bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal changes of the macular structure after lens removal combined with anterior vitrectomy after pediatric cataract surgery
Authors: Wang Dandan , Tian Tong , Wang Jiajun , Li Zhangliang , Chang Pingjun , Ding Xixia , Zhao Yinying , Zhao Yun-e 
Published: April 2020

Purpose:
To explore the macular thickness changes after lens removal combined with anterior vitrectomy for pediatric cataract surgery.

Setting:
The Eye Hospital of Wenzhou Medical University, Zhejiang, China.

Design:
Prospective study.

Methods:
Thirty children (40 eyes) aged between 3 years and 9 years with pediatric cataracts, including 20 children (20 eyes) with unilateral cataracts and 10 children (20 eyes) with bilateral cataracts, were enrolled. Spectral-domain optical coherence tomography was used to obtain macular images. Central subfield thickness (CST) and retinal thickness in the Early Treatment Diabetic Retinopathy Study subfields (inner 1.0 to 3.0 mm annulus and outer 3.0 to 6.0 mm annulus) were recorded preoperatively as well as at 1, 3, 6, and 12 months postoperatively.

Results:
Forty eyes of 30 children were included. Retinal thickness in every subfield significantly thickened at 3 months postoperatively (all P < .05). CST significantly thickened compared with preoperative levels (228.03 ± 18.58 vs 240.35 ± 17.41, P = .005) at 3 months postoperatively; macular thickness gradually decreased in the following months. At 6 months postoperatively, retinal thickness in inner nasal, inferior, temporal, and outer nasal subfields remained significantly thicker compared with preoperative levels (P = .048, P = .036, P = .029, and P = .017, respectively). At 12 months, the retinal thickness in all subfields reached the preoperative level.

Conclusions:
The influence on macular thickness lasted until 12 months after pediatric cataract surgery. The inner macular thickness increased for a longer time than the outer macular thickness postoperatively.
Acute Effects of Iron Sucrose and Iron Carboxymaltose on Endothelial Function in Nondialysis Chronic Kidney Disease Patients
Authors: Mehedinti Ana Maria , Lipan Mariana , Stancu Simona , Mircescu Gabriel , Capusa Cristina 
Published: April 2020

Background:
Intravenous iron is commonly prescribed in chronic kidney disease (CKD) patients. Iron sucrose (IS) and ferric carboxymaltose (FCM) are 2 frequently used formulations. Experimental data showed that this 2 intravenous iron preparations have different potential to induce oxidative stress and by that endothelial dysfunction. Still, direct comparisons in clinical settings are rather scarce.

Study Question:
Are there any acute changes in endothelial function after single intravenous iron infusions of IS and FCM in nondialysis CKD patients?

Study Design:
This was a prospective, crossover study in which 31 patients with CKD stages 3–5 (80% stages 3 and 4, 81% female, 55% older than 60 years, 23% diabetes mellitus, and 94% arterial hypertension) who required intravenous iron as part of their routine medical care were enrolled.

Measures and Outcomes:
The effect of flow-mediated vasodilatation infusions containing 250-mL 10% glucose, 500-mg FCM, and 200-mg IS, both in 250-mL 0.9% saline solution, was compared. The infusions were administered over 30 minutes, 72 hours apart, in the mentioned order. Ultrasound measurement of the brachial artery flow-mediated vasodilation (FMD) performed 15 minutes before and after each infusion was used to assess endothelial function. The outcome was the post/preinfusion difference (Δ) in FMD.

Results:
The baseline FMD was similar before each study intervention. The arterial reactivity significantly decreased only after IS infusion [ΔFMD −2.3 (−5.65 to −0.33) vs. 1.0 (−1.49 to 1.80) after glucose, P = 0.01], but not after FCM [ΔFMD −0.8 (−2.50 to 0.65), P = 0.27 vs. glucose]. Moreover, the arterial reactivity was higher after IS as compared to FCM.

Conclusions:
Endothelial dysfunction seems to be acutely induced by a single dose of intravenous IS, but not by FCM, in nondialysis CKD patients.
Trends in Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men After Rapid Scale-up of Preexposure Prophylaxis in Victoria, Australia
Authors: Ryan Kathleen E. , Asselin Jason , Fairley Chistopher K. , Armishaw Judy , Lal Luxi , Nguyen Long , Murphy Dean , Traeger Michael , Hellard Margaret , Hoy Jennifer , Stoové Mark , Wright Edwina 
Published: April 2020

Objective
Scale-up of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services.

Methods
We describe enrolment between July 26, 2016, and March 31, 2018, and trends in HIV testing among PrEPX participating and nonparticipating gay and bisexual and other men who have sex with men (GBM) at 5 study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the prestudy (January 2015 to June 2016) and PrEPX study (July 2016 to March 2018) periods.

Findings
There were 2,049 individuals who registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week 3, 88% (n = 876) of whom enrolled at ACCESS sites.
Prestudy period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (P < 0.01) and no significant change among non-PrEPX GBM (P = 0.72). Across the study period, HIV testing increased by 7.2 (P < 0.01) and 8.9 (P < 0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. The HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, P < 0.01) and primary care clinics (7.9 tests/month, P < 0.01). Similar trends were observed across testing for all measured STIs.

Conclusions
Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.
Virtual Pediatric Emergency Department Telehealth Network Program
Authors: Cotton James , Bullard-Berent Jeffrey , Sapien Robert 
Published: April 2020

Objectives
Pediatric patients living in rural, underserved areas have reduced access to medical care. There is a lack of research describing the use of telemedicine (TM) for general pediatric emergency medicine (PEM). In 2013, we established the Child Ready Virtual Pediatric Emergency Department Telehealth Network (CR-VPED), a PEM TM consultation service serving rural hospitals across the state of New Mexico. The aim of this article is to describe our experience for 6 years (2013–2018).

Methods
We describe the process of establishing the CR-VPED Telehealth Network. We reviewed all the TM consultations completed from June 22, 2013, to September 6, 2018. In our review, we focus on patient demographics, medical complaint, transfer status, type of referring provider, and problems encountered with each TM consultation.

Results
We had a total of 58 PEM TM consultations between June 22, 2013, and September 6, 2018. All consultations occurred at 6 of the 12 established sites. Most TM consultations (71%; 41/58) were with Indian Health Service sites. Among all TM consultations, patients ranged in age from 30 days to 17 years (mean, 54 months; median, 32 months). Only 26% (15/58) of the patients with TM consultations were transferred to the tertiary care hospital. There was a heterogeneous mix of chief complaints and diagnoses. Rash was the most common chief complaint (24%; 14/58). There was a mix of referring providers, with family medicine physicians being most common (31%; 18/58). Common technical issues were not properly recording the encounter into the electronic medical record (12%; 7/58) and difficulty logging into the CR-VPED Telehealth Network (9%; 5/58).

Conclusions
Previous studies have investigated the use of TM in pediatric acute care, but most studies have focused on critical care or subspecialty care in the office setting. Our experience with CR-VPED has shown that it has been feasible to provide general pediatric emergency care to patients in underserved, rural emergency departments across New Mexico. Patients requiring TM consultation were heterogeneous in age and presentation.
Occult Breast Carcinoma Is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis
Authors: Fitzpatrick Siobhan E. , Lam Thomas C. 
Published: April 2020

Background:
Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens.

Methods:
The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer.

Results:
Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001).

Conclusions:
Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.
Skin Excursion with Cannula Lipodissection and the Anatomical Implications of Superficial Musculoaponeurotic System Movement in the Tumescent Face Lift
Authors: Mirzabeigi Michael N. , Stark Ran Y. , Chang Catherine S. , Weissler Jason M. , Carney Martin J. , Bucky Louis P. 
Published: April 2020

Background:
The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift.

Methods:
A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements.

Results:
Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion.

Conclusions:
Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.
Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?
Authors: Zhang Ben , Chen Kevin , Ha Grace , Smith Mark L. , Bradley James P. , Thorne Charles H. , Kasabian Armen K. , Pusic Andrea L. , Tanna Neil 
Published: April 2020

Background:
The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors.

Methods:
Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors.

Results:
A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women.

Conclusions:
Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.
Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation
Authors: Nijhoff Michiel F. , Hovens Jacqueline G.F.M. , Huisman Sasja D. , Ringers Jan , Rabelink Ton A.J. , de Fijter Hans J.W. , van der Boog Paul J.M. , de Koning Eelco J.P. 
Published: April 2020

Background.
Patients that have undergone successful simultaneous pancreas/kidney (SPK) transplantation attain normoglycemia and are free from dialysis. However, only a minor improvement in quality of life (QOL) has been demonstrated. Here, we evaluated the role of psychological symptoms in QOL after SPK transplantation.

Methods.
We assessed patients with type 1 diabetes and end-stage renal disease waitlisted for SPK transplantation (pre-SPK, n = 47), and recipients of an SPK transplant (post-SPK, n = 72). Matched patients with type 1 diabetes without end-stage renal disease were included as reference group (type 1 diabetes [T1D] reference group, n = 42). The brief symptom inventory (BSI) was used to measure psychological symptoms. The Short Form-36 (SF-36) was used to determine QOL.

Results.
Post-SPK patients scored slightly better on the SF-36 than pre-SPK patients (“General health” 47.2 ± 23.1 versus 37.5 ± 18.1 [P = 0.017]). In the T1D reference group, this score was 60.6 ± 22.3. Post- and pre-SPK patients had similar BSI scores (0.54 ± 0.55 and 0.45 ± 0.42, respectively [P = 0.34]). This score was better in the T1D reference group (BSI score 0.32 ± 0.33). The BSI score inversely correlated with the SF-36 (r = −0.61, P < 0.001).

Conclusions.
Psychological symptoms are prevalent in both pre-SPK and post-SPK patients and could play an important role in the reduced QOL observed in these groups.
Prevalence of Optic Disc Drusen in Young Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A 10-Year Retrospective Study
Authors: Fraser J. Alexander , Rueløkke Lea L. , Malmqvist Lasse , Hamann Steffen 
Published: April 2020

Background:
Nonarteritic anterior ischemic optic neuropathy (NAION) in young patients (age ≤50) accounts for a minority of all cases of NAION and is more highly associated with crowding of the optic nerves and bilateral involvement than NAION in older patients. Optic disc drusen (ODD) are likewise associated with crowded optic nerves and are located in the prelaminar optic nerve head where they could contribute to NAION pathogenesis. The purpose of this study was to determine the prevalence of ODD in the eyes of young NAION patients using modern imaging methods and to compare it to the baseline 1.8%–2.0% prevalence of ODD in the general population.

Methods:
In this retrospective study, all young NAION patients (ages 18–50 years, inclusive) seen in 2 tertiary care neuro-ophthalmology clinics (in London, Canada and Copenhagen, Denmark) in the ten-year interval between April 1, 2009, and March 31, 2019, were identified and their medical charts reviewed. Patients were included in the study if ODD were diagnosed by any method (including ophthalmoscopy, ultrasound [US], fundus autofluorescence [FAF], computed tomography [CT], or any optical coherence tomography [OCT] method), or if ODD were excluded by enhanced-depth imaging OCT (EDI-OCT) using the ODD Studies (ODDS) Consortium protocol. The presence or absence of ODD was recorded for each eye.

Results:
There were 37 eligible patients (74 eyes). Mean age of NAION onset was 38.5 ± 10.0 years, and 23 patients (62%) were men. Patients had undergone the following methods of ODD detection: ophthalmoscopy (37 patients), EDI-OCT (36 patients), FAF (31 patients), US (9 patients), and CT orbits (8 patients). We found a prevalence of ODD of 56.7% in NAION–affected patients and 53.3% in NAION–affected eyes. Only 35.9% of ODD were visible on ophthalmoscopy. Twenty of 21 ODD patients (95.2%) had bilateral ODD. Age of onset and sex did not differ significantly between the ODD-positive group and the ODD-negative group. EDI-OCT outperformed any combination of ophthalmoscopy, US, FAF, and CT at detecting ODD.

Conclusion:
ODD were found with much higher prevalence in young patients with NAION than in the general population and were usually bilateral and buried. ODD may contribute to NAION pathogenesis by exacerbating an underlying compartment syndrome in the crowded “disc at risk.” EDI-OCT may be the best imaging modality for ODD detection in future studies.
Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: Preliminary findings from a national survey
Authors: Gibson Cody V. , Ventura Christian A. , Collier George D. , Baang Hyewon Sabrina , Denton Edward , Knauth Christopher , Van Court Emily , Saraya Maya , Kameen Paul 
Published: April 2020

ABSTRACTOBJECTIVEThis study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire.METHODSAn online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 12, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n=165). We approximate a 95% confidence interval (± 0.0755).RESULTSAn overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately ⅓ of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice.DISCUSSIONCurrent practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed.Key MessagesWhat is already known on this subjectCOVID-19 presents as a national emergency in the United States, and all efforts to mitigate the spread of disease should be consideredEmergency Medical Services personnel play a pivotal role in patient outcomes and are often the first healthcare providers to make contact with COVID-19 patientsThe CDC has provided an Interim guidance for EMS professionals amid the COVID-19 pandemicWhat this study addsDue to varied decontamination practices and administrative protocols that are non-compliant with CDC recommendations, EMS providers may inadvertently contribute to the spread of infectionDue to varied knowledge and opinions of EMS providers on COVID-19, current pandemic education approaches may need to be revisited
Modelling of Systemic versus Pulmonary Chloroquine Exposure in Man for COVID-19 Dose Selection
Authors: Aljayyoussi Ghaith , Rajoli Rajith KR , Pertinez Henry , Pennington Shaun H , Hong W. David , O’Neill Paul M. , Owen Andrew , Ward Steve A , Biagini Giancarlo A 
Published: April 2020

ABSTRACTChloroquine has attracted intense attention as a potential clinical candidate for prevention and treatment of COVID-19 based on reports ofin-vitroefficacy against SARS-CoV-2. While the pharmacokinetic-pharmacodynamic (PK-PD) relationship of chloroquine is well established for malaria, there is sparse information regarding its dose-effect relationship in the context of COVID-19.Here, we explore the PK-PD relationship of chloroquine for COVID-19 by modelling both achievable systemic and pulmonary drug concentrations. Our data indicate that the standard anti-malarial treatment dose of 25mg/kg over three days does not deliver sufficient systemic drug exposures for the inhibition of viral replication. In contrast, PK predictions of chloroquine in the lungs usingin-vivodata or human physiologically-based PK models, suggest that doses as low as 3mg/kg/day for 3 days could deliver exposures that are significantly higher than reported antiviral-EC90s for up to a week. Moreover, if pulmonary exposure is a driver for prevention, simulations show that chronic daily dosing of chloroquine may be unnecessary for prophylaxis purposes. Instead, once weekly doses of 5mg/kg would be sufficient to achieve a continuous cover of therapeutically active pulmonary exposures.These findings reveal a highly compartmentalised distribution of chloroquine in man that may significantly affect its therapeutic potential against COVID-19. The systemic circulation is shown as one site where chloroquine exposure is insufficient to inhibit SARS-CoV-2 replication. However, if therapeutic activity is driven by pulmonary exposure, it should be possible to reduce the chloroquine dose to safe levels. Carefully designed randomized controlled trials are urgently required to address these outstanding issues.