bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine Therapeutic Drug Monitoring of Dabigatran: Experience at a Tertiary Center
Authors: Chin Paul Ken Leong , McNeill Richard , Lee Hyun Kyoung , Zhang Mei , Jensen Berit , Smith Mark , Doogue Matthew P. 
Published: November 2019

Background:
A liquid chromatography-mass spectrometry assay to determine plasma dabigatran concentrations has been available for routine clinical use at our tertiary institutions since 2017. The aim of the study was to describe (1) the use of the assay over time; (2) the indications for testing; and (3) subsequent dabigatran prescribing decisions.

Methods:
Patients for whom dabigatran concentrations were measured were identified using the laboratory database, and clinical data were extracted from the associated electronic health records.

Results:
There were 233 samples in 24 months. The use of dabigatran increased over time, with a mean (95% confidence interval) increase of +0.5 (0.3–0.7) samples per month. Dabigatran concentrations ranged from <1 to 1060 mcg/L. The main reasons for testing were uncertainty about impact on renal function and drug interactions (39%), to inform prescribing decisions after thromboembolic or bleeding events (21%), and for investigation following dose-adjustment (16%). Dabigatran dose was changed after 30% (68/233) of assay results.

Conclusions:
The clinical use of the dabigatran assay has increased, with almost one-third of results associated with a subsequent change in dabigatran prescribing.
International Expert Panel Consensus on Fat Grafting of the Breast
Authors: Nava Maurizio B. , Blondeel Phillip , Botti Giovanni , Casabona Francesco , Catanuto Giuseppe , Clemens Mark W. , De Fazio Domenico , De Vita Roy , Grotting James , Hammond Dennis C. , Harris Paul , Montemurro Paolo , Mendonça Munhoz Alexandre , Nahabedian Maurice , Pompei Stefano , Rancati Alberto , Rigotti Gino , Salgarello Marzia , Scaperrotta Gianfranco , Spano Andrea , Stan Costantin , Rocco Nicola 
Published: November 2019

Background:
Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018).

Methods:
All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 “key questions” that were used for the Survey. The authors prepared a set of 10 “key statements” that have been discussed in a dedicated face-to-face session during the meeting.

Results:
The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements.

Conclusions:
The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.
Comparisons of Manual Tape Measurement and Morphomics Measurement of Patients with Upper Extremity Lymphedema
Authors: Horbal Steven R. , Chu Sung-Yu , Wang Nicholas C. , Chan Wen-Hui , Huang Yen-Ling , Brown Edward , Holcombe Sven A. , Cederna Paul S. , Wang Stewart C. , Cheng Ming-Huei 
Published: November 2019

Background:
Lymphedema is a debilitating condition characterized by swelling from lymph fluid exceeding transport capacity. A gold standard for arm measurement is not established, and measurement methods vary. This study evaluates the comparability of the tape measure and Analytic Morphomics in deriving limb circumference measurements in patients with upper extremity lymphedema.

Methods:
Fifteen participants with diagnosed upper limb lymphedema were included between July 2013 and June 2017 at Chang Gung Memorial Hospital in Taipei, Taiwan. Affected and unaffected arm circumferences were measured using a flexible tape or morphomic measurement at 10 cm above and below the elbow. Computed tomography scans were standardized, processed, smoothed with a piecewise polynomial algorithm for Analytic Morphomics of arm circumference. Comparative plots, mean percent difference, and adjusted coefficient of determination (R
2) were utilized to compare the consistency of both measurement procedures.

Results:
The tape measure and Analytic Morphomics demonstrated consistent measures of arm circumference. On the affected arm, the mean (95% CI) difference in arm circumference between methods was 1.60 cm (0.99–2.20) above, and 0.57 cm (0.23–0.91) below the elbow. Mean percent differences in circumference was 6.65% (SD 3.52%) above and 1.38% (SD 2.11%) below the elbow. The adjusted R
2 for both methods was 94% above and 96% below the elbow.

Conclusions:
Analytic Morphomics showed strong consistency with the manual tape measure of arm circumference measurement in those with upper extremity lymphedema. Analytic Morphomics present an opportunity for a precise, granular measurement of limb composition for assessment of disease state and patient planning.
Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis
Authors: Berthelot Melissa , Ashcroft James , Boshier Piers , Hunter Judith , Henry Francis Patrick , Lo Benny , Yang Guang-Zhong , Leff Daniel 
Published: November 2019

Background:
Failure to accurately assess the perfusion of free tissue transfer (FTT) in the early postoperative period may contribute to failure, which is a source of major patient morbidity and healthcare costs. This systematic review and meta-analysis aim to evaluate and appraise current evidence for the use of near-infrared spectroscopy (NIRS) and/or implantable Doppler (ID) devices compared with conventional clinical assessment (CCA) for postoperative monitoring of FTT in reconstructive breast surgery.

Methods:
A systematic literature search was performed in accordance with the preferred reporting items for systematic reviews guidelines. Studies in human subjects published within the last decade relevant to the review question were identified. Meta-analysis using random-effects models of FTT failure rate and STARD scoring was then performed on the retrieved publications.

Results:
Nineteen studies met the inclusions criteria. For NIRS and ID, the mean sensitivity for the detection of FTT failure is 99.36% and 100% respectively, with average specificity of 99.36% and 97.63%, respectively. From studies with sufficient reported data, meta-analysis results demonstrated that both NIRS [OR = 0.09 (0.02–0.36); P < 0.001] and ID [OR = 0.39 (0.27–0.95); P = 0.04] were associated with significant reduction of FTT failure rates compared with CCA.

Conclusions:
The use of ID and NIRS provided equivalent outcomes in detecting FTT failure and were superior to CCA. The ability to acquire continuous objective physiological data regarding tissue perfusion is a perceived advantage of these techniques. Reduced clinical staff workload and minimized hospital costs are also perceived as positive consequences of their use.
Terri Coutee: ASPS Patient of Courage, 2018
Authors: Chrysopoulo Minas T. 
Published: November 2019

Summary:
Mrs. Terri Coutee was selected as an American Society of Plastic Surgeons (ASPS) Patient of Courage in 2018. Following successful treatment of her second breast cancer, which included a double nipple-sparing mastectomy and delayed deep inferior epigastric perforator (DIEP) flap breast reconstruction, Terri changed her career path from teaching to patient advocacy. In 2016, she launched DiepCFoundation.org, a non-profit organization that provides education, support, resources, and a community for women and men seeking information about breast reconstruction after mastectomy. Today, DiepCFoundation connects patients and physicians on a global scale, fostering a shared decision-making approach to breast reconstruction.
Management of Locked Volar Radio-ulnar Joint Dislocation
Authors: Starnoni Marta , Colzani Giulia , De Santis Giorgio , Leti Acciaro Andrea 
Published: November 2019

Summary:
Isolated volar dislocation of the distal radio-ulnar joint is an extremely rare lesion. Diagnosis is commonly missed. The authors report their experience about a case of an acute locked volar distal radio-ulnar joint dislocation. A correct clinical and radiological diagnosis was done in the Emergency Department, and a closed reduction was achieved only after an axillary block, after a first failed attempt under slight sedation. A K-wire blocking the prono-supination and a short removable forearm cast protected the reduction for 25 days. Two weeks after the removal of the immobilization, the patient presented a complete functional recovery, with full range of motion. The authors highlight the importance of the clinical and radiological findings: a dorsal dimple at the ulnar side leads to a high index of suspicion, and represent the most relevant aid in diagnosis, associated to a proper imaging assessment. Prompt management allows a minimally invasive approach and a rapid functional recovery.
A Meta-analysis of Clinical, Patient-Reported Outcomes and Cost of DIEP versus Implant-based Breast Reconstruction
Authors: Khajuria Ankur , Prokopenko Max , Greenfield Max , Smith Oliver , Pusic Andrea L. , Mosahebi Afshin 
Published: November 2019

Introduction:
Comparative data on clinical outcomes and cost of deep inferior epigastric perforator (DIEP) and implant-based reconstruction (IBR) are limited. We conducted a Preferred Reporting Items for Systematic Review and Meta-analysis-compliant systematic review and meta-analysis to compare clinical, patient-reported outcomes (PROs) and cost.

Methods:
The protocol was published a priori on PROSPERO (CRD42017072557). EMBASE, MEDLINE, Google Scholar, Cochrane Controlled Register of Trials, Science Citation Index, and ClinicalTrials.gov were searched from January 1994 to August 2018. Two independent reviewers evaluated the articles for inclusion. Study quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation, and risk of bias (RoB) was assessed using Cochrane’s RoB in Nonrandomized Studies of Interventions tool.

Results:
Out of 6,381 articles screened, 16 were included [unilateral 782 DIEPs, 376 implants; mean age 49 years, follow-up (months): DIEP 29.9; IBR 35.5]. Mean flap loss and fat necrosis rates were 3.97% (SD 4.90) and 9.67% (SD 17.0), respectively. There was no difference in mean length of stay {standard mean difference 0.63 [confidence interval (CI) −9.17 to 10.43]; P =0.90}. The number of reoperations for complications was significantly lower in DIEP versus IBR [SMD −0.29 (CI −0.48 to −0.09); P < 0.01]. There were no randomized controlled trials. Study quality was low with high RoB. One study reported $11,941/Quality-adjusted Life Year incremental cost-effectiveness ratio for DIEP, with higher breast Quality-adjusted Life Year (DIEP 19.5; IBR 17.7) using Breast Questionnaire; 3 studies evaluated cost, favoring DIEP. Two comparative studies evaluating PROs favored DIEP.

Conclusions:
DIEP reconstruction maybe more cost-effective and yield superior PROs. However, poor-quality, bias-ridden studies limit the findings. Adequate reporting of core outcome measures is required to minimize reporting bias and facilitate evidence synthesis. Prospective, multicenter, cohort studies using robust patient-reported outcome measures (PROMs) tools, evaluating cost-effectiveness and contributing to national/international registries, will facilitate national-level policy and shared decision-making.
Intersection-splitting Deep Inferior Epigastric Perforator Flap
Authors: Andejani Doaa F. , AlThubaiti Ghazi A. 
Published: November 2019

Summary:
Preserving a dynamic abdominal wall is the premise behind the evolution of TRAM flaps into deep inferior epigastric perforators (DIEPs). Performing a true DIEP flap requires a highly refined surgical technique and often times involves a tedious intramuscular dissection which may account for the slow, albeit steady adaptation of DIEPs in breast reconstruction. This article intends to address a scenario in which an additional perforator from a different row is needed. Based on our current knowledge of the abdominal wall and its embryology, we propose splitting the rectus abdominis muscle through the intersections while recruiting a second perforator instead of converting the procedure into MS-TRAM or performing a second anastomosis through the perforator exchange technique, APEX. This potentially saves time and simplifies the procedure while maintaining the integrity of the abdominal wall.
“Get a Grip on Hypertension”
Authors: Gordon Benjamin D. H. , Whitmire Sarah , Zacherle Emily W. , Doyle Shelton , Gulati Sanjeev , Leamy Larry J. , Marino Joseph S. , Bennett Jeanette M. , Reitzel Adam M. , Swaine Ian L. , Howden Reuben 
Published: November 2019

Purpose:Isometric handgrip (IHG) training lowers systolic and diastolic blood pressure (SBP and DBP, respectively), but the efficacy of IHG training in cardiopulmonary rehabilitation patients is unknown. The purpose of this study was to determine if IHG decreases blood pressure in cardiopulmonary rehabilitation patients.Methods:Cardiopulmonary rehabilitation program participants (n = 11; 50-80 yr old) were randomized to IHG (n = 6) or control (CON; no treatment; n = 5) groups. IHG participants completed an IHG training program at 30% maximal voluntary contraction, 3 d/wk for 6 wk. Resting SBP, DBP, and heart rate were assessed weekly.Results:Mean regression for SBP following IHG was negative (−1.04 ± 0.80). Mean regression in the CON group was positive (0.50 ± 0.88), but there was no significant difference between groups. Separate analysis of weeks 1 to 7 yielded a negative mean regression (−1.12 ± 0.54) in the IHG group, but positive (1.2 ± 0.60) in the CON group. A Wilcoxon test of these differences yielded significance for SBP (P= .009). In 3 of 6 IHG participants, SBP was lower (mean ± SD: −16 ± 11 mm Hg;P= .12), and in 2 IHG participants, DBP was lower (−9 ± 1 mm Hg;P= .06) compared with baseline. In 2 of 5 CON participants, SBP was not significantly lower (−11 ± 7 mm Hg) and, in 3 of 5 CON participants, DBP was lower (−7 ± 4 mm Hg;P= .04).Conclusions:Our data suggest that standard IHG training may be inadequate for blood pressure management immediately following a major cardiac or pulmonary event. Future work with a larger cohort and more developed training protocol to determine the efficacy of IHG training in patients with cardiopulmonary disease is warranted.
A NOVEL FINDING OF HYPERREFLECTIVE MATERIAL IN THE SILICONE-RETINA INTERFACE
Authors: Trivizki Omer , Zur Dinah , Goldenberg Dafna , Rabina Gilad , Fleissig Efrat , Barak Adiel , Shulman Shiri , Loewenstein Anat , Schwartz Shulamit 
Published: November 2019

Purpose:
To describe novel findings of hyperreflective material in the silicone-retina interphase on spectral domain optical coherence tomography (SD-OCT) imaging in eyes with silicone oil tamponade.

Methods:
Retrospective observational clinical study of consecutive patients who underwent primary pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. Repeat clinical examination and spectral domain optical coherence tomography macular imaging performed 3 months after surgery were evaluated to identify any macular pathologies, including formation of epiretinal membranes, intraretinal changes, subretinal fluid, and edema before scheduled secondary vitrectomy for silicone oil removal.

Results:
Eighty-two patients (mean age 54 years, range 22–89) were included. Twelve eyes (14%) showed discrete preretinal hyperreflective organized coarse material in the silicone-retina interphase on spectral domain optical coherence tomography. The material was scattered in the posterior pole, with several foci showing additional hyperreflectivity of the inner retinal layers beneath. These findings did not resemble silicone oil emulsification in size, shape, or reflectivity.

Conclusion:
This is the first report on hyperreflective material detected by spectral domain optical coherence tomography in the silicone-retina interphase in eyes with silicone oil tamponade. These findings may represent an inflammatory response to silicone oil exposure that may be the initial manifestation of a future proliferative process, warranting a rigorous follow-up protocol for affected patients.
Autologous Descemet Stripping Automated Endothelial Keratoplasty to Eliminate Endothelial Rejection in Eyes at High Risk
Authors: Myerscough James , Friehmann Asaf , Bovone Cristina , Busin Massimo 
Published: November 2019

Purpose:
To determine whether autologous Descemet stripping endothelial keratoplasty is technically feasible and whether it eliminates the risk of endothelial rejection in “only eyes” at high risk of immunological rejection.

Methods:
This is a prospective observational interventional study from 2016 to 2018 with a 24-month follow-up in a tertiary-level corneal referral center, Forlì, Italy. One 25-year-old woman with failed penetrating keratoplasty after endothelial rejection in the context of chronic panuveitis and a blind fellow eye due to retinal detachment underwent autologous Descemet stripping automated keratoplasty. An endothelial graft was harvested from the fellow eye by performing a hinged, microkeratome-assisted superficial stromal flap, with removal of the central posterior stromal bed. The posterior lamellar graft created was then transplanted into the other eye using a standardized Descemet stripping automated endothelial keratoplasty (DSAEK) technique. Main outcome measures were endothelial rejection, best spectacle-corrected visual acuity, and endothelial cell density.

Results:
No endothelial rejection was seen during the 2-year follow-up duration. Stable improvement in best spectacle-corrected visual acuity from 0.2 to 0.4 (decimal Snellen) was observed. Endothelial cell density of 1465 (cells/mm2) was recorded at the final follow-up.

Conclusions:
The use of this repeatable technique to harvest and transplant an autologous DSAEK graft eliminates endothelial rejection in high-risk eyes.
Quantitative and Qualitative Differences in Endothelial Cell Loss Between Endothelium-In Versus Endothelium-Out Loading in Descemet Membrane Endothelial Keratoplasty
Authors: Ho Joanne , Jung Hoon , Banitt Michael 
Published: November 2019

Purpose:
This study compares endothelial cell loss (ECL) between donor grafts loaded in the Geuder Glass Cannula and the Coronet EndoGlide made specifically for Descemet membrane endothelial keratoplasty (DMEK).

Methods:
Prestripped tissues using the submerged cornea using backgrounds away (SCUBA) technique were obtained from an eye bank. Donor grafts were loaded with the Geuder Glass Cannula or Coronet DMEK EndoGlide. Grafts were then ejected directly onto a glass slide, stained, and imaged with confocal fluorescent microscopy. Trainable Fiji (ImageJ) segmentation software was used to quantify ECL.

Results:
Twenty-three total tissue samples were tested. Eleven grafts were loaded using the Geuder, and 12 were loaded with the Coronet. Preloading graft endothelial cell density was comparable between Geuder (2436 ± 581 cells/mm2) and Coronet (2577 ± 483 cells/mm2) groups with P = 0.56. Other baseline characteristics including donor age and time from death to loading were comparable (P = 0.73 and P = 0.66, respectively). Average ECL was 11.3% ± 3.0% in the Geuder group versus 7.2% ± 7.0% in the Coronet group and not significantly different (P = 0.07). When observing patterns of cell loss, grafts loaded in the Coronet DMEK EndoGlide resulted in more focal forceps grabs and trifold patterns. Grafts loaded with the Geuder Glass Cannula yielded more diffuse stippled stress lines.

Conclusions:
Our results suggest comparable ECL between Geuder (endothelium-out) and Coronet (endothelium-in) DMEK EndoGlide tissue injection techniques. Patterns of ECL in the Coronet group correlated with forceps grabs, but this study suggests that additional manipulation of tissue does not result in higher ECL.
Glaucoma After Iodine-125 Brachytherapy for Uveal Melanoma: Incidence and Risk Factors
Authors: Kim Eun-Ah , Salazar Diana , McCannel Colin A. , Kamrava Mitchell , Demanes David J. , Lamb James , Caprioli Joseph , McCannel Tara A. 
Published: November 2019

Précis:
A single-center retrospective review over a 10-year period discovered an 8.6% risk of developing secondary open-angle glaucoma, and a 6.7% risk of neovascular glaucoma after brachytherapy for uveal melanoma. Additional risk factors were identified.

Purpose:
To report the incidence and identify risk factors for secondary open-angle glaucoma and neovascular glaucoma after iodine-125 brachytherapy for uveal melanoma in a tertiary ocular oncology and glaucoma practice.

Patients and Methods:
Eyes of patients who had been diagnosed and treated with iodine-12 brachytherapy for uveal melanoma over a 10-year period were included for review. Secondary open-angle glaucoma was defined as meeting the following criteria: at least 3 measurements of intraocular pressure (IOP) ≥21 mm Hg after the removal of the iodine-125 plaque and an open angle on gonioscopy. Neovascular glaucoma was defined as meeting the following criteria: at least 3 measurements of IOP ≥21 mm Hg and neovascularization of the iris or anterior chamber angle. Cumulative incidence was calculated and survival analysis was used to analyze risk factors for both secondary open-angle glaucoma and neovascular glaucoma.

Results:
A total of 374 eyes in patients diagnosed with uveal melanoma and treated with Iodine-125 brachytherapy were included in the study. Thirty-one eyes (8.6%) were diagnosed with secondary open-angle glaucoma and 25 eyes (6.7%) were diagnosed with neovascular glaucoma. Multivariate analysis identified the following risk factors for secondary open-angle glaucoma: older age, greater tumor size, iris location of uveal melanoma, higher baseline IOP, ciliary body involvement, and eyes having undergone combined brachytherapy with vitrectomy and silicone oil placement for radiation attenuation. The risk factors for neovascular glaucoma were as follows: greater tumor size, greater number of pack-years smoking history, pseudophakia, and higher grade of radiation retinopathy severity by fluorescein angiogram.

Conclusions:
We have identified additional risk factors for the development of both secondary open-angle glaucoma and neovascular glaucoma in patients with uveal melanoma who have undergone iodine-125 brachytherapy for local tumor control. The risk of secondary glaucoma is substantial. Close ophthalmic monitoring of patients is necessary for detection and timely treatment of glaucoma to maximize visual outcome.