bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of a 2-Year Prospective Multicenter Study Evaluating Long-term Audiological and Clinical Outcomes of a Transcutaneous Implant for Bone Conduction Hearing
Authors: Kruyt Ivo J. , Monksfield Peter , Skarzynski Piotr H. , Green Kevin , Runge Christina , Bosman Arjan , Blechert Johan I. , Wigren Stina , Mylanus Emmanuel A. M. , Hol Myrthe K. S. 
Published: April 2020

Objective(s):
To evaluate 2-year audiological and clinical outcomes of a transcutaneous implant for bone conduction hearing of a previously published 6-month evaluation.

Design:
Fifty-four unilaterally implanted adult patients with conductive or mild mixed hearing loss or single-sided sensorineural deafness were included in this prospective multicenter study. Follow-up visits were scheduled post-surgery at 10 days; 4, 6, and 12 weeks; 6, 12, and 24 months. Main outcomes were audiological benefit, patient-reported outcomes (PROs), soft tissue status, pain, numbness, implant survival, and daily usage.

Results:
In the study population, the transcutaneous implant resulted in statistically significant improvement in objective hearing test and PROs compared with the unaided situation. Soft tissue complications were observed in 4.6% of the patients per visit. Pain/discomfort and numbness were initially reported in the majority of the patients, but declined over time; approximately 9% of patients reported some degree of numbness and 15% (slight) pain/discomfort after 2 years. During the 24-month period, two implant magnets were removed (3.7%), while two other implants were converted to the percutaneous counterpart (3.7%). At the final visit, 89.6% (n = 42 out of 47) of the patients used their sound processor, with a median daily usage of 6 h/d (range, 0–18 h/d).

Conclusions:
After 24 months, the transcutaneous implant provided statistically significant mean improvement in objective and subjective hearing performance as well as PROs compared with the preoperative unaided condition and had a low soft tissue complication rate. The test device could be considered as an alternative treatment option for appropriately selected and counseled patients.
Frequency of daily tooth brushing and subsequent cardiovascular events
Authors: Kobayashi Daiki , Mizuno Atsushi , Mitsui Rie , Shimbo Takuro 
Published: April 2020

Objective
Although previous studies have shown an inverse association between the frequency of daily tooth brushing and cardiovascular risk factors, research on cardiovascular events is limited. This study aimed to evaluate the association between the frequency of daily tooth brushing and subsequent cardiovascular events.

Methods and results
A retrospective longitudinal study was conducted at a hospital in Tokyo, Japan. We included all participants who underwent health check-ups from 2005 to 2011 and followed up to 2018. Our outcomes were the development of cardiovascular events. Outcomes were compared by the frequency of daily tooth brushing with a generalized estimating equation, adjusting for potential confounders. A total of 71 221 participants were included. The mean age was 45.6 years and 50.3% were male. During a median follow-up of 2061 (interquartile range: 933–3311) days, 1905 participants developed cardiovascular events. The adjusted odds ratios (ORs) of cardiovascular events increased in a dose-dependent manner as the frequency of tooth brushing decreased. Even those who brushed their teeth once in a day had a higher adjusted OR of stroke (1.22; 95% confidence interval, 1.01–1.48) than did those who brushed after every meal.

Conclusions
Frequent tooth brushing was inversely associated with subsequent cardiovascular events in a dose-dependent manner. Even brushing one’s teeth once a day may be related to an increased likelihood of stroke than brushing one’s teeth after every meal. Less frequent tooth brushing may be considered to be a marker for subsequent cardiovascular disease and coronary heart disease, rather than a risk factor.
Vildagliptin vs. insulin treatment alone in diabetic acute coronary syndrome patients
Authors: Dobrecky-Mery Idit , Sommer Adir 
Published: April 2020

Background
Vildagliptin, an oral antidiabetic of the dipeptidyl peptidase-4 (DPP-4) inhibitor drugs, exhibits an overall low risk of hypoglycemia with less frequent hypoglycemic events in type 2 diabetes mellitus (T2DM) patients than other antidiabetic drugs. We hypothesized that among hospitalized acute coronary syndrome (ACS) patients, the addition of vildagliptin to subcutaneous insulin therapy would reduce the risk of hypoglycemic events.

Methods
One hundred ACS T2DM adult patients naive to DPP-4 inhibitors were enrolled during admission to the ICCU. Patients were divided into two randomized controlled groups: a subcutaneous rapid-acting insulin-only therapy group and an oral vildagliptin plus subcutaneous insulin group. The trial was open label with no placebo arm. Mean glucose values, insulin values given for correction per hospitalization, and the number of hypoglycemic events (glucose < 70 mg/dL) were documented.

Results
Eight hypoglycemia events occurred in the insulin-only group and none in the insulin plus DPP-4 inhibitor group (P < 0.001). Patients with acute myocardial infarction experienced a higher number of hypoglycemic events compared with unstable angina diagnosed patients. No significant differences were found regarding glucose level (P = 0.462) and administered insulin units (P = 0.639).

Conclusions
In T2DM patients, the addition of DPP-4 inhibitors to routine subcutaneous insulin therapy may significantly reduce hypoglycemic events while maintaining acceptable recommended ranges of glucose. Further studies on a larger scale are required to verify these results and to support that DPP-4 inhibitors added to today’s standard insulin-only treatment in hospitalized diabetic ACS patients may improve overall glycemic control and provide a potential treatment option in this challenging clinical setting.
Frontostriatal Brain Activation Is Associated With the Longitudinal Progression of Cardiometabolic Risk
Authors: Allen Ben , Jennings John Richard , Muldoon Matthew F. , Gianaros Peter J. 
Published: April 2020

ABSTRACTObjectiveCardiometabolic risk refers to a set of interconnected factors of vascular and metabolic origin associated with both cardiovascular disease and various brain disorders. Although midlife cardiometabolic risk is associated with future brain dysfunction, emerging evidence suggests that alterations in autonomic and central nervous system function may precede increases in cardiometabolic risk.MethodsThe present study tested whether patterns of cerebral blood flow in brain areas associated with autonomic regulation were associated with increases in overall cardiometabolic risk. A community sample of 109 adults with resting systolic blood pressure between 120 and 139 mm Hg, diastolic blood pressure between 80 and 89 mm Hg, or both underwent pseudocontinuous arterial spin labeling to quantify cerebral blood flow responses to cognitively challenging tasks. Cardiometabolic risk and cerebral blood flow measurements were collected at baseline and at a 2-year follow-up.ResultsRegression analyses showed that greater frontostriatal cerebral blood flow responses to cognitive challenge were associated with higher cardiometabolic risk at follow-up (β = 0.26 [95% confidence interval = 0.07 to 0.44],t= 2.81,p= .006, ΔR2= 0.04). These findings were specific to frontostriatal brain regions, as frontoparietal, insular-subcortical, and total cerebral blood flow were not associated with progression of cardiometabolic risk. Moreover, cardiometabolic risk was not associated with frontostriatal cerebral blood flow responses 2 years later.ConclusionsFrontostriatal brain function may precede and possibly forecast the progression of cardiometabolic risk.
Investigating the effect of antiretroviral switch to tenofovir alafenamide on lipid profiles in people living with HIV
Authors: Lacey Aoife , Savinelli Stefano , Barco Elena Alvarez , Macken Alan , Cotter Aoife G. , Sheehan Gerard , Lambert John S. , Muldoon Eavan , Feeney Eoin , Mallon Patrick W. , Tinago Willard 
Published: April 2020

Background:
Whilst reporting improved renal and bone safety profiles, studies have noted changes in lipid profiles among people living with HIV (PLWH) receiving antiretroviral therapy (ART) switching away from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF). We aimed to characterize changes in lipids observed after switching to TAF-containing ART in a real-world setting.

Methods:
A prospective study on PLWH enrolled in the UCD-ID Cohort study who switched to TAF-containing ART. Routine laboratory data [including lipids (total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides], ART history and use of lipid-lowering therapy (LLT) were analysed preswitch and postswitch to TAF. Dyslipidaemia was classified according to the National Cholesterol Education Program-Adult Panel III (NCEP-ATP III). Change in lipid parameters and change in the proportion of individuals with dyslipidaemia postswitch was assessed using the paired t-test and the Stuart--Maxwell test, respectively.

Results:
Of 775 PLWH enrolled in the cohort, 238 switched to TAF containing ART, of whom 194 had both preswitch and postswitch lipids measured a median (IQR) 24 (14–41) weeks postswitch to TAF. TC, LDL, HDL, triglycerides and TC : HDL ratio significantly increased postswitch [mean change (SE) mmol/l; +0.37 (0.06), P < 0.001; +0.25 (0.06), P < 0.001; +0.05 (0.02), P = 0.003, +0.13 (0.07), P = 0.02, and +0.16 (0.08), P = 0.013) respectively]. There were significant increases in the proportions of PLWH with more severe dyslipidaemia postswitch across TC and LDL (both P < 0.001).

Conclusion:
These data suggest clinically relevant, worsening lipid profiles postswitch to TAF, with a larger proportion of PLWH exceeding recommended lipid thresholds postswitch. How these changes will impact on cardiovascular risk or need for LLT remains to be determined.
Drug efflux transporters and metabolic enzymes in human circulating and testicular T-cell subsets: relevance to HIV pharmacotherapy
Authors: Whyte-Allman Sana-Kay , Hoque Md. Tozammel , Gilmore Julian C. , Kaul Rupert , Routy Jean-Pierre , Bendayan Reina 
Published: April 2020

Objectives:
ATP-binding cassette (ABC) drug efflux transporters and drug metabolic enzymes could reduce antiretroviral concentrations in HIV target cells. The testis has been demonstrated to be a sanctuary site, displaying suboptimal antiretroviral concentrations and persistent HIV infection. Therefore, we compared the expression and function of ABC transporters and metabolic enzymes in CD4+ and CD8+ T cells isolated from human testis and peripheral blood mononuclear cells (PBMCs), and assessed their expression in circulating naive and memory CD4+ T-cell phenotypes.

Design:
Testicular tissue and blood were collected from 15 uninfected donors undergoing gender affirmation surgery. Testicular interstitial cells were isolated by enzymatic digestion, whereas PBMCs were isolated from blood by density gradient centrifugation. The expression and/or function of ABC transporters and metabolic enzymes were examined in blood and testicular T-cell subsets by flow cytometry.

Results:
ABC transporters (P-gp, BCRP, MRP1) and metabolic enzymes (CYP3A4, UGT1A1) were expressed in testicular and circulating CD4+ and CD8+ T cells, as well as in circulating naive, central, transitional, and effector memory T-cell phenotypes. MRP1 demonstrated lower frequencies in T cells from testis compared with PBMCs, as well as in circulating naive T cells compared with the memory T-cell phenotypes. Functional activity of P-gp and BCRP was detected in T-cell subsets from testis and PBMCs.

Conclusion:
Our findings demonstrate for the first time that antiretroviral drug efflux transporters and metabolic enzymes are functionally expressed in T-cell subsets infiltrating the human testis. These transporters and enzymes can reduce antiretroviral intracellular concentrations, potentially contributing to residual HIV replication in the testis, and negatively impact HIV cure strategies.
Outcomes of immunomodulatory and biologic therapy in people living with HIV
Authors: Peluso Michael J. , Chen Jessica , Munter Sadie , Reed Asia , Teraoka Justin , Eshun-Wilson Ingrid , Henrich Timothy J. , Chin-Hong Peter V. 
Published: April 2020

Objectives:
Immunomodulatory drugs (IMDs) are crucial for treating autoimmune, inflammatory, and oncologic conditions. Data regarding the safety of IMDs in people living with HIV (PLWH) are limited. We describe outcomes in all PLWH prescribed these agents from 2000--2019 at two academic medical centers.

Design:
Retrospective cohort study.

Methods:
We systematically identified and reviewed charts of all PLWH receiving IMDs. We defined a treatment episode as an uninterrupted period on an IMD regimen. We quantified infections, blips (detectable plasma HIV RNA following an undetectable result), and virologic failure (progression from plasma HIV RNA <200 copies/ml to two consecutive values >200 copies/ml despite ART).

Results:
Seventy-seven patients contributed 110 treatment episodes. Rheumatologic comorbidities were the most frequent indication. The most common IMD classes were TNF inhibitors, antimetabolites, and checkpoint inhibitors. Ninety percent of treatment episodes involved concomitant ART. Median pretreatment CD4+ T-cell count was 609 cells/μl (IQR 375--861). Among 51 treatment episodes on ART with undetectable pretreatment plasma HIV RNA, HIV became detectable within 1 year in 21 of 51 cases (41.2%); there were no instances of virologic failure. Compared with other agents, treatment episodes involving checkpoint inhibitors were more likely to involve a blip (77.8 vs. 33.3%, P = 0.015). Thirteen treatment episodes (11.8%) were associated with concomitant infection; none was attributed to IMDs by the treating clinician.

Conclusion:
PLWH treated with IMDs should be monitored carefully for virologic blips and incident infections. Checkpoint inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear.
Virtual Reality Haptic Simulator for Endoscopic Sinus and Skull Base Surgeries
Authors: Kim Do Hyun , Kim Hyun Mun , Park Jae-Sung , Kim Sung Won 
Published: April 2020

Objective:
This paper proposes a virtual reality (VR) haptic simulator with realistic instruments, an exchangeable patient-specific three-dimensional (3D)–printed external nostril and a caudal septum model to facilitate real surgical motion for training in endoscopic sinus and skull–base surgery.

Study design and Setting:
industry-academy cooperation development model

Methods:
The VR simulator consists of the main simulator body, a monitor, an endoscope device, 2 haptic devices, an endoscope holder support fixture, and a pair of pedals. The location of the endoscope device is determined by an electromagnetic sensor. Two haptic devices are located so as to prevent mutual interference during application of the two-nostrils/four-hands technique for endoscopic skull-base surgery. The pedals were used for select surgical instrument and endoscopes, and operate microdebriders or microdrill. An exchangeable patient-specific external nostril and caudal septum model was created using material that mimics the texture of human tissue and a 3D printer. Graphics were rendered using Unity 3D, to which the Simulation Open Framework Architecture (SOFA) physics engine can be bolted on using the Unity3d plug-in.

Results:
This VR haptic simulator enables performance of basic endoscopic sinus surgeries (eg, maxillary sinus antrostomy, ethmoidectomy, and frontostomy), as well as endoscopic endonasal transsphenoidal (including sphenoidotomy) and transclival approaches.

Conclusion:
VR haptic simulators can improve the skill and confidence of surgical trainees by allowing them to accrue experience in various tasks under different conditions. The simulator introduced here comprises novel technologies and provides a realistic training environment for endoscopic sinus and skull–base surgery.
Free Dermal Fat Autografting for Complex Craniofacial Wounds
Authors: Dufresne Craig R. , Poling Mikaela I. 
Published: April 2020

Abstract
Complex craniofacial wounds (CCW) are those refractory to initial treatment and may involve chronic infection, exposed hardware, irradiated tissue, and soft tissue volume loss. Typical reconstruction with microvascular flaps involves considerable morbidity. While free dermal fat autografting (DFA) is used extensively in many applications, its use treating CCW remains an unexplored but attractive possibility. Data from a retrospective cohort of 34 consecutive patients (13 male; 21 female and aged 2–79-years), who underwent free DFA between 1985 and 2018 for CCW by a single plastic surgeon, were analyzed. Post-operative follow-up was 1–24 years (M = 6.53, SD = 7.91). Many patients had several concomitant wound complications. Primary pre-operative wound complications were dominated by infection (N = 20), of which over 75% (N = 15) were associated with non-autogenic material. Eighteen had resolution of their pre-operative infection. Of the total (N = 34), 79.41% had stable grafts at follow-up [X2(3) = 54, P < 0.001], with only 3 experiencing observable atrophy and 1 graft necrosis. Most of the cohort was complication free [X2(1) = 7.53, P = 0.006], with 73.53% experiencing no problems involving the graft. Twenty-nine (85.29%) of 34 patients had therapeutic success with free DFA [X2(1) = 28.65, P < 0.001]. Pre-operative wound status (β = 1.13, P < 0.001) predicted therapeutic success [R2 = 0.87, F(7,9) = 8.94, P = 0.002]. While 5 (14.71%) did not have therapeutic success, no additional problems arose related to grafts. Free DFA appears to be beneficial and show low morbidity. Future studies must evaluate these findings. In this context, their use should be considered in recalcitrant craniofacial wounds.
Cranial Reconstruction Using Antibiotic-Impregnated Calcium Phosphate Bone Cement With a Titanium Mesh Sheet
Authors: Ogino Akihiro , Nakamichi Miho , Takeda Kei , Onishi Kiyoshi 
Published: April 2020

Background:
The authors treated skin ulcer accompanied by cranial osteomyelitis using a combination of antibiotic-impregnated calcium phosphate bone cement (Biopex; Pentax, Tokyo, Japan) and a titanium mesh sheet (3D Mesh Plate; Bear Medic, Tokyo, Japan).

Method:
A 71-year-old male was treated with superficial temporal artery-middle cerebral artery bypass surgery for diffuse cerebral infarction and obstruction of the left internal carotid artery by a previous doctor. Skin necrosis and epidural abscess developed in the sutured region after surgery, and ulcer accompanied by temporal bone exposure remained. Thus, the patient transferred to our department. A bone defect formed by debridement and sequestrectomy was measured at 4.5 × 8 cm (30 cm2). Methicillin-resistant Staphylococcus aureus was detected on wound culture test. Cranioplasty with a combination of calcium phosphate bone cement impregnated with teicoplanin, to which the causative bacteria showed high sensitivity, and a titanium mesh sheet and scalp reconstruction with a free rectus abdominis musculocutaneous flap were performed.

Results:
As of 6 months after surgery, no infection has relapsed and no complication, such as resorption of the calcium phosphate bone cement and breakage of the titanium mesh sheet, was noted on postoperative computed tomography.

Conclusion:
The authors performed cranial reconstruction with a combination of teicoplanin-impregnated calcium phosphate bone cement and a titanium mesh sheet in a patient with Methicillin-resistant Staphylococcus aureus infection-induced skin ulcer accompanied by cranial osteomyelitis and achieved subsidence of infection. Drug-impregnated calcium phosphate bone cement has a problem with strength, but combination with a titanium mesh sheet as an auxiliary support material enables application to relatively extensive cranial full-thickness defects and it may be a useful treatment method.
Evaluation of Changes in Nasal Projection After Surgically Assisted Rapid Maxillary Expansion With 3dMD Face System
Authors: Büyükçavuş Muhammed Hilmi , Findik Yavuz , Baykul Timuçin 
Published: April 2020

Abstract
The most appropriate treatment option for maxillary expansion in adulthood due to increased cyanosis in sutures is surgically assisted maxillary expansion (SARME). Skeletal and dental changes are observed with SARME. Three-dimensional imaging techniques are gaining importance with the developing technology in evaluating the changes that occur as a result of the treatments applied. The aim of study was to evaluate the soft tissue changes occurring in the nasal projection after SARME in 3-dimensional analyzes during the expansion and post-retention processes. The study sample consisted of 19 patients with a transverse maxillary deficiency of more than 5 mm (11 female and 8 male). 3dMD Vultus software was used for measuring height and width of the philtrum, superior alar, nasal and subnasal width; nasal length, nasal projection, nasal bridge width, nasal tip protrusion and upper face height) before surgery (T0), after the expansion phase (T1), and 6 months postoperatively (T2). A significant difference was found only subnasal width between pre-treatment and post-retention values. Surgically assisted maxillary expansion operations alter the nasal projection and this study certified these results with 3dMD face system. 3dMD face technique is an effective imaging technique for evaluating the soft tissues changes after orthognathic surgeries.
Kenny-Caffey Syndrome Type 2: A Unique Presentation and Craniofacial Analysis
Authors: Turner Acara E. , Abu-Ghname Amjed , Davis Matthew J. , Shih Linden , Volk Angela S. , Streff Haley , Buchanan Edward P. 
Published: April 2020

Abstract
Kenny-Caffey Syndrome Type 2 (KCS2) is a rare genetic disorder characterized by short stature, skeletal dysplasia, primary hypoparathyroidism, and delayed closure of the anterior fontanelle. Patients with KCS2 typically require multidisciplinary management due to numerous craniofacial and skeletal anomalies. Craniosynostosis, however, has not yet been identified in a patient with KCS2 to the best of our knowledge. We present the first case of craniosynostosis in the setting of KCS2 and provide a comprehensive analysis of the associated craniofacial findings to date. The authors will describe the craniofacial features specific to our patient and review the characteristic morphological features in a manner relevant to early recognition and focused evaluation.