bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Risk Factors Associated With Corneal Perforation in Chronic Ocular Graft-Versus-Host-Disease
Authors: Sinha Shruti , Singh Rohan Bir , Dohlman Thomas H. , Taketani Yukako , Yin Jia , Dana Reza 
Published: September 2020

Purpose:
To determine the prevalence and risk factors associated with corneal perforation in patients with chronic ocular graft-versus-host disease (oGVHD).

Methods:
We reviewed the case records of 405 patients diagnosed with chronic oGVHD over 8 years at a single academic center and assessed the prevalence of corneal perforation in the cohort. We reviewed patient demographics, indication for and type of hematopoietic stem cell transplantation (HSCT), time elapsed between HSCT and perforation, and clinical characteristics including oGVHD severity scores, ocular comorbidities, and topical medications at the time of perforation. Data were analyzed to determine the characteristics of patients with corneal perforation and establish the risk factors.

Results:
Of the 405 patients with chronic oGVHD, 15 (3.7%) developed a corneal perforation. The mean age of patients at the time of perforation was 64 ± 11 years and 10 (67%) were men. The median time to corneal perforation was 3.3 years post-HSCT. Although perforation occurred unilaterally in all cases, 44% had epithelial defects and 38% had stromal abnormalities in the contralateral eye. Of the patients with corneal perforation, 9 (60%) had a National Institute of Health oGVHD severity score of 2 and 6 (40%) had a score of 3. Patients with chronic oGVHD on antiglaucoma drops had a significantly higher risk of corneal perforation (P < 0.001).

Conclusions
Corneal perforation is a rare but vision-threatening complication of chronic oGVHD. Our study emphasizes the need for frequent and long-term follow-up of patients with oGVHD regardless of the severity of disease. In particular, patients with chronic oGVHD on topical antiglaucoma medications should be monitored closely due to a higher risk for corneal perforation.
Treatment and Outcomes of Children With Febrile Urinary Tract Infection Due to Extended Spectrum Beta-lactamase-producing Bacteria in Europe
Authors: Vazouras Konstantinos , Hsia Yingfen , Folgori Laura , Bielicki Julia , Aguadisch Elise , Bamford Alasdair , Brett Ana , Caseris Marion , Cerkauskiene Rimante , De Luca Maia , Iosifidis Elias , Kopsidas John , Manzanares Ángela , Planche Tim , Riordan Andrew , Srovin Tina Plankar , Valdivielso Martínez Ana Isabel , Vergadi Eleni , Sharland Mike , Basmaci Romain 
Published: September 2020

Background:
The prevalence of extended-spectrum beta-lactamase producing Εnterobacteriaceae (ESBL-PE) is increasing globally. ESBL-PE are an important cause of urinary tract infections (UTIs) in children. We aimed to characterize the clinical presentation, treatment and outcomes of childhood UTI caused by ESBL-PE in Europe.

Methods:
Multicenter retrospective cohort study. Children 0 to 18 years of age with fever, positive urinalysis and positive urine culture for an ESBL-PE uropathogen, seen in a participating hospital from January 2016 to July 2017, were included.

Main Outcome Measures:
Primary outcome measure: day of defervescence was compared between (1) initial microbiologically effective treatment (IET) versus initial microbiologically ineffective treatment (IIT) and (2) single initial antibiotic treatment versus combined initial antibiotic treatment. Secondary outcome measures: Clinical and microbiologic failure of initial treatment.

Results:
We included 142 children from 14 hospitals in 8 countries. Sixty-one children had IET and 77 IIT. There was no statistical difference in time to defervescence for effective/ineffective groups (P = 0.722) and single/combination therapy groups (P = 0.574). Two of 59 (3.4%) and 4/66 (6.1%) patients exhibited clinical failure during treatment (P = 0.683) when receiving IET or IIT, respectively. Eight of 51 (15.7%) receiving IET and 6/58 (10.3%) receiving IIT patients (P = 0.568) had recurring symptoms/signs suggestive of a UTI. Recurrence of a UTI occurred 15.5 days (interquartile range, 9.0–19.0) after the end of treatment.

Conclusions:
Time to defervescence and clinical failure did not differ between IET/IIT groups. Non-carbapenem beta-lactam antibiotics may be used for the empiric treatment of ESBL febrile UTIs, until susceptibility testing results become available.
Clinical and Epidemiologic Characteristics of Pertussis in Hospitalized Children: A Prospective and Standardized Long-term Surveillance Study
Authors: Zumstein Jana , Heininger Ulrich 
Published: September 2020

Background:
Surveillance of incidence and severity of pertussis is key to control success and shortcomings of vaccination programs followed by adaptations of recommendations if necessary. In Switzerland, nationwide reporting of hospitalizations due to pertussis in children has a long tradition and resumed in 2013 to evaluate the effects of pertussis immunization in pregnancy introduced in 2013.

Methods:
Since 2013, all patients <16 years of age hospitalized with suspected or proven pertussis have been reported to the Swiss Pediatric Surveillance Unit. Patient data comprising clinical and epidemiologic characteristics and laboratory confirmation were assessed in a standardized fashion, and case definitions were applied to all cases reported until the end of 2019.

Results:
Two hundred thirteen of 294 cases were valid cases of pertussis. Of these, 168 (79%) occurred in <6-month-old infants. Mean duration of hospitalization was 8 days (median 5, range 2–47) overall and highest in neonates (14.2 days); 85% of all patients had ≥1 complication, most commonly cyanosis and dyspnea, especially in infants. Overall, case fatality rate was 1.4% (8.7% in neonates). Only 4 (2%) of 168 mothers of infants <6 months had been vaccinated during pregnancy; 14 (12%) of 112 patients with precise records of immunization had completed their primary series and were up-to-date for age.

Conclusions:
Despite a decline of cases associated with the introduction of immunization against pertussis in pregnancy, control of the disease remains challenging, mainly due to failure to vaccinate rather than vaccine failure.
Disparities in Care Experienced by American Indian and Alaska Native Medicare Beneficiaries
Authors: Martino Steven C. , Elliott Marc N. , Hambarsoomian Katrin , Garcia Andrea N. , Wilson-Frederick Shondelle , Gaillot Sarah , Weech-Maldonado Robert , Haviland Amelia M. 
Published: September 2020

Background:
Little is known about the health care experiences of American Indians and Alaska Natives (AIANs) due to limited data.

Objective:
The objective of this study was to investigate the health care experiences of AIAN Medicare beneficiaries relative to non-Hispanic Whites using national survey data pooled over 5 years.

Subjects:
A total of 1,193,248 beneficiaries who responded to the nationally representative 2012–2016 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Methods:
Linear regression models predicted CAHPS measures from race and ethnicity. Scores on the CAHPS measures were linearly transformed to a 0–100 range and case-mix adjusted. Three AIAN groups were compared with non-Hispanic Whites: single-race AIANs (n=2491; 0.4% of the total sample), multiple-race AIANs (n=15,502; 1.3%), and Hispanic AIANs (n=2264; 0.2%).

Results:
Among AIAN groups, single-race AIANs were most likely to live in rural areas and areas served by the Indian Health Service; Hispanic AIANs were most likely to be Spanish-language-preferring (P’s<0.05). Compared with non-Hispanic Whites, single-race AIANs reported worse experiences with getting needed care (adjusted disparity of −5 points; a “large” difference), getting care quickly (−4 points; a “medium” difference), doctor communication (−2 points; a “small” difference), care coordination (−2 points), and customer service (−7 points; P<0.001 for all comparisons). Disparities were similar for Hispanic AIANs but more limited for multiple-race AIANs.

Conclusions:
Quality improvement efforts are needed to reduce disparities faced by older AIANs. These findings may assist in developing targeted efforts to address cultural, communication, and health system factors presumed to underlie disparities in health care access and customer service.
Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans
Authors: Samari Goleen , Sharif Mienah Z. , Alcalá Héctor E. 
Published: September 2020

Objective:
To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

Methods:
Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

Results:
White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

Conclusion:
Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

Policy Implications:
This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.
Timing of Fluid Overload and Association With Patient Outcome
Authors: Lima Lisa , Menon Shina , Goldstein Stuart L. , Basu Rajit K. 
Published: September 2020

Objectives:
To determine if the timing of excess fluid accumulation (fluid overload) is associated with adverse patient outcomes.

Design:
Secondary analysis of a prospectively collected dataset.

Setting:
PICU of a tertiary care hospital.

Patients:
Children 3 months to 25 years old admitted to the PICU with expected length of stay greater than or equal to 48 hours.

Interventions:
Patients were dichotomized by time of peak overload: peak fluid overload from ICU admission (Day0) to 48 hours (Day3–7) and peak fluid overload value after 48 hours of ICU admission, as well as time of first-time negative daily fluid balance: net fluid out greater than net fluid in for that 24-hour period.

Measurements and Main Results:
There were 177 patients who met inclusion criteria, 92 (52%) male, with an overall mortality rate of 7% (n = 12). There were no differences in severity of illness scores or fluid overload on Day0 between peak fluid overload from ICU admission (Day0) to 48 hours (Day3–7) (n = 97; 55%) and peak fluid overload value after 48 hours of ICU admission (n = 80; 45%) groups. Peak fluid overload value after 48 hours of ICU admission was associated with a longer median ICU course (8 [4–15] vs 4 d [3–8 d]; p ≤ 0.001], hospital length of stay (18 [10–38) vs 12 [8–24]; p = 0.01], and increased risk of mortality (n = 10 [13%] vs 2 [2%]; χ2 = 7.6; p = 0.006]. ICU length of stay was also longer in the peak fluid overload value after 48 hours of ICU admission group when only patients with at least 7 days of ICU stay were analyzed (p = 0.02). Timing of negative fluid balance was also correlated with outcome. Compared with Day0–2, a negative daily fluid balance on Day3–7 was associated with increased length of mechanical ventilation (3 [1–7] vs 1 d [2–10 d]; p ≤ 0.001) and increased hospital (17 [10–35] vs 11 d [7–26 d]; p = 0.006) and ICU (7 [4–13] vs 4 d [3–7 d]; p ≤ 0.001) length of stay compared with a negative fluid balance between Day0–2.

Conclusions:
Our results show timing of fluid accumulation not just peak percentage accumulated is associated with patient outcome. Further exploration of the association between time and fluid accumulation is warranted.
Assessing the Key Predictors of an Academic Career after Craniofacial Surgery Fellowship
Authors: Luby Alexandra O. , Ranganathan Kavitha , Matusko Niki , Buchman Steven R. 
Published: September 2020

Background:
As craniofacial fellowship positions outnumber the availability of academic craniofacial jobs, it is important to understand the factors associated with securing an academic position after fellowship. The purpose of this study was to evaluate the impact of bibliometric indices and trainee demographics on the ability to obtain a full-time academic plastic surgery position on completion of a craniofacial fellowship.

Methods:
Craniofacial fellowship graduates between 2009 and 2018 (n = 182) were identified. Initial job placement and demographic data were collected; bibliometric indices at fellowship completion were calculated. Chi-square and Fisher’s exact tests and multivariable logistic regression were used to assess the association of select factors with job placement.

Results:
Of the 48.9 percent of fellows that secured academic positions, 39.3 percent trained at five fellowship institutions. The majority of those completing residency at top institutions for academic surgery and research entered academic positions at fellowship completion. Geography influenced academic placement, as 72.7 percent of trainees in the Northeast secured academic positions. Only 20.3 percent of fellows completed dedicated postgraduate research time, but among these, 70.3 percent entered academic jobs. The h-index (OR, 1.14; p = 0.01) and total manuscripts (OR, 1.04; p = 0.02) were significantly associated with academic practice while adjusting for other covariates.

Conclusions:
Although residency training institution, geographic location, and postgraduate research may influence academic placement, the h-index and total manuscripts represent the best predictors of academic careers after craniofacial fellowship. This information is valuable for applicants who aspire to be academic craniofacial surgeons, and for programs and educators who can use these data to identify applicants with a propensity for academics.
Predicting Sexually Transmitted Infections Among HIV+ Adolescents and Young Adults: A Novel Risk Score to Augment Syndromic Management in Eswatini
Authors: Thivalapill Neil , Jasumback Caitlyn L. , Perry Sarah H. , Dlamini Lindokuhle , Matsenjwa Martha , Masangane Zandile T. , Mavimbela Mpumelelo , Mthethwa Nobuhle , Kirchner H. Lester , Mphaya Joyce , Lukhele Bhekumusa , Mandalakas Anna , Kay Alexander W. 
Published: September 2020

Background:
Despite poor predictive power, syndromic screening is standard of care for diagnosing sexually transmitted infections (STIs) in low-resource, high HIV-burden settings. Predictive models may augment syndromic screening when diagnostic testing is not universally available for screening high-risk patient populations such as adolescents and young adults living with HIV.

Setting:
Four hundred fifteen adolescents and young adults living with HIV, age 15–24 years, participated from 3 clinical sites in Eswatini, provided urine, sexual and medical history, and completed physical examination.

Methods:
STI cases were defined by a positive Xpert result for Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis. Features predictive of an STI were selected through Least Absolute Shrinkage and Selection Operator (LASSO) with 5-fold cross validation. Various model strategies were compared with parametric area under the Receiver Operator Curve (AUC) estimation and inferences were made with bootstrapped standard errors.

Results:
Syndromic screening poorly predicted STIs [AUC 0.640 95% Confidence Interval (95% CI): 0.577 to 0.703]. A model considering 5 predictors (age group, sex, any sexual activity, not always using condoms (either self or partner), a partner who was 25 years or older, and horizontal or unknown mode of HIV acquisition) predicted STIs better than syndromic screening [AUC: 0.829 (95% CI: 0.774 to 0.885)] and was improved when the risk score was supplemented with leukocyte esterase (LE) testing [AUC: 0.883 (95% CI: 0.806 to 0.961)].

Conclusions:
This simple predictive model, with or without leukocyte esterase testing, could improve STI diagnosis in HIV-positive adolescents and young adults in high burden settings through complementary use with syndromic screening and to guide patient selection for molecular STI diagnostic tests.
Comparative Study on the Efficacy of Frozen Amniotic Membrane Transplantation and Lamellar Keratoplasty in the Treatment of Mooren Ulcer
Authors: Chen Yingxin , Gao Ruiyao , Gao Minghong , Liu Qiming , Song Lixin 
Published: September 2020

Objective:
To compare of the clinical efficacy of frozen amniotic membrane transplantation (AMT) and lamellar keratoplasty (LKP) in the treatment of Mooren ulcer.

Method:
Forty patients (42 eyes) with Mooren's ulcer in our hospital from January 2010 to January 2019 were divided into frozen AMT group (20 eyes) and LKP group (22 eyes). Comparative observation of post-operative best corrected visual acuity (BCVA), corneal epithelial healing time, corneal epithelialization time, ulcer healing, corneal transparency, corneal graft transparency, neovascularization and original disease recurrence were observed.

Results:
The average BCVA at post-operative 6 and 12 months in LKP group were significantly lower than AMT group (P < 0.05). The ulcer healing rates in LKP group (63.6) were significantly higher than AMT group (30) (P < 0.05). The corneal epithelialization time of LKP group were 9.55 ± 1.26 days. The corneal epithelial healing time of AMT group were 13.50 ± 2.21 days. Nine cases were corneal graft transparency grade 0, and 13 cases were grade I. Three eyes in AMT group were corneal transparency grade 0, 7 were grade I and 10 were grade II. Corneal neovascularization were observed in 3 eyes in AMT group and 4 eyes in LKP group. The original disease recurrence rates in LKP group (50) were significantly higher than AMT group (20) (P < 0.05). Four cases of primary corneal transplantation failure were observed in LKP group.

Conclusion:
Lamellar keratoplasty group obtained significantly better BCVA during follow-up and faster healing time than the frozen AMT group while frozen AMT group had lower original disease recurrence rates than LKP group.
The Pyramid Chin Augmentation: A New Technique
Authors: Ramieri Valerio , Maffìa Francesco , Vellone Valentino , Marianetti Sara , Marianetti Tito M. 
Published: September 2020

Abstract
The surgical approach to chin for esthetical purpose can be isolated or in a combination with other treatments like maxillomandibular surgery. Both possibilities include sliding genioplasty or implants of autologous or alloplastic materials. In this article, the authors present their new technique, the Pyramid Chin Augmentation.
In January 2020, a 40-year-old male patient came to authors’ observation asking for a great augmentation in the sagittal dimension of the chin, a better pronunciation of mandibular angles and of his cheekbones. The surgical treatment consisted in three different procedures at the same time: a chin wing osteotomy, a Pyramid Chin Augmentation and zygomatic PEEK custom-made malar implants. The pyramid was created on the body of the chin wing with a cortical bone graft from the oblique line of the ascending ramus of the mandible. The harvested bone was cut into strips of rectangular shape gradually shorter to be superimposed on the wing forming a pyramid. A fixation with 2 screws was performed and then was necessary to smoothen the edges of the bone layers.
The result immediately after the end of the surgery was in line with the set goals. The mandibular angles were more prominent, the chin was more sagittal pronounced, and there was no evidence of depression in the symphysial region.
The Pyramid Chin Augmentation Technique can be a valid tool in chin augmentation surgery and can also represent an effective procedure in the finishing touch of other facial surgery techniques.
Oxy-right Ventricular Assist Device for Bridging of Right Heart Failure to Lung Transplantation
Authors: Lee Sung Kwang , Kim Do Hyung , Cho Woo Hyun , Yeo Hye Ju 
Published: September 2020

Background.
Right heart failure develops in lung transplantation candidates on extracorporeal membrane oxygenation (ECMO) support and increases mortality. The safety and feasibility of the oxy-right ventricular assist device (oxyRVAD) as a bridge to lung transplantation in severe right heart failure caused by terminal lung disease have not been evaluated.

Methods.
We retrospectively reviewed 14 patients who used oxyRVAD for bridging of right heart failure to lung transplantation.

Results.
The major cause of lung transplantation was acute exacerbation of interstitial lung disease (78.6%), and the median venovenous ECMO duration was 7 d. Before oxyRVAD, median mean pulmonary artery pressure was 60.5 mm Hg (interquartile range [IQR], 54–68), and the median peak tricuspid regurgitation velocity was 3.9 m/s (IQR, 3.7–4.1). After oxyRVAD conversion, median mean pulmonary artery pressure was 60.5 mm Hg (IQR, 57.3–65), and the median peak tricuspid regurgitation velocity was 2.9 (IQR, 2.6–3.2). All patients were hemodynamically stable (median arterial blood pressure, 83 mm Hg; median heart rate, 79 bpm). Three patients developed pulmonary congestion (21.4%), and all patients stabilized within 24 h. Active rehabilitation during ECMO was possible in all patients, and the median duration of awake state during ECMO was 14 d. A total of 10 patients were bridged successfully to lung transplantation, and hospital survival rates were 90%.

Conclusions.
OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.