bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consecutive 265 Profunda Artery Perforator Flaps: Refinements, Satisfaction, and Functional Outcomes
Authors: Haddock Nicholas T. , Teotia Sumeet S. 
Published: April 2020

Introduction:
The ideal form of breast reconstruction provides total permanent restoration of the breast mound. When a deep inferior epigastric (DIEP) flap is not an option or does not provide significant volume, a secondary source must be considered. In our practice, the profunda artery perforator (PAP flap) from the thigh has emerged as a second choice. We present our experience with the first 265 PAP flaps used for breast reconstruction at our institution. We specifically focus on refinements, satisfaction, and functional outcomes.

Methods:
We conducted a retrospective review of the first 265 PAP flaps at our institution. Patient demographics, perioperative data, and postoperative complications were recorded and analyzed. The Breast Q and Lower Extremity Functional Scale (LEFS) were both implemented. Additionally, a satisfaction survey was performed, particularly focused on the donor site.

Results:
Two hundred sixty-five consecutive PAP flaps were used to reconstruct 244 breasts in 138 patients. The PAP flap was used for bilateral reconstruction (107 patients) and unilateral breast (30 patients). It was used in combination with a second flap as double PAP (21 patients) or combined with a DIEP (62 patients). Mean flap size was 403 g (range: 190–800 g) and mean patient body mass index was 26.5 (range: 18–43). Complications included total flap loss (3%), donor site cellulitis (4.9%), and significant donor site wound (6.8%). Currently, the PAP flap accounts for 16.9% of our autologous breast reconstruction and the DIEP flap accounts for 76.0%. Lower Extremity Functional Scale score was 75/80 (94%) by 6 months. Satisfaction with breast reconstruction was 78.9% and satisfaction with the thigh was 82.1%.

Conclusions:
The PAP flap is an excellent option for autologous breast reconstruction. Success rate and complications are similar to those of other options. There is no significant loss to lower extremity function and satisfaction with the reconstruction is comparable with other options.
Our Experiences with Plastic and Reconstructive Surgery Procedures during Coronavirus Disease 2019 Pandemic
Authors: Wang Zhichao , Wang Wei , Bai Ting , Di Meihua , Zan Tao , Gu Bin , Li Shengli , Li Qingfeng 
Published: April 2020

Background:
The novel Coronavirus Disease 2019 (COVID-19) has rapidly become a health threat worldwide and has been declared global pandemic by the World Health Organization. Possible transmission routes, including respiratory droplets, close contact, and aerosol propagation, have put plastic and reconstructive healthcare professionals at high risk, especially during surgical procedures. The aim of this study was to summarize and share our experience of infection control measures and corresponding outcomes during the COVID-19 pandemic.

Methods:
Infection control measures, including workflow optimization, useful epidemiologic survey methods, and personal full protective clothing, were discussed. Characteristics and outcomes of emergency cases and elective cases under local and general anesthesia during the COVID-19 pandemic were summarized.

Results:
A hierarchy of interventions were applied mainly from 4 aspects. First, administration control and online consultation significantly decreased patient attendance. Second, a triage workflow was established to identify high-/low-risk patients, with clinical manifestations (fever, fatigue, cough, nasal discharge, etc), epidemiologic survey, blood test, chest computed tomographic scan, and coronavirus test if necessary. Third, strict environmental control was adopted using increasing ventilation, isolated room for inpatients, etc. Fourth, proper rotation of healthcare staff was ensured to reduce workload and minimize possible contact. A total of 904 emergency interventions, 2561 local anesthesia, and 570 general anesthesia were performed during this period, and none of the cases/healthcare professionals were found to be infected.

Conclusions:
Our experience could help global plastic and reconstructive healthcare professionals to get better preparation and continue to give qualified medical services during the COVID-19 pandemic. Proper adjustments should be taken according to their own clinical settings.
Candida Keratitis: Epidemiology, Management, and Clinical Outcomes
Authors: Qiao Grace L. , Ling Jennifer , Wong Titus , Yeung Sonia N. , Iovieno Alfonso 
Published: April 2020

Purpose:To examine the epidemiological characteristics, trends, risk factors, management strategies, and clinical outcomes ofCandida albicansand non-albicanskeratitis over a 15-year period in a tertiary Canadian eye center.Methods:In a retrospective observational case series ofCandidakeratitis from 2003 to 2017, demographics, risk factors, corrected distance visual acuity (CDVA) at initial and final consultations, medical and surgical management, and follow-up duration were recorded.Results:Twenty-one cases ofCandidakeratitis were identified (62.5% of total fungal keratitis; 10C. albicansand 11 non-albicans). The most commonly associated risk factors were topical steroid use (16 patients, 76%), ocular surface disease (15 patients, 71%), contact lens use (11 patients, 52%), and previous corneal surgery (8 patients, 38%); all patients had 2 or more combined risk factors. The number of patients with a visual acuity of 20/200 or better remained the same before and after the treatment (5/21, 24%). The mean duration of the antifungal treatment was 98 ± 126 days. Sixteen patients ultimately required surgical management (76%; 12 therapeutic keratoplasties, 3 enucleation, and 1 optical keratoplasty). When comparingC. albicanswith non-albicanskeratitis, we found no difference in presenting visual acuity, final visual acuity, or requirement for surgical management.Conclusions:Candidakeratitis accounts for the most identified fungal keratitis cases in this temperate climate area. An exposure to multiple risk factors appears necessary. A surgical intervention is required for the resolution of most cases. Different subspecies ofCandidaultimately resulted in similar clinical outcomes.
Endoscopic-Assisted Lateral Orbitotomy for Large Orbital Roof Dermoid Cysts With Dural Invasion
Authors: Kashkouli Mohsen Bahmani , Maleki Meysam , Khademi Behzad , Karimi Nasser , Hamami Parisa , Nadjafi-Semnani Fatemeh 
Published: April 2020

Purpose:
To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion.

Methods:
Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8–10 hours of observation. Skin sutures were removed 1 week later.

Results:
They were 4 men and 2 women with age range of 19–48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6–18 months follow-up time with no recurrence.

Conclusions:
Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.
Occupational Quartz Exposure in a Population of Male Individuals—Association With Risk of Developing Atrial Fibrillation
Authors: Montén Adam , Bryngelsson Ing-Liss , Fornander Louise , Wiebert Pernilla , Vihlborg Per 
Published: April 2020

Objective:
Occupational quartz exposure is a health risk, with increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases.

Methods:
The population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job exposure matrix.

Results:
The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06–2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02–4.10).

Conclusion:
Our main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m3 mean quartz dust) in men aged 20 to 55 years.
Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina
Authors: Khan Ajmal , Hashim Zia , Neyaz Zafar , Agarwal Aarti , Mohindra Samir , Nath Alok 
Published: April 2020

Background:
Tracheobronchial stenting either alone or with esophageal stenting is often required for symptom palliation in obstructive or fistulous lesions of the airway due to esophageal cancer. There is limited evidence regarding dual stenting for lesions near the carina due to esophageal cancer. Hence, this study aims to evaluate the technical feasibility, outcomes, and complications of preplanned dual stenting in these patients.

Methods:
This is a prospective observational study carried out over a period of 4 years (January 2015 to July 2019). All patients undergoing dual stenting in the airway and esophagus with obstructive or fistulous lesions near the carina were included. The esophageal stent was placed within 24 hours. Prestenting and poststenting symptoms were compared using a symptom-based visual analog scale, Hugh Jones dyspnea scale and dysphagia scale.

Results:
Twenty-nine patients (20 males; mean±SD age, 55.3±12.2 y) underwent dual stenting. Twenty-four patients had central airway obstruction due to: infiltration in 20 (69%) and external compression in 4 (13.7%), respectively. Five (17.3%) patients had tracheoesophageal fistula with no airway obstruction. In 80% of the patients (n=23), silicone stents were placed. There was significant improvement in both dyspnea and dysphagia after dual stenting (P<0.001). Mucus plugging, lower respiratory infection, and granulation tissue were the main complications. Median survival after dual stent was 97 days (range, 17 to 297 d).

Conclusion:
Dual stenting within the airway and the esophagus is a safe and viable option for palliative relief of symptoms in patients with advanced esophageal cancer.
Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans
Authors: Hebert Paul L. , Wong Edwin S. , Reddy Ashok , Batten Adam , Gunnink Eric , Wagner Todd H. , Liu Chuan-Fen 
Published: April 2020

Objectives:
We can learn something about how Veterans value the Veterans Health Administration (VHA) versus community providers by observing Veterans’ choices between VHA and Medicare providers after they turn 65. For a cohort of Veterans who were newly age-eligible for Medicare, we estimated the change in VHA reliance (VHA outpatient visits divided by total VHA and Medicare visits) associated with specific events: receiving a life-threatening diagnosis, having a Medicare-paid hospitalization, or moving further from the VHA.

Research Design:
A longitudinal cohort study of VHA and Medicare administrative data.

Subjects:
A total of 5932 VHA users who completed a health survey in 1999 and became age-eligible for Medicare from 1998 to 2000 were followed through 2016.

Principal Findings:
More Veterans chose to rely on the VHA than Medicare (64% vs. 36.%). For a VHA-reliant Veteran, a Medicare-paid hospital stay was associated with a decrease of 7.8 percentage points (pps) (P<0.001) in VHA reliance in the subsequent 12 months, but by 36 months reliance increased to near prehospitalization levels (−1.5 pps; P=0.138). Moving further from the VHA, or receiving a diagnosis of cancer, heart failure, or renal failure had no significant association with subsequent VHA reliance; however, a diagnosis of dementia was associated with a decrease in VHA reliance (−8.6 pps; P=0.026).

Conclusions:
A significant majority of newly Medicare-eligible VHA users voted with their feet in favor of sustaining the VHA as a provider of comprehensive medical care for Veterans. These VHA-reliant Veterans maintained their reliance even after receiving a life-threatening diagnosis, and after experiencing Medicare-provided hospital care.
HIV Prevalence Among Women Who Exchange Sex for Money or Drugs—4 U.S. Cities
Authors: Nerlander Lina M. , Handanagic Senad , Hess Kristen L. , Lutnick Alexandra , Agnew-Brune Christine B. , Hoots Brooke E. , Braunstein Sarah L. , Glick Sara Nelson , Higgins Emily , Padgett Paige , Schuette Stephanie M. , Broz Dita , Ivy Wade , Smith Amanda , Thorson Anna , Paz-Bailey Gabriela ,   for the NHBS High Risk Women Study Group
Published: April 2020

Background:
Limited data exist in the United States on the prevalence of HIV among women who exchange sex.

Setting:
We estimate HIV prevalence of women who exchange sex from a 2016 survey in Chicago, Detroit, Houston, and Seattle and compare it with the prevalence of HIV among women of low socioeconomic status (SES), who did not exchange sex, and women in the general population.

Methods:
Women who exchange sex were recruited via respondent-driven sampling among some cities participating in National HIV Behavioral Surveillance, interviewed, and offered HIV testing. We estimate HIV prevalence and, using prevalence ratios, compare it with the prevalence among women of low SES who did not exchange sex in the 2013 National HIV Behavioral Surveillance cycle, and to women in the general population estimated using 2015 National HIV Surveillance data.

Results:
One thousand four hundred forty women reported exchange sex in 2016. Aggregated HIV prevalence was 4.9% [95% confidence interval (CI): 2.7 to 7.1] among women who exchanged sex, 1.6% (95% CI: 0.3 to 2.8) among women of low SES who did not exchange sex, and 0.6% (95% CI: 0.5% to 0.6%) among women in the general population. HIV prevalence among women who exchanged sex was 3.1 times (95% CI: 1.6 to 5.9) as high as among women of low SES who did not exchange sex, and 8.8 times (95% CI: 7.0 to 11.1) as high as among women in the general population.

Conclusion:
HIV prevalence was significantly higher among women who exchanged sex compared with women in the general population and women of low SES who did not exchange sex.
Are White Matter Tract Integrities Different in Multiple Sclerosis Women With Voiding Dysfunction?
Authors: Tran Khue , Karmonik Christof , Boone Timothy B. , Khavari Rose 
Published: April 2020

Objectives
Two white matter tracts (WMTs) are proposed to be involved in bladder function: anterior thalamic radiation and superior longitudinal fasciculus. Multiple sclerosis (MS) patients with voiding dysfunction (VD) may have distinct changes in these 2 WMTs. This study aims to compare the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging of MS females with and without VD versus healthy controls (HCs).

Methods
Prospective observational cohorts of 28 female MS patients and 11 HCs were recruited. Multiple sclerosis patients were divided into 2 groups: voiders (patients without VD, n = 14) and VD (patients with VD, n = 14). Diffusion tensor imaging of each subject was obtained, from which FA and MD maps were generated. The mean FA and MD of each WMT on both sides were analyzed using one-way analysis of variance and pairwise comparison with adjusted P values.

Results
Overall MS patients had significantly lower mean FA (loss of coherence) and significantly higher mean MD (increased free diffusion) than HCs in both WMTs, indicating more damage. Furthermore, VD showed a trend of loss of integrity in both WMTs when compared with voiders with lower FA and higher MD.

Conclusions
There is damage reflected by lower FA and higher MD values in the proposed WMTs involved in bladder function in MS women. Voiding dysfunction in this patient population can be attributed to these damages considering women with VD demonstrated a trend of deterioration in these WMTs compared with women without VD. Future studies with larger sample sizes should be done to further confirm this correlation.
Renal Function Improvement Following ANG-3777 Treatment in Patients at High Risk for Delayed Graft Function After Kidney Transplantation
Authors: Bromberg Jonathan S. , Weir Matthew R. , Gaber A. Osama , Yamin Michael A. , Goldberg Itzhak D. , Mayne Tracy J. , Cal Weizhong , Cooper Matthew 
Published: April 2020

Background.
Patients (20%–50%) undergoing renal transplantation experience acute kidney injury resulting in delayed graft function. ANG-3777 is an hepatocyte growth factor mimetic that binds to the c-MET receptor. In animal models, ANG-3777 decreases apoptosis, increases proliferation, and promotes organ repair and function.

Methods.
This was a randomized, double-blind, placebo-controlled, phase 2 trial of patients undergoing renal transplantation with <50 cc/h urine output for 8 consecutive hours over the first 24 hours posttransplantation, or creatinine reduction ratio <30% from pretransplantation to 24 hours posttransplantation. Subjects were randomized as 2:1 to 3, once-daily IV infusions of ANG-3777, 2 mg/kg (n = 19), or placebo (n = 9). Primary endpoint: time in days to achieve ≥1200 cc urine for 24 hours.

Results.
Patients treated with ANG-3777 were more likely to achieve the primary endpoint of 1200 cc urine for 24 hours by 28 days posttransplantation (83.3% versus 50% placebo; log-rank test: χ2 = 2.799, P = 0.09). Compared with placebo, patients in the ANG-3777 arm had larger increases in urine output; lower serum creatinine; greater reduction in C-reactive protein and neutrophil gelatinase-associated lipocalin; fewer dialysis sessions and shorter duration of dialysis; fewer hospital days; significantly less graft failure; and higher estimated glomerular filtration rate. Adverse events occurred in a similar percentage of subjects in both arms. Events per subject were twice as high in the placebo arm.

Conclusions.
There was an efficacy signal for improved renal function in subjects treated with ANG-3777 relative to placebo, with a good safety profile.
Paneth Cell Alterations During Ischemia-reperfusion, Follow-up, and Graft Rejection After Intestinal Transplantation
Authors: Kip Anna M. , Ceulemans Laurens J. , Hundscheid Inca H.R. , Canovai Emilio , Hartog Hermien , Brown Rachel M. , Corcos Olivier , Joly Francisca , De Hertogh Gert , Gupte Girish , Dejong Cornelis H.C. , Olde Damink Steven W.M. , Pirenne Jacques , Mirza Darius , Lenaerts Kaatje 
Published: April 2020

Background.
Ischemia-reperfusion injury is inevitable during intestinal transplantation (ITx) and executes a key role in the evolution towards rejection. Paneth cells (PCs) are crucial for epithelial immune defense and highly vulnerable to ischemia-reperfusion injury. We investigated the effect of ITx on PC after reperfusion (T0), during follow-up, and rejection. Moreover, we investigated whether PC loss was associated with impaired graft homeostasis.

Methods.
Endoscopic biopsies, collected according to center protocol and at rejection episodes, were retrospectively included (n = 28 ITx, n = 119 biopsies) Biopsies were immunohistochemically co-stained for PC (lysozyme) and apoptosis, and PC/crypt and lysozyme intensity were scored.

Results.
We observed a decrease in PC/crypt and lysozyme intensity in the first week after ITx (W1) compared with T0. There was a tendency towards a larger decline in PC/crypt (P = 0.08) and lysozyme intensity (P = 0.08) in W1 in patients who later developed rejection compared with patients without rejection. Follow-up biopsies showed that the PC number recovered, whereas lysozyme intensity remained reduced. This persisting innate immune defect may contribute to the well-known vulnerability of the intestine to infection. There was no clear evidence that PCs were affected throughout rejection.

Conclusions.
This study revealed a transient fall in PC numbers in the early post-ITx period but a permanent reduction in lysozyme intensity following ITx. Further research is needed to determine the potential clinical impact of PC impairment after ITx.
Transient-mixed Chimerism With Nonmyeloablative Conditioning Does Not Induce Liver Allograft Tolerance in Nonhuman Primates
Authors: Chaudhry Sulemon , Kato Yojiro , Weiner Joshua , Alonso-Guallart Paula , Baker Sam , Woodland David C. , Lefkowitch Jay H. , Duran-Struuck Raimon , Sondermeijer Hugo P. , Zitsman Jonah , Sears Mallory L. , Wu Anette , Karolewski Brian , Houck Philipp J. , Martinez Mercedes , Kato Tomoaki , Sykes Megan , Griesemer Adam D. 
Published: April 2020

Background.
Although short-term outcomes for liver transplantation have improved, patient and graft survival are limited by infection, cancer, and other complications of immunosuppression. Rapid induction of tolerance after liver transplantation would decrease these complications, improving survival and quality of life. Tolerance to kidneys, but not thoracic organs or islets, has been achieved in nonhuman primates and humans through the induction of transient donor chimerism. Since the liver is considered to be tolerogenic, we tested the hypothesis that the renal transplant transient chimerism protocol would induce liver tolerance.

Methods.
Seven cynomolgus macaques received immune conditioning followed by simultaneous donor bone marrow and liver transplantation. The more extensive liver surgery required minor adaptations of the kidney protocol to decrease complications. All immunosuppression was discontinued on postoperative day (POD) 28. Peripheral blood chimerism, recipient immune reconstitution, liver function tests, and graft survival were determined.

Results.
The level and duration of chimerism in liver recipients were comparable to those previously reported in renal transplant recipients. However, unlike in the kidney model, the liver was rejected soon after immunosuppression withdrawal. Rejection was associated with proliferation of recipient CD8 T effector cells in the periphery and liver, increased serum interleukin (IL)-6 and IL-2, but peripheral regulatory T cell (Treg) numbers did not increase. Antidonor antibody was also detected.

Conclusions.
These data show the transient chimerism protocol does not induce tolerance to livers, likely due to greater CD8 T cell responses than in the kidney model. Successful tolerance induction may depend on greater control or deletion of CD8 T cells in this model.
Timing of antiviral treatment initiation is critical to reduce SARS-Cov-2 viral load
Authors: Gonçalves Antonio , Bertrand Julie , Ke Ruian , Comets Emmanuelle , de Lamballerie Xavier , Malvy Denis , Pizzorno Andrés , Terrier Olivier , Calatrava Manuel Rosa , Mentré France , Smith Patrick , Perelson Alan S , Guedj Jérémie 
Published: April 2020

AbstractWe modeled the viral dynamics of 13 untreated patients infected with SARS-CoV-2 to infer viral growth parameters and predict the effects of antiviral treatments. In order to reduce peak viral load by more than 2 logs, drug efficacy needs to be greater than 90% if treatment is administered after symptom onset; an efficacy of 60% could be sufficient if treatment is initiated before symptom onset. Given their pharmacokinetic/pharmacodynamic properties, current investigated drugs may be in a range of 6-87% efficacy. They may help control virus if administered very early, but may not have a major effect in severe patients.