bluuebunny/crossref_metadata_2025_split huggingface dataset:
The North American Opioid Epidemic
Authors: Jannetto Paul J. 
Published: December 2020

Background:
The culmination of the widespread overprescription of opioids, a resurgence of heroin use, and increased accessibility and use of illicit synthetic opioids is commonly referred to as the opioid epidemic in North America.

Methods:
This article is not intended to provide a comprehensive systematic literature review, but rather summarized recent publications and online governmental reports and datasets for English-written literature primarily published between January 1, 2015 and July 1, 2020.

Results:
In both the United States and Canada, opioids represent one of the most widely prescribed classes of medications. According to the US Centers for Disease Control and Prevention (CDC), an unprecedented increase in the use of opioid pain relievers has led to one of the worst drug overdose epidemics in US history and continues to be an ongoing major public health crisis based on recent Centers for Disease Control and Prevention mortality data, where almost two-thirds of all overdose deaths still involve opioids, including heroin and illicit opioids. In addition to the high mortality rates in both the United States and Canada, there has also been an increase in emergency department visits for nonmedical use of opioid pain relievers, along with additional individuals seeking treatment for opioid addiction, and a rise in neonatal abstinence syndrome.

Conclusions:
This article highlights the history, underlying issues, ongoing national regulatory efforts, and future strategies and therapies to help mitigate the opioid crisis in North America.
Apixaban Level and Its Influence on Immunosuppression and Graft Outcome in Kidney Transplant Recipients With Atrial Fibrillation
Authors: Green Hefziba , Rahamimov Ruth , Spectre Galia , Rozen-Zvi Benaya , Fuchs Shmuel , Avni Shiri , Nissan Ran 
Published: December 2020

Background:
Currently, there is limited information on the level of apixaban in kidney transplant (KT) patients with atrial fibrillation and the influence of apixaban therapy on the level of immunosuppression and graft function.

Methods:
This was a cross-sectional prospective study of 19 KT patients treated with apixaban. The levels of apixaban were measured using a chromogenic assay calibrated for apixaban and compared with those predicted by the manufacturer. Mean immunosuppression trough levels before and after apixaban treatment initiation were calculated using 3 consecutive measurements. Apixaban levels were compared with a historical control group comprising of 20 nontransplant patients with atrial fibrillation who were treated with the standard 5-mg bid apixaban dosage.

Results:
All KT patients should have been treated with the standard 5-mg bid apixaban dosage according to the clinical parameters; however, 7 were inappropriately treated with a reduced dosage (2.5-mg bid). There was no significant difference in apixaban level between KT patients treated with the 5-mg bid dosage and nontransplant patients. No KT patient administered the standard dose had out-of-range levels. Peak GM level was significantly lower in KT patients administered an inappropriately reduced dose (P = 0.05). Two patients had below-range peak levels. Apixaban treatment initiation had minimal influence on the level of immunosuppression. Furthermore, it had no adverse impact on graft function.

Conclusions:
Similar to nontransplant patients, KT patients administered the standard 5-mg bid dosage had apixaban levels that were well within the recommended manufacturers' expected ranges. In addition, this dosage had minimal influence on immunosuppression and no effect on graft function.
Incidence and Outcomes of Suprachoroidal Hemorrhage Following Aurolab Aqueous Drainage Implant in Adult and Pediatric Glaucoma
Authors: Wijesinghe Hiruni K. , Puthuran George V. , Gedde Steven J. , Pradhan Chinmayee , Uduman Mohammed S. , Krishnadas Subbaiah R. , Kannan Naresh B. , Robin Alan L. , Palmberg Paul 
Published: December 2020

Précis:
Postoperative suprachoroidal hemorrhage (PSCH) is an infrequent but devastating complication after nonvalved aqueous drainage implant surgery and demonstrated a bimodal distribution. The final outcomes of either conservative management or surgical drainage of the hemorrhage remained poor.

Purpose:
The aim was to report the incidence and outcomes of eyes developing PSCH after undergoing Aurolab aqueous drainage implant (AADI) surgery for adult and pediatric refractory glaucomas.

Materials and Methods:
In this retrospective series, case files of all patients who underwent AADI between May 2012 and December 2019 were retrieved from an electronic database. A PSCH was defined as the presence of hemorrhagic choroidal detachment, confirmed by ultrasound B scan, occurring in a closed system in the postoperative period.

Results:
Of the 986 eyes that underwent AADI during the study period, 7 (0.7%), developed PSCH (95% confidence interval=0.3-1.6%). There were no differences in the preoperative parameters between those with and without PSCH. Of these, 4 were seen in pediatric eyes (4/288, 1.4%) and 3 in adult eyes (3/698, 0.4%) (P<0.01). Four eyes (57%) had PSCH in the immediate postoperative period (ie, between 24 and 48 h of AADI surgery), while the remaining 3 had onset ranging from 6 to 7 weeks after surgery. Anatomic risk factors were present in all eyes including hypotony (n=4), myopia (n=3), microcornea (n=2), microphthalmos (n=1), postvitrectomy (n=1), and staphyloma (n=1). Visual acuity improved in only 1 (14%) eye while 3 (43%) eyes developed phthisis bulbi, all in the pediatric age group.

Conclusions:
PSCH is a rare complication following AADI and is seen in <1% eyes. The incidence is higher in the pediatric age group. Visual and anatomic outcomes are dismal following PSCH with globe salvage possible in only about half these eyes.
Clozapine Response in Schizophrenia and Hematological Changes
Authors: Blackman Graham , Lisshammar Jenny E.L. , Zafar Rayyan , Pollak Thomas A. , Pritchard Megan , Cullen Alexis E. , Rogers Jonathan , Carter Ben , Griffiths Kira , Nour Matthew , David Anthony S. , McGuire Philip , Stewart Robert , MacCabe James 
Published: December 2020

Abstract

Background
Clozapine is the only effective medication for treatment-resistant schizophrenia; however, its mechanism of action remains unclear. The present study explored whether its effectiveness is related to changes in hematological measures after clozapine initiation.

Methods
Patients with treatment-resistant schizophrenia commenced on clozapine between January 2007 and December 2014 by the United Kingdom’s largest mental health trust were identified from electronic patient records. Hematological data from these patients were obtained from a monitoring registry. White blood cell, neutrophil, and platelet count were assessed at baseline and during the early phase of clozapine treatment. Clozapine response at 3 months was defined as “much,” or “very much” improved on the seven-point Clinical Global Impression—Improvement (CGI-I) subscale.

Results
In the total sample (n = 188), clozapine initiation was associated with a significant transient increase (peaking in weeks 3 to 4) in white blood cell, neutrophil, and platelet count (P < 0.001). There were 112 (59.6%) patients that responded to treatment; however, none of the hematological factors assessed at baseline, nor changes in these factors, were directly associated with treatment response.

Implications
Clozapine treatment is associated with transient hematological changes during the first month of treatment; however, there was no evidence that these were related to the therapeutic response.
Covert Dyskinesia With Aripiprazole
Authors: Gomaa Hassaan , Mahgoub Yassir , Francis Andrew 
Published: December 2020

Abstract

Background
Tardive dyskinesia (TD) is an involuntary movement disorder most commonly involving the tongue, lips, and face and less commonly the trunk and limbs. Although TD is historically associated with conventional antipsychotics, it still occurs with newer agents. Covert dyskinesia (CD), a form of TD, occurs after the discontinuation of antipsychotics, and it differs from other withdrawal emergent dyskinesia by its persistence for more than 8 to 12 weeks after discontinuation of dopamine receptor-blocking agents. Although initially reported in the 1960s with conventional antipsychotics, multiple recent reports describe several cases in association with aripiprazole (APZ).

Methods
We used PubMed and the Google Scholar for CD reports during the past 20 years. We also report a recent case ofCD.

Results
We identified 11 case reports of CD. Six were related to APZ, 3 to risperidone, 1 to amisulpride, and 1 to haloperidol. Our patient was an 81-year-old woman with a history of major depressive disorder who was admitted for worsening depression. Before hospitalization, she had been on APZ 5 mg/d for 2 years, but it was discontinued 4 months prior, and then she developed repetitive involuntary movements in her tongue, lips, and jaw 2 months after APZ discontinuation. The Abnormal Involuntary Movement Scale score was 5. Reinstating APZ a few months later led to disappearance of movements.

Conclusions
Literature to date suggests that APZ is the atypical antipsychotic most commonly reported with CD. A possible risk might be APZ's unique mechanism of action and its association with akathisia. Following up patients with serial Abnormal Involuntary Movement Scale after antipsychotic discontinuation is recommended.
Quality Analysis of Online Patient Resources for Hepatocellular Carcinoma
Authors: Li Jim (Zhang Hao) , McLeod Jane , Ingledew Paris-Ann 
Published: December 2020

Goal:This study aims to evaluate the quality of online hepatocellular carcinoma (primary liver cancer) resources by using a validated tool to determine the strengths and limitations of hepatocellular carcinoma Web sites designed for patient education.Background:In recent years, online health information-seeking behavior has become more prevalent. Meanwhile, hepatocellular carcinoma incidence rates have also increased. However, there is currently limited literature assessing the quality of online hepatocellular carcinoma information.Materials and Methods:The term “hepatocellular carcinoma” was searched using the search engine Google and the meta-search engines Dogpile and Yippy. A validated rating tool was used to assign quality scores to 100 Web sites based on the domains of Web site affiliation, accountability, interactivity, structure and organization, readability, and content quality. Overall quality scores were tallied for all Web sites.Results:Noncommercial hepatocellular carcinoma Web sites received significantly higher overall quality scores compared with their commercial counterparts. Overall, 30% of the Web sites identified their author(s), 42% cited sources, and 33% were updated within the past 2 years. The majority of Web sites utilized at least 1 interactive feature and 4 structural tools. Average readability was at a grade 11.8 level using the Flesch-Kincaid grading system, which is significantly higher than the recommended grade 6 level. Definition and treatment were the most commonly covered topics, while prevention and prognosis were the least commonly covered.Conclusions:The quality of online hepatocellular carcinoma information is highly variable. Health care professionals should be aware of its limitations and be proactive in guiding patients to reliable resources.
Qualitative sonographic assessment of transmural ileal inflammation in Crohn’s disease: a comparison with MRI activity score
Authors: Livne Moran , Amitai Michal Mariene , Klang Eyal , Ben Horin Shomron , Ungar Bella , Levartovsky Asaf , Kopylov Uri , Carter Dan 
Published: December 2020

Background
Intestinal ultrasound (IUS) is an accurate tool for monitoring Crohn’s disease. To date, there is no clinically used validated quantitative ultrasonographic score for assessing disease activity. For magnetic resonance enterography (MRE), the magnetic resonance index of activity (MaRIA) is most used. The goal of this study was to devise a new quantitative IUS score for assessing Crohn’s disease inflammation, by using a partial MaRIA score as a reference.

Methods
This was a retrospective cohort study. The study cohort included patients with Crohn’s disease followed between January 2016 and December 2018. Inclusion criteria were age >18 and <3 months between MRE and IUS. Linear/logistic regression was performed for the correlation of ultrasonographic parameters with MaRIA score. Ultrasonograpic features included: bowel wall thickness, disrupted bowel wall stratification, mesenteric fat proliferation, presence of lymph nodes, hypervascularity present on color Doppler flow, and the presence of complications (strictures, inflammatory mass, and fistula).

Results
Forty-two patients were included. A stepwise multiple regression model was constructed to predict MaRIA score using ultrasound features. Two variables were found to be independently significant: terminal ileum (TI) thickness (r = 0.68, P = 0.001) and mesenteric fat proliferation (r = 0.45, P = 0.019). A model was constructed as follows: MaRIA = 7 + 2.5 * TI US thickness (mm) + 7 * US fat proliferation (0 = no, 1 = yes). This model has an R
2 of 0.51 for explaining the variability in the results.

Conclusions
IUS measurements are significantly correlated with MaRIA score in the terminal ileum and a simple computational model can be constructed.
Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?
Authors: Abdulrahim Ashraf , Fagih Mosa , Troncone Riccardo , Bashir Muhammed Salman , Asery Ali , Alruwaithi Muhanad , Al-Jurayyan Abdullah N. , Al-Alallah Ibrahim , Al-Hussaini Abdulrahman 
Published: December 2020

ABSTRACT

Objectives:
Use of deamidated gliadin peptide (DGP) test kits as adjunctive to tissue-transglutaminase-IgA (TTG-IgA) for the diagnosis of celiac disease (CD) has been a controversial issue. The objectives of our study were to evaluate the diagnostic performance of DGP antibodies compared with TTG-IgA and to evaluate the correlation between DGP-antibody titers and degree of enteropathy.

Methods:
We included children who underwent endoscopy and biopsies because of positivity of any of the serology tests in the “celiac profile” (TTG-IgA, DGP-IgA, and DGP-IgG) from 2012 to 2019. We divided children into clinically suspected cases of CD (group 1) and asymptomatic cases screened as they were from a high-risk group (group 2).

Results:
Group 1 constituted 52 children and group 2 included 81 children (76 type-1 diabetes [T1D]). The sensitivity and positive-predictive value (PPV) of DGP-IgG in group 1 (90%, 98%) and group 2 (91%, 85.5%) were comparable with TTG-IgA (98%, 92% in group 1; 100%, 80% in group 2). By adding DGP-IgG to TTG-IgA, the performance of TTG-IgA has improved marginally in group 1 (sensitivity 100%, PPV 92.3%). All cases with DGP-IgG titer 2 times ULN in group 1, and >4 times ULN in group 2 had villous atrophy. All T1D patients with TTG IgA >10 times ULN had villous atrophy.

Conclusions:
DGP-IgG assay did not add to the performance of TTG-IgA. DGP-IgG titer correlated with enteropathy. The diagnosis of CD can be made in asymptomatic T1D child with TTG-IgA titer >10 times ULN and positive endomyseal antibodies.
Interindividual and Intraindividual Variations of Breast Sensitivity Before and After Breast Reduction
Authors: Silhol Thomas , Chaouat Marc , Noel Warren , Mimoun Maurice , Boccara David 
Published: December 2020

Background
More than 300,0000 breast plastic surgery procedures are performed annually worldwide, of which more than 100,000 are reduction mammoplasties carried out in the United States. Although most patients tend to be satisfied with the immediate outcomes of this procedure, there is increasing concern among surgeons as well as patients with regard to breast sensibility and the postoperative recovery.
The objectives of this study were to assess the variation in the sensibility in patients undergoing hypertrophic breast surgery by quantification of the impact of various variables and to evaluate its progression from before the surgery to between 3 and 6 months and 1 year postoperatively.

Methods
We carried out a nonrandomized, monocentric, prospective study. All of the patients were examined by the same evaluator using a set of 20 von Frey monofilaments on the day before the surgery and at 3 to 6 months and 1 year postoperatively. The breast skin, areola, and nipple sensibilities were tested. Age, body mass index, tobacco use, and the breast volume were recorded.

Results
We did not find any significant effect of the body mass index, tobacco use, or age on breast sensibility. The nipple and areola complex (NAC) sensibility was inversely correlated with the degree of hypertrophy before the surgery, but this difference disappeared in the postoperative evaluations. After the surgery, the NAC sensibility decreased at the first follow-up at 4.5 months and returned to normal after 1 year.

Conclusions
The inverse relationship between breast volume and sensibility in the preoperative evaluation disappeared after mammaplasty reduction. In the early postoperative period, the sensibility decreased on the NAC but returned to normal after 1 year.
One Pedicled Superficial Temporal Artery Hair-bearing Flap to Reconstruct Three Different Anatomical Areas of the Burnt Face
Authors: Al-Qattan Mohammad M. 
Published: December 2020

Abstract
Reconstruction of the burnt face is a challenge. In men, the best option to hide facial scars and get rid of the grafted facial appearance is to use the superficial temporal artery hair-bearing flap. In the literature, the superficial temporal artery flap hair-bearing flap has been used to reconstruct one facial anatomical area in men such the eyebrows, the beard, or the mustache area. In this communication, the author describes a personal technique that allows the use of one pedicled superficial temporal artery hair-bearing flap to reconstruct both eyebrows and improve the grafted appearance of the upper/lower lips post the release and graft of burn contractures. The technique will be demonstrated by a case presentation.
Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Skelly Alyson , Guo Lifei 
Published: December 2020

Abstract
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized malignancy of T-lymphocytes that is linked to certain types of textured breast implants. Although rare, the increasing awareness of the disease is resulting in more case reports and heightened anxiety in patients with textured breast implants. This review aims to summarize the available BIA-ALCL data, including the existing theories of etiopathogenesis, the diagnostic work-up for BIA-ALCL patients, BIA-ALCL treatment recommendations, the epidemiologic challenges, and the current opinions surrounding the use of textured breast implants.
Assessing the Readability of Online Patient Education Resources Related to Gynecomastia
Authors: Nnamani Silva Ogonna N. , Ammanuel Simon G. , Segobiano Brett M. , Edwards Caleb S. , Hoffman William Y. 
Published: December 2020

BackgroundThe Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages.MethodsThe readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites.ResultsFifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages.ConclusionsThe readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.
Videofluoroscopic Findings as Predictors of Velopharyngeal Insufficiency After Orthognathic Surgery in Patients With Cleft Lip and Palate
Authors: Yao Chuan-Fong , Bhandari Kishor , Lee Min-Chao , Chen Philip Kuo-Ting , Lu Ting-Chen 
Published: December 2020

Background
Midface retrusion is a common problem in patients with cleft lip and palate owing to the lack of adequate growth of the maxilla. Midface advancement surgery is a definite treatment for midface retrusion; however, the subsequent oropharyngeal airway changes might result in velopharyngeal insufficiency (VPI) in affected patients. Determining the predictors of VPI beforehand and modifying the surgical procedure would be beneficial.

Materials and Methods
A retrospective review of 42 patients with cleft lip and palate who underwent orthognathic surgery from 2013 to 2014 was performed. A total of 25 patients met the inclusion criteria and had undergone complete pre- and postsurgery videofluoroscopy, nasopharyngoscopy (NPS), and speech assessment. We compared 2 groups of patients, those who showed NPS finding changes of more than 0.1 (8 patients) and those without changes (17 patients), by measuring the distances of the contact point to the tip of the velum, gap size at maximum closure (MC) and rest, contact area length, lateral wall closure rate, closure velocity, and 2 angles (from the velum to the hard palate and genu) at MC and rest. The amount of maxillary advancement was also recorded.

Results
Among the 8 patients with NPS finding changes, 3 underwent Furlow palatoplasty for VPI. No significant difference was found in the amount of maxillary advancement between the groups (5.8 vs 5.7 mm). Significant differences were found in the preoperative gap size at MC and angle at the genu at MC (P = 0.035 and .012). These could be considered as the predictors before surgery. After surgery, a significant difference was found in the contact area, lateral wall closure rate, and gap size at MC (P = 0.005, 0.018, and 0.01).

Conclusion
Videofluoroscopy is a relatively applicable method of determining dynamic changes in the velum function. By performing videofluoroscopy before midface advancement surgery in patients with cleft lip and palate, we may predict the risk of VPI and consider alternative surgical strategies.