bluuebunny/crossref_metadata_2025_split huggingface dataset:
MIMS Procedure: Concept and Evaluation of Safety, Feasibility, and Efficacy in a Porcine Experimental Model
Authors: Gershoni Assaf , Glovinsky Yoseph , Rotenberg Michael , Barayev Edward , Segal Ori , Geffen Noa 
Published: October 2020

Precis:
We present a novel stentless filtration system used to create a permanent sclerocorneal drainage channel that reduces intraocular pressure (IOP) without the need to create a conjunctival incision or a scleral flap.

Purpose:
The purpose of this study was to evaluate the safety, feasibility, and preliminary performance of a novel surgical system, the minimally invasive micro sclerostomy (MIMS), in an in vivo porcine experimental model.

Materials and Methods:
MIMS is an ab externo stentless filtration procedure. An activation system is used to operate a handpiece that includes a 600 µm needle containing an injectable 300 µm triangular blade that spins around its longitudinal axis. The needle is inserted into the subconjunctival space and the blade is injected at the limbal area creating a drainage channel at the sclerocorneal junction, connecting the anterior chamber to the subconjunctival space. The first generation of the MIMS surgical system was assessed in a porcine experimental model, firstly on 6 pigs and thereafter on 10 pigs. All adverse events, IOP measurements, and bleb descriptions were recorded for up to 14 weeks. The shape and location of the scleral tunnel, the subconjunctival bleb, and the healing process were examined by slit-lamp examination, by histopathologic analysis, and by anterior segment optical coherence tomography imaging.

Results:
No device malfunctions were recorded. Scleral tunnels were repeatedly achieved in all models. No significant intraoperative or postoperative complications were recorded. Effective fluid percolation was achieved in all eyes. The mean IOP statistically significantly decreased from 19.0±3.2 mm Hg preoperatively to 11.1±4.9 mm Hg on the first follow-up visit (P=0.0046) in the first leg of the study, and from 18.5±3.8 to 13.3±1.9 mm Hg in the second leg (P=0.0165). In both, IOP gradually returned to preoperative values toward the end of the follow-up period, as expected in a porcine experimental model. Histologic analysis of the analyzed tissue was not associated with significant tissue reaction.

Conclusions:
The MIMS procedure exhibited a consistent and relatively high safety, feasibility, and efficacy profiles. In the future, the MIMS procedure may provide a novel solution for uncontrolled IOP.
Primary Epstein-Barr Virus Infection With Marked Cholestasis, Warm Autoimmune Hemolytic Anemia, and Pancytopenia
Authors: Kazi Aamir S. , Hart Aaron A. , Rajakumar Priya , Janardhan Sujit J. , Dehghan-Paz Irene , Rhee Yoona 
Published: October 2020

Abstract
Primary Epstein-Barr virus (EBV) infection may rarely present with cholestatic hepatitis or hemolytic anemia. We share a case of EBV-associated infectious mononucleosis presenting with a unique triad of findings comprising cholestatic hepatitis with marked hyperbilirubinemia, warm autoimmune hemolytic anemia, and pancytopenia. Early diagnostic challenges included negative Monospot heterophile testing. Additional testing revealed EBV serologies consistent with acute primary infection, EBV viremia and bone marrow biopsy showing EBV-encoded RNA–positive cells. A tapered prednisone course was administered for warm autoimmune hemolytic anemia. Improvement in symptoms and laboratory findings occurred over 3 weeks.
Very Rare Gastrointestinal Anthrax in a Pregnant Woman
Authors: Akrami Alireza , Dolatabad Mostafa Laale , Tashrifi Fatemeh , Gholizadeh Abdolmajid , Moradi Bagher 
Published: October 2020

Abstract
Anthrax is an acute infectious disease caused by Bacillus anthracic. Gastrointestinal anthrax is considered as a rare condition in pregnancy, and there are few reports describing its complication and treatment procedure. Meanwhile, there is no article reporting successful treatment of a pregnant woman; however, we have reported a successful treatment of gastrointestinal anthrax in a pregnant woman. In this study, we reported a 38-years-old pregnant woman who was referred to the hospital with abdominal pain and persistent hemorrhagic diarrhea. Suzerain operation was also used, and laparotomy showed necrotic gangrene in colon. After the first surgery, the patient showed left lower quadrant abdominal pain (left lower quadrant collection), and drainage was performed during the second surgery. Finally, after 20 days, the patient was recovered and discharged from the hospital in a very good condition. Gastrointestinal anthrax during pregnancy is a very rare condition. In this study, we reported a patient with gastrointestinal anthrax who was recovered by a suitable treatment.
Preterm Labor and Birth
Authors: Griggs Kellie M. , Hrelic Debra A. , Williams Nina , McEwen-Campbell Michelle , Cypher Rebecca 
Published: October 2020

Abstract
When caring for women experiencing preterm labor and birth, nurses play a significant role as bedside experts, advocates, patient educators, and key members of the maternity care team. Enhanced expertise on clinical and professional knowledge of preterm labor and birth is crucial in prevention and treatment. As preterm birth rates continue to rise, perinatal nurses as well-informed clinical experts have the opportunity to offer innovative education, holistic assessments, and communication through shared decision-making models. Educating pregnant women about early recognition of preterm labor warning signs and symptoms allows for timely diagnosis, interventions, and treatment. Informed and collaborative nursing practice improves quality of clinical care based on individualized interactions. A clinical review of preterm labor and preterm birth is presented for perinatal nurses.
Infective Uvulitis in a Child
Authors: De Pieri Carlo , Valentini Elena , Pusiol Anna , Passone Eva , Gamalero Lisa , Cogo Paola Elisa 
Published: October 2020

Abstract
Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticosteroid. Uvulitis is usually caused by group A Streptococcus or Haemophilus influentiae, but also other bacteria can be detected. Uvulitis can be isolated, or it can occur with epiglottitis and become an emergency.
Community-based delivery of HIV treatment in Zambia: costs and outcomes
Authors: Nichols Brooke E. , Cele Refiloe , Jamieson Lise , Long Lawrence C. , Siwale Zumbe , Banda Patrick , Moyo Crispin , Rosen Sydney 
Published: October 2020

Objective:
The aim is to determine the total annual cost per patient treated and total cost per patient retained on antiretroviral therapy in Zambia in conventional care in facilities and across community-based differentiated service delivery (DSD) models.

Design:
Economic evaluation was conducted using retrospective electronic record review.
Twenty healthcare facilities (13 with DSD models and 7 as comparison sites) in six of Zambia's 10 provinces were considered.

Methods:
All individuals on antiretroviral therapy (ART) >18 years old at the study sites were enrolled in a DSD model or conventional care by site type, respectively, with at least 12 months of follow-up data. Accessing care through DSD models [community adherence groups (CAGs), urban adherence groups (UAGs), home ART delivery and care, and mobile ART services] or facility-based conventional care with 3-monthly visits. Total annual cost per patient treated and the annual cost per patient retained in care 12 months after model enrolment. Retention in care was defined as attending a clinic visit at 12 months ± 3 months.

Results:
The DSD models assessed cost more per patient/year than conventional care. Costs ranged from an annual $116 to $199 for the DSD models, compared with $100 for conventional care. CAGs and UAGs increased retention by 2 and 14%, respectively. All DSD models cost more per patient retained at 12 months than conventional care. The CAG had the lowest cost/patient retained for DSD models ($140–157).

Conclusions:
Although they achieve equal or improved retention in care, out-of-facility models of ART were more expensive than conventional care.
Unexpected interactions between dolutegravir and folate: randomized trial evidence from South Africa
Authors: Chandiwana Nomathemba C. , Chersich Matthew , Venter W.D. François , Akpomiemie Godspower , Hill Andrew , Simmons Bryony , Lockman Shahin , Serenata Celicia M. , Fairlie Lee , Moorhouse Michelle A. 
Published: October 2020

Objective:
Dolutegravir exposure at conception was associated with a preliminary signal of increased infant neural tube defect risk. As low maternal folate levels are linked with neural tube defects, we aimed to assess serum folate concentrations in women starting dolutegravir.

Design:
We analysed serum folate concentrations from stored plasma among women enrolled in the South African ADVANCE trial.

Methods:
We compared changes in mean serum folate and occurrence of low serum folate (<14.0 nmol/l) at weeks 0, 12 and 24 across study arms. In ADVANCE, 1053 treatment-naïve participants were randomized to initiate tenofovir–alafenamide/emtricitabine + dolutegravir (TAF/FTC + DTG), tenofovir–disoproxil–fumarate (TDF)/FTC + DTG or TDF/FTC/efavirenz (EFV).

Results:
Analysis includes 406 females, mean age 31.5 years and baseline CD4+ cell count 356 cells/μl. At baseline, folate concentrations were similar across treatment arms. However, serum folate increased over 12 weeks in the TAF/FTC + DTG arm (+4.0 ± 8.1 nmol/l), while folate concentrations decreased slightly in the TDF/FTC + DTG arm (−1.8 ± 8.9 nmol/l) and decreased in the TDF/FTC/EFV arm (−5.9 ± 8.1 nmol/l). Women taking TDF/FTC/EFV had low folate concentrations at both 12 and 24 weeks compared with the other arms (P < 0.001). Of 26 women who became pregnant on study before week 24, folate concentrations increased between baseline and 12 weeks by a mean 2.4 ± 7.1 nmol/l in the TAF/FTC + DTG arm and 2.3 ± 8.4 nmol/l in the TDF/FTC + DTG arm, but decreased by −3.3 ± 8.1 with TDF/FTC/EFV arm.

Conclusion:
Unexpectedly, no declines were noted in the dolutegravir-containing arms, and concentrations were considerably higher than in the EFV arm. The possibility that dolutegravir may block cellular uptake of folate warrants investigation.
The Change of 68Ga–Prostate-Specific Membrane Antigen Uptake in Myeloma After Chemotherapy in a Patient With Multiple Myeloma and Concurrent Prostate Cancer
Authors: Pan Qingqing , Luo Yaping , Ma Yanru , Li Fang 
Published: October 2020

Abstract
A bone lesion in the right calcaneus was found in a 76-year-old man with a history of prostate cancer. 68Ga-PSMA-11 PET/CT showed multiple PSMA-expressing lytic bone lesions in appendicular skeleton. Biopsy of the lesion in the right calcaneus confirmed plasmacytoma. After several cycles of chemotherapy, the patient was in serologically stringent complete remission. The follow-up PET/CT showed a significant reduction of 68Ga-PSMA-11 uptake in the previously PSMA-avid bone lesions without morphological changes on CT. The reduction of PSMA expression in myelomas after chemotherapy is suggested to result from the treatment response.
Concurrent Liver and Mesentery Primary Extraosseous Multiple Myeloma on 18F-FDG PET/CT
Authors: Carnahan Molly B. , Larsen Jeremy T. , Conley Christopher R. , Yang Ming 
Published: October 2020

Abstract
Extramedullary multiple myeloma (EMM) is a subset of multiple myeloma with a poor prognosis. We report a rare case with biopsy-proven concurrent liver and mesentery primary EMM at the time of initial staging after serologic diagnosis of multiple myeloma. 18F-FDG PET/CT is valuable in detection of EMM when the patient has no osseous lesions and a negative bone marrow biopsy.
Evaluating Quality of Life After Facial Reanimation Using the Facial Clinimetric Evaluation Scale in a Series of Pediatric Patients
Authors: Mackay Duncan J.D. , Kimia Rotem , Magee Leanne , Jackson Oksana , Nguyen Phuong D. 
Published: October 2020

Background:
Facial palsy can have significant functional and psychological impact. Dynamic facial reanimation methods have provided means of restoration of smile. There remains a dearth of quality of life data in children. The authors aim to assess patient reported outcomes in this underreported population.

Methods:
A retrospective review was performed of pediatric patients with facial palsy who had dynamic facial reanimation from 2009 to 2017 at a single institution. Patients were sent a digital Facial Clinimetric Evaluation (FaCE) questionnaire, a validated tool to assess patient quality of life. FaCE statements are grouped into 6 categories: facial movement, facial comfort, oral function, eye comfort, lacrimal control, and social control.

Results:
Twenty patients met inclusion criteria. Fourteen successfully completed the survey. With normal function being 100, our cohort scored: facial movement 38.7 ± 14.3; facial comfort 67.3 ± 23, oral function 75 ± 22.7, eye comfort 68.75 ± 18.2, lacrimal control 53.6 ± 32.5, social function 64.3 ± 25.6. The overall FaCE score was 61.07 ± 10.85. The facial movement subscores were lower for brow raise 16.1 ± 33.4 relative to smiling 53.6 ± 29.2 and lip pucker, 46.4 ± 23.7. No correlation was found between facial movement scores and total scores (R
2 < 0.01). There was a strong negative correlation between total scores and time since procedure (Spearman's rho R =  –0.45).

Conclusion:
Our pediatric facial reanimation cohort demonstrated excellent social function, in contrast to a relatively lower facial movement score. The low facial movement score was mediated by low score for brow raise and was not correlated to overall FaCE score. Interestingly, overall FaCE score tended to decrease with time from procedure.
Blepharoplasty Combined With Mini-incision and Interrupted Buried Suture Techniques
Authors: Di Wen J. , Liu Bing , Yin Ning B. , Li Si L. , Wang Yong Q. 
Published: October 2020

Background:
Blepharoplasty has become one of the most popular plastic surgery techniques for generating double-eyelid folds. The mini-incision blepharoplasty technique results in minimal trauma and the formation of supratarsal folds.

Methods:
In this study, the authors combined mini-incisions with interrupted buried sutures. To perform the blepharoplasty procedure, the authors marked the supratarsal folds and divided them into 5 line segments: 3 cutting lines and 2 noncutting lines. For the cutting lines, the authors used orbicularis-tarsus fixation to form double eyelids and only removed a small strip of muscle under the incision to maintain the physiological structure of the pretarsal tissue. For the noncutting lines, the authors used the interrupted buried suture technique to add 2 fixed points.

Results:
A total of 42 patients (mean age 25.25 years) underwent this minimally invasive blepharoplasty. Among these patients, 42 underwent bilateral surgery. The average follow-up period was 35.91 months (range: 13–47 months). Only one patient underwent a second operation to address a shallow, unilateral supratarsal crease. Nonetheless, all patients were satisfied with their results.

Conclusion:
Our minimally invasive blepharoplasty approach resulted in minimal damage to the pretarsal tissues and robust supratarsal folds and is relatively easy to perform for the novice surgeon.

Evidence Statement:
Level IV
Comprehensive Molecular Characterization of Adenocarcinoma of the Gastroesophageal Junction Between Esophageal and Gastric Adenocarcinomas
Authors: Suh Yun-Suhk , Na Deukchae , Lee Ju-Seog , Chae Jeesoo , Kim EuiHyun , Jang Giyong , Lee Jieun , Min Jimin , Ock Chan-Young , Kong Seong-Ho , George Joshy , Zhang Chengsheng , Lee Hyuk-Joon , Kim Jong-Il , Kim Seong-Jin , Kim Woo Ho , Lee Charles , Yang Han-Kwang 
Published: October 2020

Objective:
To investigate the molecular characteristics of AGEJ compared with EAC and gastric adenocarcinoma.

Summary of Background Data:
Classification of AGEJ based on differential molecular characteristics between EAC and gastric adenocarcinoma has been long-standing controversy but rarely conducted due to anatomical ambiguity and epidemiologic difference.

Methods:
The molecular classification model with Bayesian compound covariate predictor was developed based on differential mRNA expression of EAC (N = 78) and GCFB (N = 102) from the Cancer Genome Atlas (TCGA) cohort. AGEJ/cardia (N = 48) in TCGA cohort and AGEJ/upper third GC (N = 46 pairs) in Seoul National University cohort were classified into the EAC-like or GCFB-like groups whose genomic, transcriptomic, and proteomic characteristics were compared.

Results:
AGEJ in both cohorts was similarly classified as EAC-like (31.2%) or GCFB-like (68.8%) based on the 400-gene classifier. The GCFB-like group showed significantly activated phosphoinositide 3-kinase-AKT signaling with decreased expression of ERBB2. The EAC-like group presented significantly different alternative splicing including the skipped exon of RPS24, a significantly higher copy number amplification including ERBB2 amplification, and increased protein expression of ERBB2 and EGFR compared with GCFB-like group. High-throughput 3D drug test using independent cell lines revealed that the EAC-like group showed a significantly better response to lapatinib than the GCFB-like group (P = 0.015).

Conclusions:
AGEJ was the combined entity of the EAC-like and GCFB-like groups with consistently different molecular characteristics in both Seoul National University and TCGA cohorts. The EAC-like group with a high Bayesian compound covariate predictor score could be effectively targeted by dual inhibition of ERBB2 and EGFR.
Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma
Authors: Crippa Stefano , Pergolini Ilaria , Javed Ammar A. , Honselmann Kim C. , Weiss Matthew J. , Di Salvo Francesca , Burkhart Richard , Zamboni Giuseppe , Belfiori Giulio , Ferrone Cristina R. , Rubini Corrado , Yu Jun , Gasparini Giulia , Qadan Motaz , He Jin , Lillemoe Keith D. , Castillo Carlos Fernandez-del , Wolfgang Christopher L. , Falconi Massimo 
Published: October 2020

Objective:
To describe PNI and to evaluate its impact on disease-free (DFS) and overall survival (OS) in patients with resected pancreatic ductal adenocarcinoma (PDAC).

Summary of Background Data:
Although PNI is a prognostic factor for survival in many GI cancers, there is limited knowledge regarding its impact on tumor recurrence, especially in ‘‘early stage disease’’ (PDAC ≤20 mm, R0/ N0 PDAC).

Methods:
This multicenter retrospective study included patients undergoing PDAC resection between 2009 and 2014. The association of PNI with DFS and OS was analyzed using Cox proportional-hazards models.

Results:
PNI was found in 87% of 778 patients included in the study, with lower rates in PDAC ≤20 mm (78.7%) and in R0/N0 tumors (70.6%). PNI rate did not differ between patients who underwent neoadjuvant therapy and upfront surgery (88% vs 84%, P = 0.08). Although not significant at multivariate analysis (P = 0.07), patients with PNI had worse DFS at univariate analysis (median DFS: 20 vs 15 months, P < 0.01). PNI was the only independent predictor of DFS in R0/N0 tumors (hazard ratio [HR]: 2.2) and in PDAC ≤ 20 mm (HR: 1.8). PNI was an independent predictor of OS in the entire cohort (27 vs 50 months, P = 0.01), together with G3 tumors, pN1 status, carbohydrate antigen (CA) 19.9 >37 and pain.

Conclusions:
PNI represents a major determinant of tumor recurrence and patients’ survival in pancreatic cancer. The role of PNI is particularly relevant in early stages, supporting the hypothesis that invasion of nerves by cancer cells has a driving role in pancreatic cancer progression.
Low Anti-Factor Xa Level Predicts 90-Day Symptomatic Venous Thromboembolism in Surgical Patients Receiving Enoxaparin Prophylaxis
Authors: Pannucci Christopher J. , Fleming Kory I. , Varghese Thomas K. , Stringham John , Huang Lyen C. , Pickron T. Bartley , Prazak Ann Marie , Bertolaccini Corinne , Momeni Arash 
Published: October 2020

Objective:
To examine the relationship between enoxaparin dose adequacy, quantified with anti-Factor Xa (aFXa) levels, and 90-day symptomatic venous thromboembolism (VTE) and postoperative bleeding.

Summary Background Data:
Surgical patients often develop “breakthrough” VTE events—those which occur despite receiving chemical anticoagulation. We hypothesize that surgical patients with low aFXa levels will be more likely to develop 90-day VTE, and those with high aFXa will be more likely to bleed.

Methods:
Pooled analysis of eight clinical trials (N = 985) from a single institution over a 4 year period. Patients had peak steady state aFXa levels in response to a known initial enoxaparin dose, and were followed for 90 days. Survival analysis log-rank test examined associations between aFXa level category and 90-day symptomatic VTE and bleeding.

Results:
Among 985 patients, 2.3% (n = 23) had symptomatic 90-day VTE, 4.2% (n = 41) had 90-day clinically relevant bleeding, and 2.1% (n = 21) had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high aFXa (4.2% vs 1.3%, P = 0.007). In a stratified analysis, this relationship was significant for patients who received twice daily (6.2% vs 1.5%, P = 0.003), but not once daily (3.0% vs 0.7%, P = 0.10) enoxaparin. No association was seen between high aFXa and 90-day clinically relevant bleeding (4.8% vs 2.9%, P = 0.34) or major bleeding (3.6% vs 1.6%, P = 0.18).

Conclusions:
This manuscript establishes inadequate enoxaparin dosing as a plausible mechanism for breakthrough VTE in surgical patients, and identifies anticoagulant dose adequacy as a novel target for process improvement measures.
Virtual Interviews During COVID-19: Perspectives of Female Pelvic Medicine and Reconstructive Surgery Program Directors
Authors: Menhaji Kimia , Gaigbe-Togbe Bertille HA. , Hardart Anne , Bui Anthony H. , Andiman Sarah E. , Ascher-Walsh Charles J. , Dabney Lisa , Do Tran Ann 
Published: October 2020

Objective
The aim of the study was to evaluate female pelvic medicine and reconstructive surgery (FPMRS) fellowship program directors’ opinions regarding the effectiveness of virtual interviews for selecting fellows and their future interview mode preferences.

Methods
This was a cross-sectional online survey of all FPMRS program directors in the United States conducted from April 29, 2020, to May 30, 2020. At the time of this study, there were 73 program directors and 69 obstetrics and gynecology and urology–accredited FPMRS programs nationwide. The primary outcome was to subjectively assess the effectiveness of virtual interviews as compared with in-person interviews for evaluating applicants.

Results
Fifty seven (82.6%) of the program directors completed the survey. A total of 80.7% (46/57) of the respondents had participated in interviews for the active match cycle. Of the programs that participated in the interview process, almost all conducted interviews using virtual platforms (97.8%, 45/46). Program directors who conducted interviews virtually found them effective in evaluating applicants (88.9%, 40/45) and were satisfied with the virtual interview process (86.7%, 39/45). A total of 31.1% of respondents (14/45) preferred a virtual platform to an in-person setting for future interviews, and 60% (27/45) reported that they will likely perform future interviews virtually.

Conclusions
Although the pandemic resulted in a sudden reformatting of FPMRS fellowship interviews, most program directors nationally were satisfied with the process and found virtual interviews effective for assessing applicants. More than 50% of FPMRS program directors are likely to consider the virtual format for future interviews.