bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors
Authors: Fracol Megan , Qiu Cecil S. , Chiu Wen-Kuan , Feld Lauren N. , Shah Nikita , Kim John Y. S. 
Published: May 2020

Background:
Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and risk factors for implant malposition in this setting.

Methods:
Retrospective review of a single surgeon’s prosthetic breast reconstructions was performed. Variables collected included age, BMI, radiation, chemotherapy, implant characteristics and malposition location (inferior or lateral). Binary logistic regression identified risk factors for malposition. Chi-square test assessed malposition rate as a function of implant volume to BMI subgroups.

Results:
Of 836 breasts, 82 (9.8%) exhibited implant malposition. Risk factors for any malposition were older age (OR 1.05, 95% CI 1.02-1.07), BMI<25 (OR 1.64, 95% CI 1.00-2.70) and bilateral reconstruction (OR 13.41, 95% CI 8.50-21.16). Risk factors for inferior malposition were older age (OR 1.04, 95% CI 1.01-1.06), BMI<25 (OR 3.43, 95% CI 1.88-6.26) and bilateral reconstructions (OR 11.50, 95% CI 6.79-19.49), while risk factors for lateral malposition were only older age (OR 1.05, 95% CI 1.02-1.08) and bilateral reconstructions (OR 7.08, 95% CI 4.09-12.26). Post-mastectomy radiation was protective against lateral malposition (OR 0.30, 95% CI 0.10-0.88). Stratification by implant volume and BMI demonstrated patient subgroups with distinct patterns of malposition (incidence 0.0% versus 10.9%, P = 0.001).

Conclusions:
This is the first study to identify risk factors for implant malposition after prosthetic breast reconstruction. Different risk factors contributed to malposition in different directions. The effect of implant size on malposition was mediated through BMI, highlighting the interplay of implant and patient characteristics with respect to malposition.
The Modified Crescenteric Anterior Intercostal Perforator Flap
Authors: Denning Max , Hayes Philippa , Tsang Fiona , Leff Daniel , Thiruchelvam Paul , Hadjiminas Dimitri 
Published: May 2020

Summary:
Lower pole breast cancers are challenging to manage because conventional wide local excision may produce a “bird’s beak” deformity. In an era of oncoplastic surgery, techniques that balance oncological results with cosmetic outcomes such as local flaps have extended the role of breast-conserving surgery. Local flaps are particularly useful for partial breast reconstruction due to the relative simplicity of the surgical procedure and reduced morbidity. Intercostal artery perforator flaps have a shorter duration of surgery than free flaps and do not require microsurgical anastomoses. Anterior intercostal artery perforator (AICAP) flaps provide excellent cosmesis, yet traditional crescenteric harvest yields limited volume for reconstruction. We describe a modification to an established reconstructive technique for lower pole breast defects. The technique is based on 3 extensions of tissue, providing a larger volume of tissue replacement compared with traditional AICAP flaps. The technique is particularly suitable for small- and medium-sized non-ptotic breasts, with lower pole tumors. The modified crescenteric AICAP technique can be used to increase the available tissue when performing lower pole reconstructions.
Cost Analysis for In-house versus Industry-printed Skull Models for Acute Midfacial Fractures
Authors: Lor Lyfong S. , Massary Dominic A. , Chung Scotty A. , Brown Philip J. , Runyan Christopher M. 
Published: May 2020

Background:
Industry-printed (IP) 3-dimensional (3D) models are commonly used for secondary midfacial reconstructive cases but not for acute cases due to their high cost and long turnaround time. We have begun using in-house (IH) printed models for complex unilateral midface trauma. We hypothesized that IH models would decrease cost and turnaround time, compared with IP models.

Methods:
We retrospectively examined cost and turnaround time data from midface trauma cases performed in 2017–2019 using 3D models (total, n = 15; IH, n = 10; IP, n = 5). Data for IH models were obtained through itemized cost reports from our Biomedical Engineering Department, where the models were printed. Data associated with IP models were obtained through itemized cost reports from our industry vendor. Perioperative data were collected from electronic medical records.

Results:
The average cost for IH models ($236.38 ± 26.17) was significantly less (P < 0.001) than that for IP models ($1677.82 ± 488.43). Minimal possible time from planning to model delivery was determined. IH models could be produced in as little as 4.65 hours, whereas the IP models required a minimum of 5 days (120 hours) from order placement. There were no significant differences in average operating room time (P = 0.34), surgical complications, or subjective outcomes, but there was a significant difference in estimated blood loss (P = 0.04).

Conclusion:
Utilization of IH 3D skull models is a creative and practical adjunct to complex unilateral midfacial trauma that also reduces cost and turnaround time compared with IP 3D models.
Academic and Clinical Background of Plastic Surgery Residents of the Saudi Training Program
Authors: Shah Mardan Qutaiba N. M. , Alharbi Ahmed B. , Alzaidi Salman A. , Aldhafeer Eman S. , Allazzam Abdulmohsen M. 
Published: May 2020

Background:Plastic surgery residents are required to contribute to the scientific milieu, apart from honing their surgical skills. Data regarding their academic and clinical background are limited locally in comparison with their counterparts. This is the first study of its kind on the Saudi training program, with suggested potential solutions to shortcomings.Methods:This is a cross-sectional study based on an electronic, 27-element, self-administered questionnaire sent to a WhatsApp group gathering all 40 plastic surgery residents of the Saudi program, with the exclusion of a single participant.Results:The mean of overall residents’ publications was 2.29 articles. No significant difference (P= 0.438) was found in the number of publications among residents of different levels. However, seniors have published significantly (P= 0.002) more articles (mean = 1.6; SD = 1.24) during residency compared with juniors (mean = 0.42; SD = 1). The group that had taken rotations in plastic surgery abroad published more articles (P= 0.02) than the group that did not. Usingηcorrelation, a positive correlation (η= 0.36) was found between taking courses in research and publication.Conclusions:The Saudi plastic surgery residents are ahead of their colleagues in other local specialties but fall behind their counterparts internationally. The relatively poor contribution in terms of research, posters, and oral presentations could be remedied with measures such as providing protected research time and mentorship. They should be emboldened to pursue postgraduate studies, as only 3 residents had a Master of Science degree.
Hypertension in the elderly: recent developments and insights
Authors: Sternlicht Hillel , Basile Jan 
Published: May 2020

Purpose of review
This article will summarize the effects of more intensive blood pressure (BP) control on cardiovascular, cognitive, and renal outcomes among elderly (age ≥75 years) individuals at high risk for cardiovascular events. Subsets of patients who may not benefit and obstacles to implementation will be addressed. The authors’ insights will conclude the review.

Recent findings
A burst of new research regarding the effects of lower BP targets on cardiovascular, cognitive, and renal endpoints among the elderly has been published. Achieved values of 123 mmHg systolic in those without diabetes or prior stroke revealed striking declines in all-cause mortality, heart failure, and stroke. Although there was no benefit on the incidence of dementia, mild cognitive impairment was reduced. A trend towards modest declines in renal function and higher adverse event rates with normalization of BP were noted. Whether those with poor functional status or diastolic hypotension realize comparable gains remains unknown.

Summary
Intensive BP control (systolic goal 120–130 mmHg systolic) results in lower rates of all-cause mortality and major adverse cardiac events. Elderly individuals with a good functional status and no history of diabetes or stroke are suitable candidates.
The Efficacy of Intense Pulsed Light Combined With Meibomian Gland Expression for the Treatment of Dry Eye Disease Due to Meibomian Gland Dysfunction: A Multicenter, Randomized Controlled Trial
Authors: Yan Xiaoming , Hong Jing , Jin Xiuming , Chen Wei , Rong Bei , Feng Yun , Huang Xiaodan , Li Jinyang , Song Wenjing , Lin Lin , Cheng Yu 
Published: May 2020

Objectives:
To compare the efficacy of intense pulsed light (IPL) combined with Meibomian gland expression (MGX), and instant warm compresses combined with MGX, for treatment of dry eye disease (DED) due to meibomian gland dysfunction (MGD).

Methods:
In a prospective, multicenter, interventional study, 120 subjects with DED due to MGD were randomized 1:1 to an IPL arm or a control arm. Each subject was treated 3 times at 3-week intervals. The primary outcome measure was the tear break up time (TBUT). Tear break up time and a few additional outcome measures were evaluated at the baseline and at 3 weeks after the last treatment.

Results:
All outcome measures improved in both arms, but in general, the improvement was significantly larger in the IPL arm. Tear break up time increased by 2.3±1.9 and 0.5±1.4 sec, in the IPL and control arms respectively (P<0.001). SPEED was reduced by 38% and 22% in the IPL and control arms, respectively (P<0.01). Meibomian Gland Yielding Secretion Score was improved by 197% in the IPL arm and 96% in the control arm. Corneal fluorescein staining also decreased by 51% and 24% in the IPL and control arms respectively, but the differences between the two arms were not statistically significant (P=0.61). A composite score of lid margin abnormalities improved in both arms, but more in the IPL arm (P<0.05).

Conclusions:
Intense pulsed light combined with MGX therapy was significantly more effective than instant warm compresses followed with MGX. This suggests that the IPL component has a genuine contribution to the improvement of signs and symptoms of DED.
Bilateral Corneal Graft Rejection Associated With Pembrolizumab Treatment
Authors: Vanhonsebrouck Eva , Van De Walle Mieke , Lybaert Willem , Kruse Vibeke , Roels Dimitri 
Published: May 2020

Purpose:
To report the first case of corneal graft rejection presumably associated with pembrolizumab immunotherapy.

Methods:
Case report and literature review.

Results:
An asymptomatic 85-year-old woman with a history of bilateral penetrating keratoplasty presented for a follow-up visit with bilateral diffuse keratic precipitates and subepithelial infiltrates. There were no anterior chamber cells. Bilateral subclinical corneal graft rejection was suspected. Three months previously, pembrolizumab immunotherapy was started for a metastatic urothelial cell tumor. Corneal graft rejection was managed with topical dexamethasone drops, which were tapered slowly. Pembrolizumab treatment was continued with careful ophthalmological follow-up. Unfortunately, recurrence of corneal graft rejection was observed 8 weeks after cessation of topical dexamethasone drops. After consulting the treating oncologist, pembrolizumab treatment was stopped to prevent recurrent corneal graft rejection.

Conclusions:
We report the first case of corneal graft rejection presumably associated with pembrolizumab immunotherapy. Corneal graft rejection may be successfully managed with corticosteroid therapy. However, constant vigilance and follow-up are advised because of the risk of recurrence in case of continued pembrolizumab treatment. Given the subclinical presentation, baseline ophthalmological screening is advised in all corneal graft patients after initiating immune checkpoint inhibitor therapy.
Impact of Scleral Contact Lens Use on the Rate of Corneal Transplantation for Keratoconus
Authors: Ling Jennifer J. , Mian Shahzad I. , Stein Joshua D. , Rahman Moshiur , Poliskey Joel , Woodward Maria A. 
Published: May 2020

Purpose:
To evaluate the association of scleral contact lens (SCL) use on the risk for keratoplasty for people with keratoconus.

Methods:
The electronic health records of patients receiving eye care at the University of Michigan Kellogg Eye Center between August 1, 2012, and December 31, 2018, were reviewed. Patients with a diagnostic code of keratoconus or corneal ectasia, no previous history of keratoplasty, and for whom data were available for both eyes were included. Using a multivariable Cox regression model, associations between SCL use and keratoplasty were tested and adjusted for sociodemographic factors, maximum keratometry, and current contact lens (CL) use.

Results:
Two thousand eight hundred six eyes met the inclusion criteria. CL use in each eye was 36.2% with no CL, 7.2% soft, 33.9% rigid gas permeable (RGP), and 22.7% scleral. A total of 3.2% of eyes underwent keratoplasty. In the adjusted model, SCL or RGP CL use significantly lowered the hazard of undergoing keratoplasty (HR = 0.19, 95% confidence interval [CI] 0.09–0.39, P < 0.0001 and HR = 0.30, 95% CI 0.17–0.52, P < 0.0001, respectively) when compared with no CL use. Factors associated with increased risk of keratoplasty were black race as compared to white (HR = 1.87, 95% CI 1.10–3.16, P = 0.02), younger age (HR = 0.92 per 5-year increment, 95% CI 0.86–0.99, P = 0.032), and lower socioeconomic status (HR = 1.08 per 5-point increase in the Area Deprivation Index, 95% CI 1.03–1.13, P = 0.0008). Keratoplasty was not associated with sex, insurance, or maximum keratometry.

Conclusions:
Physicians should maximize the use of scleral or RGP CL because patients who successfully use CL have almost one-fifth the risk of undergoing keratoplasty.
The Nasopharyngeal and Gut Microbiota in Children in a Pediatric Otolaryngology Practice
Authors: Thapa Santosh , Runge Jessica Kristel , Venkatachalam Alamelu , Denne Carter , Luna Ruth Ann , Anon Jack Bryant 
Published: May 2020

Background:
The human microbiome evolves rapidly in early life with contributions from various factors such as diet, delivery mode, medical history, antibiotics exposure, genetics, immunomodulators and the environment. A high use of antibiotics in pediatric outpatient settings has been well documented, and improvement in antibiotic selection is required to reduce the risks of antibiotic resistance and disruption of the microbiome.

Methods:
We performed an exploratory study using 16S rRNA gene-based sequencing to characterize the gut and nasopharyngeal microbiome of children (n = 50) age 1–6 years of age in a pediatric otolaryngology practice.

Results:
Relative abundance of Haemophilus and Moraxella were higher in nasopharyngeal swabs, while Prevotella, Bacteroides, Porphyromonas and Faecalibacterium were highly abundant in rectal swabs. The gut microbiome composition in children <2 years old was different compared with children ≥2 years age. Gut bacterial diversity increased with an increase in age of the children. Children taking probiotics had a notable increase in abundance of potentially beneficial gut bacteria such as Bacteroides and Akkermansia. The nasopharyngeal microbiome differed between children who received antibiotics in the 3 months before sample collection compared with those that did not. Haemophilus spp. was highly abundant in children who received antibiotics 3 months before sampling.

Conclusions:
The pediatric nasopharyngeal and rectal microbiomes differ in bacterial composition and diversity. The increased abundance of Haemophilus spp. in the nasopharyngeal microbiome of children who received antibiotics during the 3 months before sampling suggests a potential impact of antibiotics in colonization with the otopathogen and may be relevant to clinical practice.
Procalcitonin as a Biomarker of Unresponsiveness to Intravenous Immunoglobulin for Kawasaki Disease
Authors: Nakamura Nami , Muto Taichiro , Masuda Yu , Numoto Shingo , Kodama Shunsuke , Miyamoto Ryosuke , Miyata Kenji , Hayakawa Tomohito , Mori Hiromitsu , Kuroyanagi Yoshiyuki , Akaihata Mitsuko , Iwayama Hideyuki , Kurahashi Hirokazu , Shimomura Yasuhito , Nagai Takuhito , Hori Toshinori , Agata Hiroatsu , Okumura Akihisa 
Published: May 2020

Objective:
To investigate the usefulness of procalcitonin (PCT) as predictive factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease patients.

Methods:
We retrospectively analyzed the laboratory data from 215 children with Kawasaki disease treated with IVIG from 2014 to 2019. We analyzed the clinical and laboratory parameters just before the IVIG including serum levels of PCT with respect to the IVIG response.

Results:
Eventually, 127 patients were analyzed. The median age was 2.4 years. IVIG was effective in 108 children (responders) and was ineffective in 19 (non-responders). Serum PCT concentration was higher in non-responders than those of responders (P < 0.001). Multivariate logistic regression analyses indicated that higher PCT concentration (odds ratio 1.34, 95% confidence interval 1.10–1.64) were associated with IVIG resistance. Analyses of the receiver operating characteristic curve showed that the cutoff value of PCT 2.18 ng/mL had 46.4% of sensitivity and 93.9% of specificity. Receiver operating characteristic analysis yielded an area under the curve of 0.82 (0.72–0.92) to predict IVIG resistance.

Conclusions:
Serum PCT value can be an excellent biomarker for predicting unresponsiveness to IVIG with a good discriminatory ability as well as the existing prediction scores.
Viral Etiology, Clinical Features and Antibiotic Use in Children <5 Years of Age in the Gambia Presenting With Influenza-like Illness
Authors: Jarju Sheikh , Greenhalgh Khristianne , Wathuo Miriam , Banda Mustapha , Camara Bakary , Mendy Simon , Sowe Ghata , Dahaba Pa Omar , Jammeh Lamin , Bajinka Yaya , Sanneh Papis , Jallow Edrissa , Yates Alexandra , Lindsey Benjamin B. , Owens Stephen , Kampmann Beate , Forrest Karen , Clarke Ed , de Silva Thushan 
Published: May 2020

Background:
Knowledge regarding the prevalence, clinical features and etiology of pediatric influenza-like illness (ILI) remains limited in African settings. Furthermore, it is likely that many children presenting with ILI receive antibiotics unnecessarily. More data are required to develop antimicrobial stewardship practice and guide effective vaccine strategies. We undertook a 1-year prospective study of ILI in the Gambia.

Methods:
Children <5 years of age presenting with ILI from March 2018 to March 2019 were recruited. Clinical and antibiotic prescribing data were collected. Nasopharyngeal swabs were collected and analyzed for 12 respiratory viruses using a multiplex polymerase chain reaction.

Results:
From a total of 735 ILI episodes, 530 (72.1%) nasopharyngeal swabs were positive for ≥1 virus. Of these, 36.7% were positive for rhinovirus, 14.7% for respiratory syncytial virus, 8.4% for influenza and 7.2% for human metapneumovirus. Compared with children <6 months of age, influenza was more common in 6- to 23-month-old children [odd ratio (OR): 5.68; 95% confidence interval (CI): 1.72–18.76; P = 0.004]. Respiratory syncytial virus and human metapneumovirus were associated with low peripheral oxygen saturations (OR: 2.13; 95% CI: 1.23–3.69; P = 0.007; and OR: 2.44; 95% CI: 1.13–5.27; P = 0.023, respectively). Antibiotics were prescribed in 78.3% of all ILI cases.

Conclusions:
A broad range of viruses are responsible for pediatric ILI in the Gambia. Refined treatment guidelines, improved diagnostic capacity and vaccines to prevent respiratory viruses will all play a role in reducing antimicrobial use for these cases.
A pain-induced tonic hypodopaminergic state augments phasic dopamine release in the nucleus accumbens
Authors: Gee Taylor A. , Weintraub Nathan C. , Lu Dong , Phelps Caroline E. , Navratilova Edita , Heien Michael L. , Porreca Frank 
Published: May 2020

Abstract
Diseases and disorders such as Parkinson disease, schizophrenia, and chronic pain are characterized by altered mesolimbic dopaminergic neurotransmission. Dopamine release in the nucleus accumbens influences behavior through both tonic and phasic signaling. Tonic dopamine levels are hypothesized to inversely regulate phasic signals through dopamine D2 receptor feedback inhibition. We tested this hypothesis directly in the context of ongoing pain. Tonic and phasic dopamine signals were measured using fast-scan controlled-adsorption voltammetry and fast-scan cyclic voltammetry, respectively, in the nucleus accumbens shell of male rats with standardized levels of anesthesia. Application of capsaicin to the cornea produced a transient decrease in tonic dopamine levels. During the pain-induced hypodopaminergic state, electrically evoked phasic dopamine release was significantly increased when compared to baseline, evoked phasic release. A second application of capsaicin to the same eye had a lessened effect on tonic dopamine suggesting desensitization of TRPV1 channels in that eye. Capsaicin treatment in the alternate cornea, however, again produced coincident decreased dopaminergic tone and increased phasic dopamine release. These findings occurred independently of stimulus lateralization relative to the hemisphere of dopamine measurement. Our data show that (1) the mesolimbic dopamine circuit reliably encodes acute noxious stimuli; (2) ongoing pain produces decreases in dopaminergic tone; and (3) pain-induced decreases in tonic dopamine correspond to augmented evoked phasic dopamine release. Enhanced phasic dopamine neurotransmission resulting from salient stimuli may contribute to increased impulsivity and cognitive deficits often observed in conditions associated with decreased dopaminergic tone, including Parkinson disease and chronic pain.
Decision Support for Implantable Cardioverter-Defibrillator Replacement
Authors: Lewis Krystina B. , Birnie David , Carroll Sandra L. , Brousseau-Whaley Carolynne , Clark Lorraine , Green Martin , Nair Girish M. , Nery Pablo B. , Redpath Calum , Stacey Dawn 
Published: May 2020

Background
Decision support can help patients facing implantable cardioverter-defibrillator (ICD) replacement understand their options and reach an informed decision reflective of their preferences.

Objective
The aim of this study was to evaluate the feasibility of a decision support intervention for patients faced with the decision to replace their ICD.

Methods
A pilot feasibility randomized trial was conducted. Patients approaching ICD battery depletion were randomized to decision support intervention or usual care. Feasibility outcomes included recruitment rates, intervention use, and completeness of data; secondary outcomes were knowledge, values-choice concordance, decisional conflict, involvement in decision making, and choice.

Results
A total of 30 patients were randomized to intervention (n = 15) or usual care (n = 15). The intervention was used as intended, with 2% missing data. Patients in the intervention arm had better knowledge (77.4% vs 51.1%; P = .002). By 12 months, 8 of 13 (61.5%) in the intervention arm and 10 of 14 (71.4%) in the usual care arm accepted ICD replacement; 1 per arm declined (7.7% vs 7.1%, respectively).

Conclusion
It was feasible to deliver the intervention, collect data, despite slow recruitment. The decision support intervention has the potential to improve ICD replacement decision quality.