.
International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients
Authors: Noël Kim C. , Papenburg Jesse , Lacroix Jacques , Quach Caroline , O’Donnell Shauna , Gonzales Milagros , Willson Douglas F. , Gilfoyle Elaine , McNally James D. , Reynolds Steven , Kazzaz Yasser , Kawaguchi Atsushi , Sato Masanori , Kongkiattikul Lalida , Leteurtre Stéphane , Dubos François , Karaca Yasemin , Chiusolo Fabrizio , Piva Jefferson , Dendukuri Nandini , Fontela Patricia S. ,   on behalf of the Canadian Critical Care Trials Group (CCCTG) and the Pediatric Lung Injury and Sepsis Investigators (PALISI) Network
Published: June 2020

Objectives:
We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.

Design:
Cross-sectional survey.

Setting:
PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil.

Subjects:
Pediatric intensivists.

Interventions:
None.

Measurements and Main Results:
We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped ses. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5–4.0 d] to 9.5 d [95% CI, 8.5–10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries.

Conclusions:
Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Postauricular Masses
Authors: Tasli Hamdi , Gokgoz Mert Cemal , Karakoc Omer 
Published: June 2020

Objective:
The postauricular region (PR) is an anatomic area that has been neglected until now, due to the fact that the significant cosmetic changes and features of this region are often overlooked. There are limited and inconsistent data about postauricular masses in the literature and the definition of the PR and its borders remain unclear. The aim of the present study was to define the PR and evaluate benign and malignant masses that may arise in the PR.

Methods:
Fifty-two patients were enrolled in the study. The patients were evaluated retrospectively in terms of demographic data, including age, gender, operative method, lesion side and size, diagnostic tools, and histopathologic diagnosis of the masses.

Results:
The masses were categorized into 4 groups according to the etiology; neoplastic (n: 15, 28.8%), inflammatory (n: 13, 25%), congenital (n: 22, 42.3%) and traumatic (n: 2, 3.8%). Of the neoplastic masses, 6 (11.5%) were nonmelanoma skin cancer, comprising 4 (7.6%) basal cell carcinomas and 2 (3.8%) squamous cell carcinomas. A total of 9 (17.3%) neoplastic masses were benign, comprising 3 (5.7%) lipomas, 3 (5.7%) temporal bone osteomas, 2 (3.8%) nevi, and 1 (1.9%) plexiform neurofibroma. Of the 13 (25%) inflammatory masses, 12 (23%) were lymph nodes and 1 (1.9%) was pilonidal sinus. There were 22 (42.3%) congenital masses comprising 15 (28.8%) epidermal cysts, 4 (7.6%) dermoid cysts, and 3 (5.7%) hemangiomas. The 2 (3.8%) patients with traumatic lesion were both keloid patients.

Conclusion:
The PR does not attract attention from the cosmetic point of view but many benign and malignant masses can be found in this region. Any masses detected in this area should be treated to prevent further growth.
One-Stage Reconstruction of the Large Lower Nose Defect Involving 2 Subunits With Lateral Nasal Artery Pedicle Nasolabial Flap
Authors: Jiang Banghong , Zhang Li , Xu Jing , Zhang Leiming , Liu Hongwei 
Published: June 2020

Background:
Large nose defect reconstructions involving the tip and alar subunits are still difficult to achieve in one stage. This study aimed to investigate the size of the nasal tip and alae, observe the distribution patterns of the lateral nasal artery and present our clinical experience with the lateral nasal artery pedicle nasolabial (LNAPN) flap.

Methods:
From June 2019 to January 2020, lower nose parameters from 60 subjects were measured by a 3-dimensional scan, and the cranial digital subtraction angiogram results of 20 patents without vascular malformation were retrospectively analyzed. The case series consisted of four patients with nasal tip and alar defects who underwent surgery with LNAPN flaps from December 2018 to June 2019. Outcomes and complications were followed-up at 6 to 12 months.

Results:
For the 3-dimensional scan study, the mean area of the 2 subunits involving the tip and alae was 7.986 ± 1.728 cm2. In the digital subtraction angiogram data, the lateral nasal artery was identified among all facial arteries and had a mean diameter of 1.0 ± 0.20 mm. Sixteen people (80%) had a rich connection between the lateral nasal artery and the transverse facial artery. All cases revealed satisfactory aesthetic outcomes by reconstruction of large defects in one stage. The largest flap of 4.2 cm × 3.0 cm in our study showed complete healing.

Conclusions:
The LNAPN flap represents a feasible, flexible, efficient, and easily mastered reconstructive method for large nose defects involving the tip and alar subunits.
Cleft Palate Repair: A New Maxillary Nerve Block Approach
Authors: Moggi Luis E. , Ventorutti Tatyana , Bennun Ricardo D. 
Published: June 2020

Objective:
To introduce a different approach for maxillary nerve block (MNB), in cleft palate repair. To reduce the use of opioids during surgery and to prevent frequent respiratory complications by means of an adequate intra and postoperative pain relief.

Patients and Methods:
A prospective clinical trial was planned, to collect scientific evidences between 2 groups of patients with primary cleft palate, receiving surgery in 2 Pediatric centers of Buenos Aires, utilizing a different protocol.
Sixty patients undergoing primary cleft palate repair in both hospitals, from January 2017 to July 2018, by senior surgeons and the same expert anesthesiologists’ team, were included.
Syndromic and secondary cases, and patients whose parents rejected to participate of this study were excluded. The first group called Hospital A included 45 children, the second group identified as Hospital B was formed by 15 patients.
A combination of general whit local anesthesia and a bilateral regional MNB, was used in all the patients of the Hospital A. Utilizing an aspirating syringe, children received 0.15 ml/kg of lidocaine clorhidrate 2% with epinephrine 1:50.000, under direct vision through the spheno palatine holes, just before surgery. A traditional general anesthesia procedure plus local anesthesia, was utilized in all the patients treated at the Hospital B Medial blood pressure and cardiac frequency parameters were tested during induction, along the surgical procedure and in the immediate post op, to detect any sign of pain (12). After surgery, patient reactivity, airway depression symptoms, time of initial feeding and discharge time, were also monitored (13).
This study was approved by the Hospitals Ethics Committees of both hospitals, and is in accordance with the 1975 Helsinki Declaration, as amended in 1983. The parents have signed an informed consent form for all the patients included.

Results:
Patients of both groups did not show any significant variant in the monitored parameters to detect signals of pain, along the surgery. The rest of controls during and after surgery showed significant differences in favor of the patients of Hospital A.

Conclusions:
Bilateral regional MNB, under direct vision trough the spheno palatine holes results an effective, easy, and safe method for pain relief during and after primary cleft palate repair surgeries.
The combination of slight general anesthesia with local anesthesia and regional blocks, results a good option to reduce opioids utilization, to prevent neurotoxicity, respiratory depression, sickness, and vomiting facilitating early feeding and patient discharge.
Evaluation of Hyoid Position and Retroglossal Airway After Mandibular Alveolar Archwise Distraction Osteogenesis
Authors: Acar Yasemin Bahar , Yöndem Cihan , Erverdi Ahmet Nejat , Bakkalbaşi Banu Çakirer 
Published: June 2020

Abstract
The interaction between form and function in the craniofacial region is a well-accepted fact in orthodontics. The aim of the present study is to objectively evaluate if mandibular sagittal symphyseal distraction causes an increase in the retroglossal airway size and hyoid position in a retrospective clinical study. The pretreatment (T0) and 3 months post-distraction (T1) cone-beam computed tomography images of 12 patients (mean age 17.1 years) were retrieved. The retroglossal airway volume and hyoid-mandibular plane distance, hyoid-C3 distance, sella-nasion-B point angle angle, lower incisor to mandibular plane, and Mandibular plane angles were measured using 3D medical imaging software. The average amount of distraction at the superior border of the bony transport segment was 6.2 mm and 4.4 mm at the inferior border. The changes in retroglossal airway volume (2943.2 mm3), incisor to mandibular plane (6.5°), and mandibular plane (2.1°) were significant. The changes in hyoid-mandibular plane distance and hyoid-C3 distances were not significant. However, a downward repositioning in Hyoid position was observed along with the mandibular clockwise rotation. This study showed that symphyseal dentoalveolar distraction osteogenesis, as a complementary to orthodontic therapy, can affect the form and size of the pharynx. Therefore, the airway size should be one of the diagnostic and decisive factors for an ideal treatment planning.
Lip Synechia Resulting From Toxic Epidermal Necrolysis: A Rare Condition
Authors: Mendes Bruno Coelho , Santos Anderson Maikon de Souza , Cervantes Lara Cristina da Cunha , Pereira Rodrigo dos Santos , Hochuli-Vieira Eduardo , Bonardi João Paulo 
Published: June 2020

Abstract
Toxic epidermal necrolyses represent a severe epidermolytic reaction characterized by cutaneous erythema and target lesions affecting >30% of the body surface, skin, and mucous membranes. Ulcerative lesions on the labial mucosa may evolve during healing, resulting in rare complications, such as lip adhesions. This report shows the successful treatment of a lip synechia resulting from the healing of mucosal lesions in a patient with toxic epidermal necrolysis caused by the use of Lamotrigine and Ibuprofen. Although the treatment of the presented lip synechia was simple, this sequela can be avoided by measures such as hydration, hygiene and lip lubrication.
Broad, Recurrent Nasal Dermoid Cyst: A Challenging Task
Authors: Kuzu Selçuk 
Published: June 2020

Abstract
Nasal dermoid sinus cyst is a rare congenital midline anomaly. The embryological origin is different from the dermoid cysts seen in other parts of the face. Nasal dermoid sinus cysts constitute 1% to 3% of all dermoid cysts and 11% to 12% of head and neck dermoid cysts. While most lesions are detected in the first 3 years, in some cases they may not be noticed until later years. Delay in diagnosis increases recurrent infections, airway obstruction and intracranial complications. The authors present a 34-year-old patient with a broad nasal dermoid cyst who had previously undergone external rhinoplasty for a nasal dermoid cyst but relapsed after 5 months.
Intraosseous Hemangioma of Nasal Bone: Unusual Cause of Epiphora
Authors: Choi Jung Sik , Kim Seong Ae , Kim Yu Il. , Lee Jung Ho 
Published: June 2020

Abstract
Intraosseous hemangioma is very rare, accounting for <1% of bone tumors. Nasal bone origin of it is even rarer. A 63-year-old female patient visited our clinic with a complaint of epiphora. On physical examination, about 2-cm-sized nontender and fixed mass was palpated along the left nasomaxillary suture area. Preoperative magnetic resonance imaging findings were consistent with intraosseous hemangioma originating from the nasal bone. Epiphora was thought to be developed due to the mass effect and a marginal resection of the mass was performed. The defect was reconstructed with a septal cartilage and porous polyethylene implant (Synpor). Postoperatively, epiphora subsided and there has been no sign of recurrence or facial deformity during 6 months of follow-up.
The Effect of Xinmailong Infusion on Sepsis-Induced Myocardial Dysfunction: a Pragmatic Randomized Controlled Trial
Authors: He Jianzhuo , Zhao Xujie , Lin Xinfeng , Yang Zhixu , Ma Mingyuan , Ma Li , Liang Qun , Li Lan , Ye Yong , Wen Zehuai , Zhang Zhanlin , Zhang Minzhou , Guo Liheng 
Published: June 2020

ABSTRACT
Sepsis-induced myocardial dysfunction (SIMD) contributes significantly to cardiovascular dysfunction during septic shock. We aimed to evaluate the potential role of Xinmailong injection (XMLI), a polypeptide medicine extracted from Periplaneta americana, in reversing the progression of myocardial damage to SIMD in sepsis patients. This was a multicenter, randomized, double-blind, parallel-group trial. We recruited all patients consecutively admitted to intensive care units (ICUs) who were aged 18 to 85 years old and met the sepsis 3.0 criteria. The primary outcome measure was the incidence of sepsis-induced myocardial dysfunction while in the ICU. Of the 192 patients, 96 were assigned to the treatment group, and 96 to the control group. Subsequently, 41 patients [41/96 (42.7%)] in the XMLI group and 61 patients in the placebo group [61/96 (63.5%)] were confirmed to have diastolic dysfunction on the fifth day (D5). The incidence of diastolic SIMD was significantly different between the two groups (P = 0.004). There were 36 deaths in the two groups during the 28-day follow-up, with a general mortality rate of 18.8% (36/192). The 28-day mortality rates were not significantly different between the groups (P = 0.45). However, the brain natriuretic peptide (BNP) plasma concentration trends on D0, D2, and D5 significantly differed between the two groups (P = 0.049). In septic patients, XMLI decreased the occurrence rate of diastolic SIMD more effectively than the placebo. The improvement in serum BNP concentration was also greater in the XMLI group. XMLI may, therefore, effectively and safely improve cardiac function in patients with sepsis.
Assessment and management of women with heavy menstrual bleeding in Kenya: a best practice implementation project
Authors: Akumu Lydia A. , Ratemo Stanley N. , Owende Philomena 
Published: June 2020

ABSTRACT

Aim:
The aim of this evidence implementation project is to make a contribution to promoting evidence-based practice in the assessment and management of women with heavy menstrual bleeding (HMB) attending the gynaecology outpatient clinic at Kenyatta National Hospital (KNH) and thereby improve patient outcomes and resource utilization.

Methods:
The evidence implementation project was carried out at the gynaecology outpatient clinic of the largest referral facility in Kenya. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool were used. A baseline audit was conducted using a sample of 40 patient files; this was followed by interventions such as trainings, developing of visual tools and updating of protocols. A follow-up audit was then conducted 4 months post intervention.

Results:
Baseline audit results demonstrated varying results in each of the nine criteria selected. Four of the criteria recorded less than 51% compliance, with two of these recording 0% compliance. Postintervention results showed a remarkable increase in most of the audit criteria selected, with eight of these having compliance levels of 90% or more.

Conclusion:
The implementation project served the dual purpose of enlightening health care workers on best practices and educating patients on what they need to know about their condition. This led to an overall improvement in the management of HMB.
Stereotypic Neutralizing VHClonotypes Against SARS-CoV-2 RBD in COVID-19 Patients and the Healthy Population
Authors: Kim Sang Il , Noh Jinsung , Kim Sujeong , Choi Younggeun , Yoo Duck Kyun , Lee Yonghee , Lee Hyunho , Jung Jongtak , Kang Chang Kyung , Song Kyoung-Ho , Choe Pyoeng Gyun , Kim Hong Bin , Kim Eu Suk , Kim Nam-Joong , Seong Moon-Woo , Park Wan Beom , Oh Myoung-don , Kwon Sunghoon , Chung Junho 
Published: June 2020

AbstractIn six of seven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, VHclonotypes, encoded by either immunoglobin heavy variable (IGHV)3-53 or IGHV3-66 and immunoglobin heavy joining (IGHJ)6, were identified in IgG1, IgA1, and IgA2subtypes, with minimal mutations, and could be paired with diverse light chains, resulting in binding to the SARS-CoV-2 receptor-binding domain (RBD). Because most human antibodies against the RBD neutralized the virus by inhibiting host cell entry, we selected one of these clonotypes and demonstrated that it could potently inhibit viral replication. Interestingly, these VHclonotypes pre-existed in six of 10 healthy individuals, predominantly as IgM isotypes, which could explain the expeditious and stereotypic development of these clonotypes among SARS-CoV-2 patients.