bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcomes after operative treatment for tibial pilon fractures
Authors: van der Vliet Quirine M.J. , Ochen Yassine , McTague Michael F. , Weaver Michael J. , Hietbrink Falco , Houwert Roderick M. , Leenen Luke P.H. , Heng Marilyn 
Published: November 2019

AbstractObjectives:Aims of the present study were to establish generalizable outcome data on long-term functional outcomes and health-related quality of life (HRQoL) after operative treatment of pilon fractures on a large scale. Second, it was aimed to examine factors associated with these outcomes.Design:Retrospective cohort study with follow-up by questionnaire.Setting:Two level 1 trauma centers.Patients:Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%).Intervention:Open reduction internal fixation for tibial pilon fracture.Main outcome measurements:Ankle function measured using the Foot and Ankle Ability Measure, physical function using the Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire and HRQoL using the EuroQol 5-Dimensions 3-Level (EQ-5D-3L) questionnaire.Results:At a medium follow-up of 82 months (82 (interquartile range (IQR), 45–120), median Foot and Ankle Ability Measure was 74 (IQR, 57–82), median PROMIS PF 49 (IQR, 44–57), median EQ-5D-3L 0.81 (IQR, 0.71–0.84). HRQoL was significantly lower compared to a reference population (P < .001). In multivariable regression analyses, smoking was associated with poorer HRQoL. Higher body mass index, deep infection, and lower HRQoL were associated with worse ankle function.Conclusions:Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context.Level of evidence:Prognostic level III.
Resistance Mechanisms to Targeted Agents in Chronic Lymphocytic Leukemia
Authors: Kittai Adam S. , Woyach Jennifer A. 
Published: November 2019

Abstract
Agents that specifically target pathologic mechanisms of survival have now been approved for the treatment of chronic lymphocytic leukemia in both the treatment-naive and relapsed/refractory settings. These 4 agents include the Bruton tyrosine kinase inhibitor ibrutinib, the B-cell leukemia/lymphoma-2 inhibitor venetoclax, and the phosphatidylinositol-3 kinase inhibitors idelalisib and duvelisib. Although clinical outcomes are improved with all of these inhibitors, acquired resistance does occur and leads to progression of disease. Resistance to targeted therapy can occur through direct mutations of the target or through the overexpression of alternative cell survival pathways not affected by the specific inhibitor. Determining which patients will develop resistance, why resistance occurs, how to overcome resistance, and when to test for resistance are all subjects of ongoing research. In this review, we describe the current data relative to the development of resistance to targeted therapies in CLL.
Interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: protocol for a systematic scoping review
Authors: Park Rex , Mohiuddin Mohammed , Poulin Patricia , Salomons Tim , Edwards Robert , Nathan Howard , Haley Chris , Gilron Ian 
Published: November 2019

Abstract

Introduction:
Most current chronic pain treatment strategies have limitations in effectiveness and tolerability, and accumulating evidence points to the added benefits of rational combinations of different therapies. However, most published clinical trials of treatment combinations have involved combinations of 2 drugs, whereas very little research has been performed to characterize interactions between drug and nondrug interventions. Mindfulness-based interventions (MBIs) have been emerging as a safe and potentially effective treatment option in the management of chronic pain, but it is unclear how MBIs can and should be integrated with various other pain treatment interventions. Thus, we seek to review available clinical trials of MBIs for chronic pain to evaluate available evidence on the interactions between MBIs and various pharmacological treatments.

Methods:
A detailed search of trials of MBIs for the treatment of chronic pain in adults will be conducted on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO from their inception until the date the searches are run to identify relevant randomized controlled trials. Primary outcomes will include the following: (1) what concomitant analgesic drug therapies (CADTs) were allowed; (2) if and how trials controlled for CADTs and analyzed their interaction; and (3) results of available analyses of interactions between the MBI and CADT.

Perspective:
This review is expected to synthesize available evidence describing the interactions between MBIs and various studied drug therapies for chronic pain. Available evidence may help inform the rational integration of MBIs with drug therapy for chronic pain.
Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis
Authors: Powcharoen Warit , Yang Wei-fa , Yan Li Kar , Zhu Wangyong , Su Yu-xiong 
Published: November 2019

Background:
Computer-assisted mandibular reconstruction facilitates preoperative surgery simulation and transfers the virtual plan to a real operation. This systematic review and meta-analysis aimed to compare the accuracy, efficiency, postoperative complications, and economic viability between computer-assisted mandibular reconstruction and conventional freehand mandibular reconstruction.

Methods:
The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched up to November of 2018. The accuracy, efficiency, postoperative complications, and economic viability of computer-assisted mandibular reconstruction compared to conventional freehand mandibular reconstruction were systematically reviewed. Continuous and dichotomous data were pooled in mean difference (or standardized mean difference if necessary) and odds ratio, subsequently, with 95 percent confidence interval.

Results:
A total of 12 studies were included in the systematic review, and data extracted from 11 of them were combined in meta-analysis. The accuracy of computer-assisted mandibular reconstruction was better than or equal to that of conventional freehand mandibular reconstruction according to qualitative analysis, although the quantitative comparison from meta-analysis was excluded because of the diversity of measurements. As for efficiency, computer-assisted mandibular reconstruction, when compared to conventional freehand mandibular reconstruction, revealed a shorter ischemic time, reconstructive time, total operative time, and length of stay. There was no difference in postoperative complication rate.

Conclusions:
Computer-assisted mandibular reconstruction showed increased efficiency considering the reduced ischemic time, total operative time, reconstructive time, and length of stay. However, the accuracy, reconstruction outcomes, and perioperative cost should be further elucidated because of diverse measurements and the lack of included studies.
The Efficacy of Platelet-Rich Plasma Dressing for Chronic Nonhealing Ulcers: A Meta-Analysis of 15 Randomized Controlled Trials
Authors: Xia YiJun , Zhao Jun , Xie Juan , Lv Yang , Cao Dong Sheng 
Published: November 2019

Background:
Several randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds have been published. Previous articles have revealed that the role of platelet-rich plasma in promoting chronic wound healing is uncertain. This quantitative meta-analysis was conducted to evaluate whether superior outcomes can be obtained by using platelet-rich plasma in nonhealing ulcers compared with traditional wound care.

Methods:
The PubMed, EMBASE, EBSCO (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases were searched through November of 2018 for randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds. For binary outcome measures, we calculated the risk ratio. The continuous outcomes were expressed as the mean differences. Subgroup analyses were also performed according to the type of chronic ulcer.

Results:
Overall, 630 adult patients in 15 randomized controlled trials from 2000 to 2018 were included. The number of ulcers healed in the platelet-rich plasma group was higher than in the control group, and the difference was statistically significant (risk ratio, 1.26; 95 percent CI, 1.11 to 1.42; p = 0.0003). During the fourth week of follow-up, the number of ulcers healed in the platelet-rich plasma group was significantly greater than in the control group (risk ratio, 3.50; 95 percent CI, 1.80 to 6.81; p = 0.0002).

Conclusions:
Platelet-rich plasma is a valuable and safe treatment dressing for chronic nonhealing ulcers; it is simple to prepare and has remarkable effects. Further high-quality prospective studies are necessary to validate these results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Polydioxanone Threads for Facial Rejuvenation: Analysis of Quality Variation in the Market
Authors: Aitzetmueller Matthias M. , Centeno Cerdas Carolina , Nessbach Phillipp , Foehr Peter , Brett Elizabeth , Thor Dominik , Machens Hans-Guenther , Burgkart Rainer , Duscher Dominik 
Published: November 2019

Background:
Beside botulinum-toxin injections and hyaluronic acid fillers, thread lifts have established themselves as the third column of minimally invasive facial rejuvenation. Most commonly, barbed threads for this approach are made out of polydioxanone, a material known for decades from application in resorbable sutures. The clinical efficacy and the putative material safety of polydioxanone have fueled the popularity of thread lifts.

Methods:
The present study highlights significant variation among six commercially available threads in microstructure, tensile strength, elasticity, anchoring capacity in human tissue, and biocompatibility.

Results:
Despite their license to be marketed and sold in the European Union, some products performed significantly worse than others on material testing, and even displayed cytotoxic characteristics.

Conclusion:
The results of this study are highly relevant for clinicians and may be linked to various typical side effects of polydioxanone threads for facial rejuvenation.
Left ventricular diastolic dysfunction in HIV-uninfected infants exposed in utero to antiretroviral therapy
Authors: Lipshultz Steven E. , Sasaki Nao , Thompson Bruce , Eidem Benjamin W. , Cheng Irene , Colan Steven D. , O’Brien Sharon E. , Amdani Shahnawaz , Shearer William T. , Orav Endel John , Miller Tracie L. , Wilkinson James D. 
Published: November 2019

Objectives:
To longitudinally measure LV diastolic function in HIV-exposed but uninfected (HEU) children perinatally exposed to ART.

Design:
HEU children who were perinatally exposed to antiretroviral therapy (ART) may be at risk for adverse cardiac effects. We have previously reported that those children have decreased left ventricular (LV) mass, dimension, and septal thickness with increased contractility.

Methods:
Serial echocardiograms were obtained at specific times from birth to 48 months from two groups of HIV-uninfected children: 148 HIV-negative children who were perinatally exposed to ART and 130 non-ART-exposed HIV-unexposed healthy controls. The following LV diastolic indices were obtained: mitral valve early and late diastolic velocity (E and A), tissue Doppler-derived LV-free wall and septal early diastolic velocity (LV e′ and sep e′).

Results:
All echocardiographic indices were significantly different in ART-exposed children compared with ART-unexposed healthy controls. Both E and A were overall lower at all ages by 8.28 cm/s (P = 0.0002) and 13.46 cm/s (P < 0.0001) respectively. E/A ratio was higher by 0.27, 0.46, and 0.28 units at birth, 1 year and 2 years of age, respectively (all P ≤ 0.01). Moreover, LV e′ and sep e′ were overall lower at all ages by 0.84 cm/s (P = 0.01) and 0.47 cm/s (P = 0.02), respectively.

Conclusion:
Children who were exposed to ART in utero have subclinical yet significant differences in specific LV diastolic indices. Follow-up with serial echocardiograms are recommended in this population to further assess the potential cardiac toxicity of perinatal exposure to ART.
Insights for Implementation Science From 2 Multiphased Studies With End-Users of Potential Multipurpose Prevention Technology and HIV Prevention Products
Authors: Minnis Alexandra M. , Montgomery Elizabeth T. , Napierala Sue , Browne Erica N. , van der Straten Ariane 
Published: November 2019

Background:
Lower adherence to biomedical HIV prevention and challenges with persistence among young women underscore the need for methods to identify factors that will achieve higher adoption and use of effective prevention options and inform new approaches.

Setting:
South Africa, Kenya, and Zimbabwe.

Methods:
We synthesized findings from 2 multiphased studies (TRIO and Quatro) conducted with young women aged 18–30 years that included a crossover clinical study with placebo products, a discrete-choice experiment, and qualitative interviews with women, male partners, and health providers. TRIO evaluated 3 products (tablets, ring, and injections), and Quatro compared 4 vaginal products (ring, insert, film, and gel) for HIV prevention. Both were designed to assess product preferences, choice, and use.

Results:
Increased experience with placebo products in the crossover study informed young women's product ratings and preferences. Over half changed their mind regarding their most preferred product after trying each one. The integrated qualitative component was vital to understanding what prompted these preference shifts. The discrete choice experiment provided insights on how features not available in placebos, like efficacy and contraception, influence choice and the tradeoffs women may be willing to make to gain a desired product feature.

Conclusion:
The use of multiple research methods allowed for evaluation of varied dimensions of acceptability, preference, and choice in the context of diverse biomedical HIV prevention delivery forms. Findings elucidated the value of product choice with differences in preference within and across settings. Collectively, the 3 methodologies offered important insights about these products informative to enhanced product design development and future implementation.
Cascade Analysis: An Adaptable Implementation Strategy Across HIV and Non-HIV Delivery Platforms
Authors: Wagner Anjuli D. , Gimbel Sarah , Ásbjörnsdóttir Kristjana H. , Cherutich Peter , Coutinho Joana , Crocker Jonny , Cruz Emilia , Cuembelo Fatima , Cumbe Vasco , Eastment McKenna , Einberg Jennifer , Floriano Florencia , Gaitho Douglas , Guthrie Brandon L. , John-Stewart Grace , Kral Alex H. , Lambdin Barrot H. , Liu Shan , Maina Martin , Manaca Nelia , Matsuzaki Mika , Mattox Loris , Mburu Nancy , McClelland R. Scott , Micek Mark A. , Mocumbi Ana Olga , Muanido Alberto , Nduati Ruth , Njuguna Irene N. , Oluoch Geoffrey , Oyiengo Laura B. , Ronen Keshet , Soi Caroline , Wagenaar Bradley H. , Wanje George , Wenger Lynn D. , Sherr Kenneth 
Published: November 2019

Background:
Cascades have been used to characterize sequential steps within a complex health system and are used in diverse disease areas and across prevention, testing, and treatment. Routine data have great potential to inform prioritization within a system, but are often inaccessible to frontline health care workers (HCWs) who may have the greatest opportunity to innovate health system improvement.

Methods:
The cascade analysis tool (CAT) is an Excel-based, simple simulation model with an optimization function. It identifies the step within a cascade that could most improve the system. The original CAT was developed for HIV treatment and the prevention of mother-to-child transmission of HIV.

Results:
CAT has been adapted 7 times: to a mobile application for prevention of mother-to-child transmission; for hypertension screening and management and for mental health outpatient services in Mozambique; for pediatric and adolescent HIV testing and treatment, HIV testing in family planning, and cervical cancer screening and treatment in Kenya; and for naloxone distribution and opioid overdose reversal in the United States. The main domains of adaptation have been technical—estimating denominators and structuring steps to be binary sequential steps—as well as logistical—identifying acceptable approaches for data abstraction and aggregation, and not overburdening HCW.

Discussion:
CAT allows for prompt feedback to HCWs, increases HCW autonomy, and allows managers to allocate resources and time in an equitable manner. CAT is an effective, feasible, and acceptable implementation strategy to prioritize areas most requiring improvement within complex health systems, although adaptations are being currently evaluated.
Tenascin C Plasma Levels in Critically Ill Patients with or Without Sepsis: A Multicenter Observational Study
Authors: Meijer Mariska T. , Uhel Fabrice , Cremer Olaf L. , Schultz Marcus J. , van der Poll Tom 
Published: November 2019

ABSTRACTTenascin C (TNC) is an extracellular matrix protein able to modulate the immune response. Knowledge regarding its role during sepsis and general critical illness is still limited. We here assessed the temporal dynamics of plasma TNC during sepsis and nonseptic critical illness, its capacity to predict patient outcome, and its specificity toward infection. TNC plasma concentrations were measured in 895 consecutive sepsis patients on ICU admission, day 2 and 4 thereafter, and, in a subset, before ICU discharge. To assess TNC diagnostic value, we compared patients with abdominal sepsis (N = 143) to noninfectious abdominal surgery controls (N = 98), and patients with severe community-acquired pneumonia (CAP, N = 227) to patients whose CAP diagnosis was retrospectively refuted (no-CAP controls, N = 70). Plasma TNC levels were persistently elevated in sepsis patients compared with healthy volunteers throughout the ICU stay. TNC levels varied by the site of infection and increased with the number of organs failing. Association of TNC levels with 30-day mortality could be wholly attributed to differences in disease severity. Noninfectious ICU patients also showed elevated TNC levels, albeit with different temporal dynamics. Although admission TNC was higher in CAP than in no-CAP patients, it performed poorly in distinguishing the 2 groups.TNC plasma levels are persistently elevated during sepsis and nonseptic critical illness. In sepsis patients, they are reflective of disease severity more than independent predictors of mortality. Despite higher levels in patients with infection compared with noninfectious controls, TNC does not perform sufficiently to be used as a standalone biomarker discriminating sepsis from noninfectious critical illness.
Complete Uniportal Thoracoscopic Anatomic Lung Resection With Systematic Mediastinal Lymphadenectomy for Non–Small Cell Lung Cancer: Personal Experience of 326 Cases
Authors: Deng Youjun , Wang Jiaqing , Mu Juwei , Wang Zheng , Wang Guangsuo 
Published: November 2019

Background:
With its growing popularity and potential outcome, complete uniportal thoracoscopic (CUT) surgery has been used in the treatment of thoracic diseases. This study aimed to summarize a personal experience of CUT anatomic lung resection with systematic mediastinal lymphadenectomy (CUT-ALR-SML) for non–small cell lung cancer (NSCLC) and to evaluate the feasibility and safety of CUT-ALR-SML in our institute.

Materials and Methods:
A total of 326 patients with NSCLC were chosen to undergo CUT-ALR-SML in our institute from August 2013 to July 2018. Data such as clinicopathologic characteristics and perioperative outcomes were reviewed in this article.

Results:
For the 326 cases of ALR, the specific procedures and the corresponding number of cases were as follows: segmentectomy, 90; lobectomy, 218; sleeve lobectomy, 9; ipsilateral lobe combined with segment resected synchronously (i-L+S), 6; and pneumonectomy, 3. A total of 31 cases required conversion to open surgery, and 4 cases were converted to multiportal thoracoscopic surgery. All patients underwent SML. The average mediastinal lymph node stations and mediastinal lymph nodes dissected under CUT-ALR-SML were 3.3±1.4 and 9.6±8.4, respectively. Approximately 99.7% of the patients acquired free resection margins. A total of 42 (12.9%) patients suffered from postoperative complications, and 1 patient died of pneumonia during the perioperative period.

Conclusions:
Complete uniportal ALR, particularly for segmentectomy and lobectomy is safe and feasible with low complication rates and excellent free resection margin rates. SML during complete uniportal thoracoscopic surgery adequately assesses the N2 lymph node. However, further studies need to be conducted to evaluate the role of CUT-ALR-SML in the treatment of NSCLC.
Pretransplant Opioid Use and Survival After Lung Transplantation
Authors: Vahidy Sana , Li David , Hirji Alim , Kapasi Ali , Weinkauf Justin , Laing Bryce , Lien Dale , Halloran Kieran 
Published: November 2019

Background.
The impact of opioid use in lung transplant candidates on posttransplant outcomes is unknown. Studies on opioid therapy in kidney and liver transplant candidates have suggested increased risk of graft failure or death. We sought to analyze the relationship between pretransplant opioid use in lung transplant candidates and retransplant-free survival.

Methods.
We retrospectively reviewed adult patients transplanted consecutively between November 2004 and August 2015. The exposure was any opioid use at time of transplant listing and primary outcome was retransplant-free survival, analyzed via Cox regression model adjusted for recipient age, gender, ethnicity, diagnosis, and bridging status. Secondary outcomes included duration of ventilation, intensive care unit and hospital length of stay, 3-month and 1-year survival, continuing opioid use at 1 year, and time to onset of chronic lung allograft dysfunction.

Results.
The prevalence of opioid use at time of listing was 14% (61/425). Median daily oral morphine equivalent dose was 31 mg (18–54). Recipient ethnicity was associated with pretransplant opioid use. Opioid use at time of listing did not increase risk of death or retransplantation in an adjusted model (hazard ratio 1.12 [95% confidence interval 0.65-1.83], P = 0.6570). Secondary outcomes were similar between groups except hospital length of stay (opioid users 35 versus nonusers 27 d, P = 0.014). Continued opioid use at 1-year posttransplant was common (27/56, 48%).

Conclusions.
Pretransplant opioid use was not associated with retransplant-free survival in our cohort and should not necessarily preclude listing. Further work stratifying opioid use by indication and the association with opioid use disorder would be worthwhile.