bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Contraception Class on Incidence and Severity of Acne Vulgaris
Authors: Barbieri John S. , Mitra Nandita , Margolis David J. , Harper Cynthia C. , Mostaghimi Arash , Abuabara Katrina 
Published: May 2020

OBJECTIVE:
To evaluate the association of different contraceptive methods on the incidence and severity of acne.

METHODS:
Using a de-identified commercial claims database, we performed a retrospective cohort study evaluating the incidence of clinical encounters for acne in the first year after initiation of contraception among female patients aged 12–40 years who were new contraceptive users. To evaluate the association of contraception class with acne severity, a subgroup analysis was performed among a cohort of patients with a history of acne examining the incidence of treatment escalation from topical acne medications to an oral tetracycline-class antibiotic in the year after initiation of contraception.

RESULTS:
Among new contraceptive users with no history of acne (N=336,738), compared with combined oral contraceptives (OCs), the copper intrauterine device (IUD) (hazard ratio [HR] 1.14; 95% CI 1.01–1.29) and levonorgestrel IUDs (HR 1.09; 95% CI 1.03–1.16) were associated with increased risk of clinical encounters with acne. Among those with a history of acne (n=21,178), compared with combined OCs, the copper IUD (HR 1.44; 95% CI 1.00–2.06) and levonorgestrel IUDs (HR 1.34; 95% CI 1.10–1.64) were associated with increased risk of treatment escalation from topical acne medications to an oral tetracycline class antibiotic.

CONCLUSION:
Combined OCs appear to be associated with a modest (or small) protective effect with respect to incident acne and treatment escalation compared with other contraceptive methods. However, absolute differences between contraceptive methods were small.
Intraoperative Identification of Clavicle Fracture Patterns: Do Clavicles Fail in a Predictable Pattern?
Authors: Drayer Nicholas J. , Dukes Chase A. , Dudevoir Michelle L. , Greenhouse Alyssa R. , Rao Meghana V. , Arrington Edward D. , Friedman Richard J. , Grassbaugh Jason A. , Eichinger Josef K. 
Published: May 2020

Objectives:
To characterize the fracture pattern and pattern of fragmentation for displaced, midshaft clavicle fractures undergoing operative management.

Design:
Prospective observational study.

Setting:
Two institutions. Level 1 and Level 2 Trauma Centers.

Patients/Participants:
Fifty-three patients who underwent operative repair of midshaft clavicle fracture.

Intervention:
All clavicles were treated by operative open reduction internal fixation.

Main Outcome Measurements:
All clavicles were categorized by the Robinson classification based on injury plain film bilateral upright clavicle radiographs. In addition, intraoperative fracture characteristics of fragment length and location were measured and recorded to evaluate the fracture pattern. All fractures were analyzed to determine the frequency of segmental comminution versus length-stable patterns, analyze characteristics of butterfly fragment size, number and location as well as the location of the cortical read for those length-stable fractures.

Results:
Analysis revealed 55% were Robinson 2B2 based on preoperative radiographs. Length-stable, anatomic reduction was achievable in 83%. For those in which an anatomic cortical read was achievable, 97.7% had a read present in the posterior-superior aspect of the clavicle.

Conclusions:
Midshaft clavicle fractures that meet conventional criteria for operative repair occur in a predictable manner with butterfly fragments generated from anterior-inferior compression and simple fracture line generated from tension along the posterior-superior aspect of the clavicle. Understanding this pattern can assist in the in surgical planning.
Electric Scooter Orthopaedic Injury Demographics at an Urban Level I Trauma Center
Authors: Siow Matthew Y. , Lavoie-Gagne Ophelie , Politzer Cary S. , Mitchell Brendon C. , Harkin William E. , Flores Alec R. , Schwartz Alexandra K. , Girard Paul J. , Kent William T. 
Published: May 2020

Objectives:
This study highlights demographics and orthopaedic injuries of electric scooter–related trauma that presented to our institution over a 27-month period.

Design:
Retrospective review.

Setting:
Urban Level 1 trauma center.

Patients:
Patients presenting to the emergency department, trauma bay, or outpatient clinic after electric scooter injury were identified from November 2017 through January 2020 using ICD-10 diagnosis codes.

Main Outcomes:
Patient charts were reviewed for demographics, injury characteristics, imaging, treatment, perioperative data, and Injury Severity Scores.

Results:
Four hundred eighty-five patients presented during the study period. Of these, 44% had orthopaedic injuries, including 30% with pelvis or extremity fractures. There were 21 (10%) polytraumatized patients in the orthopaedic cohort. The age ranged from 16 to 79 years (average 36 years), with 58% men, and 18% were visitors from out of town. Of 49 patients requiring orthopaedic surgery, 8 underwent surgery on an urgent basis. The average Injury Severity Score for orthopaedic patients was 8.4 with a median of 5.0 for nonoperative injuries versus a significantly higher median of 16.0 for operative injuries. Twenty-nine percent of patients were intoxicated and only 2% wore a helmet.

Conclusions:
Electric scooter injuries are increasing, and many patients sustain high-energy injuries. As electric scooter use continues to increase, the prevalence of orthopaedic injuries is also likely to rise. Further studies are needed to fully understand the impact scooter-related injuries have on individual patients and the health care system.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Lateral Stress Radiograph Identifies Occult Instability of Lateral Compression Pelvic Ring Injuries Without Sedation
Authors: Parry Joshua A. , Salameh Motasem , Maher Michael H. , Stacey Stephen C. , Mauffrey Cyril 
Published: May 2020

Objectives:
To determine if pelvic ring displacement on the lateral stress radiograph (LSR) correlated with displacement on examination under anesthesia (EUA).

Design:
Retrospective cohort study.

Setting:
Urban Level I trauma center.

Patients/Participants:
Twenty consecutive patients with unilateral minimally displaced LC1 injuries with complete sacral fractures.

Intervention:
An anteroposterior pelvis radiograph taken in the lateral decubitus position (LSR) was performed on awake patients before EUA in the operating room.

Main Outcome Measurements:
Correlation between ≥1 cm of pelvic ring displacement on the LSR and EUA.

Results:
The LSR demonstrated ≥1 cm of displacement in 11 of the 20 patients (55%). All of these patients had ≥1 cm of displacement on EUA and underwent surgical fixation. The remaining 9 patients with <1 cm of displacement on the LSR also had <1 cm of displacement on EUA and were managed nonoperatively.

Conclusions:
The LSR reliably identified occult instability in LC1 pelvic ring injuries and demonstrated 100% correlation with EUA. In contrast to EUA, the LSR does not require sedation and normalizes the amount of force applied to determine instability.

Level of Evidence:
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Association Between IV Thiamine and Mortality in Patients With Septic Shock: A Nationwide Observational Study
Authors: Miyamoto Yoshihisa , Aso Shotaro , Iwagami Masao , Yasunaga Hideo , Matsui Hiroki , Fushimi Kiyohide , Hamasaki Yoshifumi , Nangaku Masaomi , Doi Kent 
Published: May 2020

Objectives:
To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine.

Design:
Retrospective observational cohort study from July 2010 to March 2017.

Setting:
More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan.

Patients:
Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed.

Interventions:
Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group.

Measurements and Main Results:
We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, –0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, –0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, –0.3%; 95% CI, –1.3% to 0.8%).

Conclusions:
The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.
Pedunculated Perianal Mass in a Neonate: A Rare Case Report
Authors: Aihole Jayalaxmi Shripati 
Published: May 2020

Abstract:
Congenital perianal pedunculated masses are a rare occurrence in neonates. They are benign in nature and can be excised completely for definitive diagnosis. Here is a report of a rare case of pedunculated perianal mass occurring in a neonate managed successfully.
Fertility and Endocrine Preservation in the Management of Colorectal Cancer in Women
Authors: Chae-Kim Jennifer , Hayslip Clifford C. 
Published: May 2020

Case Summary:A 28-year-old nulliparous woman presented with rectal bleeding. Colonoscopy revealed a 4-cm malignant-appearing mass in the proximal rectum, and biopsies confirmed invasive adenocarcinoma of the rectum. Computed tomography scan showed no evidence of metastatic disease. Staging MRI found transmural extension with minimal stranding in the adjacent fat, as well as no evidence of pathological pelvic adenopathy, consistent with a T3N0 lesion. The proposed treatment plan involved neoadjuvant chemotherapy and radiation therapy before primary surgical resection. The patient desired fertility preservation and was referred immediately to Reproductive Endocrinology and Infertility. She underwent assisted reproduction with oocyte and blastocyst cryopreservation followed by laparoscopic ovarian transposition. Nine months after surgical low anterior resection of the tumor and completion of her cancer treatment, her ovaries were repositioned to their normal pelvic position during an ileostomy takedown procedure. She underwent a frozen embryo transfer but did not conceive. She resumed menses and later conceived spontaneously. Her pregnancy was complicated by cervical incompetence, requiring cervical cerclage. She delivered a live male infant via cesarean delivery at 32 weeks gestation, approximately 2 years after completion of cancer therapy. Four years after diagnosis, the patient remains in remission with undetectable CEA levels.
A multicenter, randomized study to select the minimum effective dose of estetrol (E4) in postmenopausal women (E4Relief): part 1. Vasomotor symptoms and overall safety
Authors: Gaspard Ulysse , Taziaux Mélanie , Mawet Marie , Jost Maud , Gordenne Valérie , Coelingh Bennink Herjan J.T. , Lobo Rogerio A. , Utian Wulf H. , Foidart Jean-Michel 
Published: May 2020

Abstract

Objective:
The aim of this study was to select the minimum effective dose of estetrol (E4) for the treatment of vasomotor symptoms in postmenopausal women.

Methods:
This was a multicenter, randomized, double-blind, placebo-controlled study. Postmenopausal women (n = 257, of whom 32 were hysterectomized) aged 40 to 65 years, with ≥7 moderate to severe hot flushes (HFs) per day, or 50 or more moderate to severe HFs weekly, received 2.5, 5, 10, or 15 mg E4, or placebo once-daily for a period of 12 weeks. Efficacy was assessed by recording the frequency and severity of HFs. Overall safety was assessed by recording adverse events, measuring endometrial thickness, and monitoring bleeding patterns. Treatment groups were compared using analysis of covariance.

Results:
The frequency of moderate to severe HFs decreased with all E4 doses. The difference in the percentage change of weekly HF frequency was significant for 15 mg E4 versus placebo at both W4 (−66% vs −49%, P = 0.032) and W12 (−82% vs −65%, P = 0.022). The decrease in severity of HFs was significantly more pronounced for 15 mg E4 than for placebo at both W4 (−0.59 vs −0.33, P = 0.049) and W12 (−1.04 vs −0.66, P = 0.049); the other doses failed to achieve statistical significance. In nonhysterectomized women, endometrial thickness increased during treatment and normalized following progestin treatment at study completion. No endometrial hyperplasia was observed.

Conclusions:
Estetrol 15 mg is considered to be the minimum effective daily oral dose for treatment of vasomotor symptoms. Its current seemingly favorable safety profile is further to be confirmed in phase 3 clinical development.

Video Summary:

http://links.lww.com/MENO/A591.
Combined treatment with epoxyeicosatrienoic acid analog and 20-hydroxyeicosatetraenoic acid antagonist provides substantial hypotensive effect in spontaneously hypertensive rats
Authors: Gawrys Olga , Husková Zuzana , Baranowska Iwona , Walkowska Agnieszka , Sadowski Janusz , Kikerlová Soňa , Vaňourková Zdeňka , Honetschlägerová Zuzana , Škaroupková Petra , Červenka Luděk , Falck John R. , Imig John D. , Kompanowska-Jezierska Elzbieta 
Published: May 2020

Objectives:
The global morbidity and mortality related to hypertension and associated disorders increases continuously and novel therapeutic strategies are still in high demand. Increasing evidence suggests the important role in blood pressure regulation of cytochrome P-450-dependent metabolites of arachidonic acid. Epoxyeicosatrienoic acids (EETs) induce vasodilation and natriuresis, and have renoprotective and anti-inflammatory properties. 20-HETE is an arachidonic acid metabolite with both prohypertensive and antihypertensive activities. To explore the pathophysiological role of arachidonic acid metabolites in more detail, we examined the antihypertensive efficiency of EET-A, a stable analog of 14,15-EET, and of AAA, a novel antagonist of the 20-HETE receptors.

Methods:
Male spontaneously hypertensive rats (SHR) were treated for 5 weeks with EET-A, AAA or the combination; age-matched untreated SHR and normotensive Wistar–Kyoto rats served as controls. EET-A and AAA were administered in drinking water at 10 mg/kg/day each. SBP was measured by telemetry and urine, blood, and tissue samples were collected for relevant analyses.

Results:
EET-A or AAA given alone had no significant effect on SHR blood pressure. In contrast, combined treatment with AAA and EET-A was significantly antihypertensive, causing a decrease in SBP from 180 ± 3 to 160 ± 5 mmHg (P < 0.05). Additionally, the combined treatment attenuated cardiac hypertrophy, decreased kidney ANG II level, increased natriuresis, and increased the excretion of nitric oxide metabolites.

Conclusion:
Considering the beneficial impact of the combined treatment with EET-A and AAA on SHR blood pressure and cardiovascular and renal function, we suggest that the treatment is a promising therapeutic strategy for human hypertension.
Effects of Amifostine Pre-treatment on miRNA, lncRNA, and mRNA Profiles in the Hypothalamus of Mice Exposed to 60Co Gamma Radiation
Authors: Tian Baolei , Fu Hangjiang , Liu Bin , Zhu Jie , Zheng Xiaofei , Ge Changhui 
Published: May 2020

Abstract
There is increasing evidence that the expression of non-coding RNA and mRNA (messenger RNA) is significantly altered following high-dose ionizing radiation (IR), and their expression may play a critical role in cellular responses to IR. However, the role of non-coding RNA and mRNA in radiation protection, especially in the nervous system, remains unknown. In this study, microarray profiles were used to determine microRNA (miRNA), long non-coding RNA (lncRNA), and mRNA expression in the hypothalamus of mice that were pretreated with amifostine and subsequently exposed to high-dose IR. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed. We found that fewer miRNAs, lncRNAs, and mRNAs were induced by amifostine pre-treatment in exposed mice, which exhibited antagonistic effects compared to IR, indicating that amifostine attenuated the IR-induced effects on RNA profiles. GO and KEGG pathway analyses showed changes in a variety of signaling pathways involved in inflammatory responses during radioprotection following amifostine pre-treatment in exposed mice. Taken together, our study revealed that amifostine treatment altered or attenuated miRNA, lncRNA, and mRNA expression in the hypothalamus of exposed mice. These data provide a resource to further elucidate the mechanisms underlying amifostine-mediated radioprotection in the hypothalamus.
Punching a Graft for Descemet Membrane Endothelial Keratoplasty Onto a Contact Lens Reduces Endothelial Cell Loss at the Graft's Margin
Authors: Achiron Asaf , Nahum Yoav , Adler Avital , Nisgav Yael , Bahar Irit , Livny Eitan 
Published: May 2020

Purpose:
To evaluate whether punching Descemet membrane endothelial keratoplasty (DMEK) corneal grafts onto a contact lens scaffold reduces endothelial cell loss at the graft margin in comparison to punching the graft directly onto the donor stroma.

Methods:
DMEK grafts were prepared using 2 different methods after peeling the graft from the stroma: punching onto a contact lens and punching onto the donor stroma. The grafts were then evaluated for the width of Descemet membrane devoid of endothelial cells in the peripheral ring, measured at 4 points at the graft margin.

Results:
Our study included 6 grafts, harvested from 3 donors aged 66.3 ± 5.1 years. Grafts prepared on a contact lens scaffolding had more of their Descemet membrane margin populated by endothelial cells than did grafts that were punched directly onto the donor stroma (total denuded area: 0.06 ± 0.08 mm2 vs. 1.17 ± 0.02 mm2, P = 0.018; maximal width of denuded area: 59.6 ± 28.4 μm vs. 100.2 ± 59.7 μm, P = 0.07). Donor grafts on contact lens had approximately 2.5% more endothelial cells available for transplantation (2425 cells/mm2 vs. 2367 cells/mm2). Graft preparation time did not significantly differ between the methods (6.4 ± 0.49 vs. 9.8 ± 3.7 minutes, P = 0.46).

Conclusions:
Punching DMEK grafts onto a contact lens reduces endothelial loss at the grafts’ margins and may prolong their survival.
“Pseudophakic Reverse Pupillary Block” Following Yamane Technique Scleral-fixated Intraocular Lens
Authors: Bharathi Mahesh , Balakrishnan Divya , Senthil Sirisha 
Published: May 2020

Purpose:
The authors report a rare complication of “pseudophakic reverse pupillary block” after a secondary, scleral-fixated intraocular lens implantation using the Yamane technique.

Methods/Results:
A 52-year-old male patient was referred for uncontrolled intraocular pressure (IOP) despite 3 topical antiglaucoma medications in his right eye (RE). Elevated IOP occurred after the RE cataract surgery performed elsewhere 1 year ago. On examination, the RE visual acuity was 20/60, IOP was 28 mm Hg, the iris showed mid-peripheral transillumination defects with iris chaffing, posterior bowing of the iris with a deep anterior chamber, pigment dispersion, and scleral-fixated intraocular lens (SFIOL). Ultrasound biomicroscopy showed a deep anterior chamber with posterior bowing of iris with concave iris configuration with iridolenticular contact with the SFIOL, suggestive of reverse pupillary block. After laser peripheral iridotomy, the iris moved forward into planar position, iridolenticular contact was relieved with a resolution of the pupillary block, and the IOP reduced to 14 mm Hg.

Conclusions:
The present case describes a rare complication of “pseudophakic reverse pupillary block” after a glued SFIOL implantation. The probable mechanism for the pupillary block is the reduced gap between the posterior surface of iris and optic of the IOL. This is likely caused by the loss of 5-degree posterior angulation of the 3-piece IOL because of stretching of the haptics leading to an increase in the iridolenticular contact and reverse pupillary block and elevated IOP. The persistent anterior chamber inflammation as a result of iris chaffing and pigment dispersion could also contribute to compromised trabecular outflow and further IOP elevation.
Reverse pupillary block can occur after a glued SFIOL implantation that can be relieved by a laser peripheral iridotomy. The authors recommend either preoperative laser peripheral iridotomy or surgical iridectomy intraoperatively in eyes with a glued intraocular lens to prevent this rare complication.
Children Hospitalized With Severe COVID-19 in Wuhan
Authors: Wang Yanli , Zhu Feng , Wang Cheng , Wu Jing , Liu Jie , Chen Xue , Xiao Han , Liu Zhisheng , Wu Zubo , Lu Xiaoxia , Ma Jiehui , Zeng Ye , Peng Hua , Sun Dan 
Published: May 2020

Background:
Novel coronavirus disease (COVID-19) is spreading globally. Little is known about the risk factors for the clinical outcomes of COVID-19 in children.

Methods:
A retrospective case-control study was taken in children with severe acute respiratory syndrome coronary virus-2 infection in Wuhan Children’s Hospital. Risk factors associated with the development of COVID-19 and progression were collected and analyzed.

Results:
Eight of 260 children diagnosed with severe COVID-19 pneumonia were included in the study. Thirty-five children with COVID-19 infection matched for age, sex and date of admission, and who classified as non-severe type, were randomly selected from the hospital admissions. For cases with severe pneumonia caused by COVID-19, the most common symptoms were dyspnea (87.5%), fever (62.5%) and cough (62.5%). In laboratory, white blood cells count was significantly higher in severe children than non-severe children. Levels of inflammation bio-makers such as hsCRP, IL-6, IL-10 and D-dimer elevated in severe children compared with non-severe children on admission. The level of total bilirubin and uric acid clearly elevated in severe children compared with non-severe children on admission. All of severe children displayed the lesions on chest CT, more lung segments were involved in severe children than in non-severe children, which was only risk factor associated with severe COVID-19 pneumonia in multivariable analysis.

Conclusions:
More than 3 lung segments involved were associated with greater risk of development of severe COVID-19 in children. Moreover, the possible risk of the elevation of IL-6, high total bilirubin and D-dimer with univariable analysis could identify patients to be severe earlier.