bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiologic Characteristics and Postoperative Complications following Augmentation Mammaplasty: Comparison of Transgender and Cisgender Females
Authors: Cuccolo Nicholas G. , Kang Christine O. , Boskey Elizabeth R. , Ibrahim Ahmed M.S. , Blankensteijn Louise L. , Taghinia Amir , Lee Bernard T. , Lin Samuel J. , Ganor Oren 
Published: November 2019

Background:
Breast augmentation in transgender women can be an important first step in addressing gender incongruence and improving psychosocial functioning. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females.

Methods:
We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2017 to establish 2 cohorts: (1) transgender females undergoing gender-affirming breast augmentation (“top surgery”) and (2) cisgender females seeking cosmetic breast augmentation (CBA). Demographic characteristics and postoperative outcomes were compared between the 2 cohorts. Multivariable regression analysis was used to control for confounders.

Results:
A total of 1,360 cases were identified, of which 280 (21%) were feminizing top surgeries and 1,080 (79%) were CBA cases. The transfeminine cohort was significantly older, had a higher average body mass index, and was more racially diverse than the CBA cohort. Transfeminine patients also had higher rates of smoking, diabetes, and hypertension. The rates of all-cause complications were low in both cohorts, and differences were not significant (1.6% transfeminine versus 1.8% CBA, P = 0.890) for the first 30-days after operation. After controlling for confounding variables, transfeminine patients had postoperative complication profiles similar to their cisgender counterparts. Multivariable regression analysis revealed no statistically significant predictors for all-cause complications.

Conclusions:
Transfeminine breast augmentation is a safe procedure that has a similar 30-day complication profile to its cisgender counterpart. The results of this study should reassure and encourage surgeons who are considering performing this procedure.
Restoration of Elbow Flexion with a Pedicled Latissimus Dorsi Myocutaneous Flap to a Brachial Plexus Injury at the Terminal Nerve Level
Authors: Kameda Takuya , Soichi Ejiri , Yokota Takeru , Konno Shin-ichi 
Published: November 2019

Summary:
A pedicled latissimus dorsi (LD) myocutaneous flap is a reliable reconstructive method for elbow flexion, though there are no reports regarding its application to a terminal nerve level injury of the brachial plexus. A 29-year-old man presented with dysfunction of elbow flexion, wrist extension, and finger extension. Physical examination and electromyography showed that the palsy was caused by an injury at the terminal nerve level of the brachial plexus without dysfunction of the axillary nerve. Bipolar transfer of LD for reconstruction of elbow flexion and subsequent tendon transfer for wrist and finger extension were performed. The final British Medical Research Council grade was 4 for elbow flexion, and active range of motion was 0/135. An injury at the terminal nerve level of the brachial plexus should be listed in the differential diagnosis of elbow flexion dysfunction even if shoulder function is intact, and a suitable reconstructive method for this atypical type of palsy could be bipolar transfer of a LD flap.
Small Finger Osteocutaneous Fillet Flap for Reconstruction in Ring Finger Trauma
Authors: Parent Brodie , Camison Liliana , Barreiro Guilherme , Spiess Alexander 
Published: November 2019

Summary:
Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring fingers with severe crush injury and soft tissue avulsion. Of the tissues and bones in the small finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small finger, the bony gap and soft tissue deficits in the ring finger were reconstructed. The ring finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring finger. This case demonstrates the creative use of a “spare-parts” osteocutaneous fillet flap in the reconstruction of a traumatic finger injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a finger amputation.
Cost Utility of Breast Tissue Expansion using Carbon Dioxide versus Saline: An Analysis of Infection Risk
Authors: Chopra Karan , Slavin Benjamin , Khavanin Nima , Kraenzlin Franca , Darrach Halley , Holton Luther , Landford Wilmina N. , Singh Devinder P. 
Published: November 2019

Background:
The AeroForm System, a needle-free, patient-controlled carbon dioxide-filled tissue expander, represents a novel option for tissue expansion in 2-stage breast reconstruction. This technology has previously been found to decrease time to expansion, health-care utilization, and infection rates. The purpose of this study was to determine the economic impact of the reduced infection rate observed with the AeroForm tissue expander as compared with saline tissue expansion.

Methods:
A decision model incorporating costs, quality-adjusted life years, and clinical outcomes of infection was designed to evaluate the cost-efficacy of AeroForm tissue expanders versus conventional saline expanders. All statistical calculations were performed in the R statistical computing environment.

Results:
Pooled infection rates from the published literature following saline and AeroForm tissue expander placement were 5.83% and 2.62%, respectively. Cost-utility analysis resulted in a baseline expected savings of $253.29 and an expected gain of 0.00122 quality-adjusted life years with AeroForm tissue expanders. One-way sensitivity analysis revealed that AeroForm tissue expanders were dominant when the surgical site infection rate was greater than 4.56% with traditional saline expanders.

Conclusions:
Clinical benefits of an innovation are no longer sufficient to justify its acquisition costs. Novel technologies must also demonstrate favorable economic outcomes. This cost-utility analysis demonstrates that the use of AeroForm expanders is likely a cost-saving technology for 2-stage breast reconstruction.
Benefits of Cardiac Rehabilitation in Coronary Artery Disease
Authors: Braga Marta , Nascimento Helena , Pinto Roberto , Araújo Paulo , Nunes Alzira , Rodrigues Joana , Araújo Vítor , Parada-Pereira Fernando , Maciel Maria Júlia , Rocha Afonso 
Published: November 2019

Purpose:
To evaluate the response of patients with obesity to a cardiac rehabilitation program (CRP), compared with patients without obesity.

Methods:
We performed a retrospective analysis of 731 patients who completed phase II of a CRP after an acute coronary syndrome. The response to the CRP was assessed using the relative changes in exercise capacity (EC), resting heart rate (HR), and chronotropic index (CI).

Results:
Only 23% of patients had obesity. Patients with obesity showed lower EC and CI at baseline and at the end of phase II of the CRP. Despite that, we reported a higher relative improvement for EC in patients with obesity (median [interquartile range], 23.9% [5.2, 40.8] vs 17.6% [8.1, 35.9], P = .043) and similar improvements in CI (10.9% [−1.4 to 34.2] vs 7.1% [−7.1 to 28.2], P = .100), compared with patients without obesity. There were no significant changes in resting HR.

Conclusion:
Regardless of their lower exercise performance at baseline, patients with obesity had a remarkably positive response to the CRP compared with patients without obesity.
Cardiovascular Reactivity to Acute Mental Stress
Authors: Gecaite Julija , Burkauskas Julius , Brozaitiene Julija , Mickuviene Narseta 
Published: November 2019

Purpose:
Links between psychophysiological reactions to stress stimuli and perceived mental distress, including type D personality, anxiety, and depression, are still under debate. The aim of this study was to examine associations between cardiovascular reactivity to social stress and mental distress in patients after acute coronary syndrome.

Methods:
Patients (n = 116, 86% males, 52 ± 8 yr) with coronary artery disease 2 wk after acute coronary syndrome were evaluated for sociodemographic, clinical characteristics and coronary artery disease risk factors. The Trier Social Stress Test was employed to measure cardiovascular reactions to social stress (systolic and diastolic blood pressure and heart rate). Mental distress assessment included type D personality (Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and state and trait anxiety (State-Trait Anxiety Inventory).

Results:
Multiple linear regression analysis showed associations between type D personality and lower heart rate during Trier Social Stress Test periods of task instruction (β = −.196, P < .04), preparation time (β = −.232, P < .01), and recovery time (β = −.209, P < .029). Higher trait anxiety was linked with lower heart rate during baseline rest (β = −.287, P < .01), task instruction (β = −.286, P < .01), preparation time (β = −.241, P < .01), and recovery period (β = −.209, P < .05). Depressive symptoms were associated with higher systolic blood pressure during baseline rest (β =.187, P < .05), task instruction (β = .306 P < .01), and free speech (β = .264, P < .05).

Conclusions:
Mental distress was associated with cardiovascular stress reactions independent from possible covariates, suggesting dysregulated psychophysiological reactions to acute stress.
Dengue Fever in End-Stage Renal Failure Patient
Authors: Lim Xue Meng , Lim Christopher Thiam Seong 
Published: November 2019

Abstract
Dengue viral infection is common in tropical and subtropical parts of the world and may lead to death. There are an estimated 390 million cases of dengue viral infections reported worldwide each year, putting 2.5 billion individuals at risk of this arthropod-borne viruses. The cornerstone of its management is prompt diagnosis, appropriate monitoring, and careful fluid replacement. This is particularly difficult in end-stage renal failure (ESRF) patients on maintenance dialysis, as there is a complex issue of the ability of making a prompt diagnosis, the presence of coagulopathy, and the risk of fluid overload due to constant evolving fluid dynamic as part of the dengue fever disease process. There is a serious lack of literature report in the area of dengue infection in ESRF patient. We report a case of a man with ESRF with a delayed diagnosis of dengue viral infection, who admitted at the critical phase of the illness. Despite that, he managed to recover uneventfully with tailored management in his fluid replacement, medication adjustment, and dialysis prescription. Hence, a high index of suspicion is needed when an ESRF patient presents with fever in a dengue-endemic area. A multidisciplinary approach with good collaboration between physician and nephrologist is needed to ensure the best outcome. Renal replacement therapy and medications should be individually tailored according to the patient's clinical condition. We hope that our reported clinical case will contribute to the understanding of the complex issue of management of dengue fever in ESRF patients.
A Successful Aztreonam Desensitization Protocol
Authors: Schorsch Philip , Brillante Christie , Yaqoob Maidah , Pappalardo Andrea A. , Benken Scott T. 
Published: November 2019

Abstract
Drug desensitization involves slowly increasing the dose of a medication until an induced tolerance is achieved and is typically performed when therapeutic options are limited and hypersensitivity reactions are a concern. We present a patient with an extensive history of hypersensitivity to multiple antibiotics and symptoms of potential gentamicin toxicity requiring aztreonam desensitization for the treatment of bacteremia. A desensitization protocol was created, and sequential rapid aztreonam desensitization was executed with no hypersensitivity reactions. This protocol provides guidance to other providers who need to use aztreonam where drug hypersensitivity is a concern.
Herpes Simplex Virus 1 Hepatitis Leading to Liver Failure and Hemophagocytic Lymphohistiocytosis
Authors: Cheney-Peters Dianna , Weber Devin M. 
Published: November 2019

Abstract
A 65-year-old immunocompetent adult presented with fever, fatigue, and laboratory evidence of acute liver failure. He was unable to undergo liver biopsy secondary to coagulopathy. His herpes simplex virus 1 (HSV-1) polymerase chain reaction level was elevated in the serum, leading to presumptive diagnosis of HSV-1–associated hepatitis. His course was complicated by rising ferritin, and workup revealed hemophagocytic lymphohistiocytosis suspected to be secondary to infection with HSV-1. He improved on intravenous acyclovir and completed a 21-day course. Review of the literature demonstrates that this is the fourth case of hemophagocytic lymphohistiocytosis associated with HSV-1 alone in an immunocompetent adult. Case reports have described treatment regimens including antivirals, antivirals in combination with immunosuppressant agents, and liver transplantation with immunosuppression with successful outcomes.
Bowel obstruction in advanced cancer
Authors: Ferraz Gonçalves José António , Faria Magda , Araújo Vânia , Monteiro Ana Raquel , Silva Ana Vítor , Jamal Sheila , Moutinho Adelaide 
Published: November 2019

Abstract

Purpose:
Assessment of treatment of cancer patients with bowel obstruction, identification of prognostic factors, and assessment of reference to palliative care.

Methods:
Records of patients with a diagnosis of bowel obstruction over a 6-month (January–June 2013) period were reviewed.

Results:
Seventy-five patients were diagnosed with bowel obstruction. Fifty-one (68%) were female and the median age was 65 years (27–100). The most frequent cancer was colorectal, 30 (40%), followed by gynecological cancer, 20 (27%). Forty-three (57%) patients underwent conservative treatment; 26 (35%) underwent surgery; and 6 (8%) had a stent placement. In 68 (91%), the bowel obstruction was resolved. Three years after the bowel obstruction episode, 15 (20%) patients were still alive. An analysis of the possible association of variables recorded with mortality was carried out, and for death at the first admission, only the resolution of the obstruction was significant (P < .001); for the 3-year survival the significant factors were hemoglobin >10.7 g/dL (P < .001) and ascites (P = .001) at the time of obstruction. Thirty-seven (49%) patients were referred to palliative care.

Conclusions:
Although bowel obstruction in cancer patients is usually associated with a short life expectancy, some patients have relatively long survivals. Only about half of the patients were referred to palliative care.
Long-Term Response to Clozapine and Its Clinical Correlates in the Treatment of Tardive Movement Syndromes
Authors: Lee Dongbin , Baek Ji Hyun , Bae Moonoh , Choi Yujin , Hong Kyung Sue 
Published: November 2019

Abstract

Purpose
Given that switching to clozapine is an important treatment option for tardive movement syndrome (TMS), its effect and clinical correlates have not been fully explored yet. This study investigated the improvement of TMS after switching to clozapine and factors associated with the response in a naturalistic outpatient setting.

Methods
Subjects were 35 patients with schizophrenia or bipolar disorder receiving only clozapine as an antipsychotic drug for more than 12 months. Their prior antipsychotics were switched to clozapine after the onset of tardive dyskinesia and/or tardive dystonia. Tardive movement syndrome and clinical characteristics were assessed through direct examination and review of hospital records.

Findings
Offending antipsychotics administered at the time of TMS onset were second-generation antipsychotics in 88.6% of patients. Tardive movement syndrome symptoms were remitted in 65.7% of patients after switching to clozapine. Younger age, younger age at onset of TMS, and lower baseline Abnormal Involuntary Movement Scale score were significantly associated with remission of TMS. Female sex and good antipsychotic effects of clozapine showed a trend of association with better response.

Implications
Clozapine seems to be an excellent treatment option for TMS in the era of second-generation antipsychotics, especially for younger patients with mild tardive dyskinesia. Clinical trials comparing the effect of switching antipsychotics to clozapine with add-on therapy of new drugs targeting TMS are difficult to design in ordinary clinical settings. Therefore, more naturalistic observational studies are warranted to identify predictors of TMS response to clozapine.
Adjunctive Memantine Treatment of Schizophrenia
Authors: Hassanpour Fatemeh , Zarghami Mehran , Mouodi Sussan , Moosazadeh Mahmood , Barzegar Fatemeh , Bagheri Maedeh , Hendouei Narjes 
Published: November 2019

AbstractPurpose/BackgroundThis double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of memantine augmentation to standard regimen of antipsychotic treatment on psychotic symptoms and cognitive function in individuals with chronic schizophrenia for 8 weeks.Methods/ProceduresForty stabilized individuals with chronic schizophrenia were randomized in a 1:1 ratio to memantine (20 mg/d) and control (placebo) groups, along with their antipsychotic regimen for 8 weeks. The efficacy of treatment was assessed by the Positive and Negative Syndrome Scale (PANSS) and Brief Assessment of Cognition Scale, and the safety was measured by the Abnormal Involuntary Movement Scale and Barnes Akathisia Rating Scale at baseline and at weeks 4 and 8.Findings/ResultsNo significant differences were observed in demographic or clinical variables between both groups at baseline. During the study, all subscales and total scores of PANSS decreased significantly within both groups, except the subscale score in memantine, which was found to be positive. Reduction in general subscale and total scores of PANSS was significantly higher in the control group compared with the memantine group. All subscale scores of the Brief Assessment of Cognition Scale increased significantly only in the memantine group. The increase in the Verbal Memory, Working Memory, Verbal Fluency Letter, and Verbal Fluency Total subscale scores was significantly higher in the memantine group than in the control group. There was no significant difference in the Abnormal Involuntary Movement Scale and Barnes Akathisia Rating Scale scores between the 2 groups during the study.Implications/ConclusionsThis study showed that adjunctive memantine to antipsychotic regimen improved the verbal memory, learning, verbal letter fluency, and working memory without improvement on psychotic symptoms in individuals with chronic schizophrenia.
The Relationship Between Cumulative Exogenous Corticosteroid Exposure and Volumes of Hippocampal Subfields and Surrounding Structures
Authors: Nguyen Duc M. , Yassa Michael A. , Tustison Nicholas J. , Roberts Jared M. , Kulikova Alexandra , Nakamura Alyson , Ivleva Elena I. , Van Enkevort Erin , Brown E. Sherwood 
Published: November 2019

Abstract

Purpose/Background
Glucocorticoids are a class of hormones that include naturally occurring cortisol and corticosterone, as well as prescription drugs commonly used to manage inflammatory, autoimmune, and allergic conditions. Adverse effects, including neuropsychiatric symptoms, are common. The hippocampus appears to be especially sensitive to the effects of glucocorticoids. However, to our knowledge, no studies to date have examined hippocampal subfields in humans receiving glucocorticoids. We examined patients on chronic glucocorticoid regimens to determine relationships between dose and duration of treatment, and hippocampal subfields, and related regions volumes.

Methods/Procedures
The study included adult men and women receiving at least 5 mg daily of prednisone equivalents for at least 6 months. Volumes of brain regions were measured via magnetic resonance imaging. A multivariate general linear model was used for analysis, with brain volumes as dependent variables and age, sex, and cumulative corticosteroid exposure, as predictors.

Findings/Results
The study population consisted of 81 adult outpatients (43 male) on corticosteroids (mean dose, 7.88 mg; mean duration, 76.75 months). Cumulative glucocorticoid exposure was negatively associated with left and right hippocampal dentate gyrus/CA3 volume. In subsequent subgroup analysis, this association held true for the age group older than the median age of 46 years but not for the younger age group.

Implications/Conclusions
This finding is consistent with previous studies showing detrimental effects of elevated glucocorticoids on the hippocampus but further suggests that the dentate gyrus and CA3 regions are particularly vulnerable to those effects, which is consistent with animal models of chronic stress but has not been previously demonstrated in humans.
Serotonin Toxicity
Authors: Moss Michael J. , Hendrickson Robert G. 
Published: November 2019

Abstract

Background
Serotonin toxicity is a common cause of drug-induced altered mental status. However, data on the causes of serotonin toxicity, symptomatology, complications, and rate of antidotal treatment are limited.

Methods
This study evaluated cases of serotonin toxicity in the ToxIC registry, an international database of prospectively collected cases seen by medical toxicologists. Serotonin toxicity was diagnosed by bedside evaluation of medical toxicology specialists and explicit criteria were not used. The database was searched for “serotonin syndrome” between January 1, 2010, and December 31, 2016.

Results
There were 1010 cases included. Females made up 608 (60%) cases. Ages are as follows: younger than 2 years (3, 0.3%), 2 to 6 years (8, 0.8%), 7 to 12 years (9, 0.9%), 13 to 18 years (276, 27.3%), 19 to 65 years (675, 67%), older than 66 years (33, 3.4%), unknown (6, 0.6%). Reasons for encounter: intentional (768, 76%), adverse drug event/reaction (127, 12.6%), unintentional (66, 6%), and unknown (55, 5.4%). Signs/symptoms: hyperreflexia/clonus/myoclonus (601, 59.5%), agitation (337, 33.4%), tachycardia (256, 25.3%), rigidity (140, 13.9%), seizures (139, 13.7%), and hyperthermia (29, 2.9%). Complications: rhabdomyolysis (97, 9.7%), dysrhythmias (8, 0.8%), and death (1, 0.1%). Treatments: benzodiazepines 67% (677/1010), cyproheptadine 15.1% (153/1010). There were 192 different xenobiotics reported with 2046 total exposures. Antidepressants were most common (915, 44.7%) with bupropion the most frequent overall (147, 7.2%). Common non-antidepressants were dextromethorphan (95, 6.9%), lamotrigine (64, 3.1%), and tramadol (60, 2.9%).

Discussion
Serotonin toxicity most often occurred in adult patients with intentional overdose. Antidepressants were the most common agents of toxicity. Interestingly, bupropion, a norepinephrine/dopamine reuptake inhibitor, was the most frequently mentioned xenobiotic. Though often cited as a potential antidote, only 15% of patients received cyproheptadine. Severe toxicity was rare. A single death was reported.