bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facelift With Power-Assisted Dissection: A Preliminary Report
Authors: Cohen Steven R , Hewett Sierra , Baraf Patrick , Crowley Sarah Jiwon , Atlan Michael 
Published: July 2020

Abstract

Background
Subcutaneous elevation of the skin has remained a key component in all facelift techniques.

Objectives
The aim of this preliminary report was to introduce the ABC facelift as a 3-step method addressing photodamage, soft tissue laxity, and areas of bone and volume loss.

Methods
The procedure consists of: (A) anatomic and regenerative adipose grafting prior to skin elevation; (B) the use of a Baraf elevator for takedown of perpendicular subcutaneous fibers following hydrodissection of the skin flaps with tumescent solution; and (C) cautery dissection of the superficial muscular aponeurotic system (SMAS) and platysma in the neck.

Results
Thirty-four patients (31 females; 3 male), aged 50 to 77 years at the date of procedure, underwent an ABC facelift. Dissection of the skin flaps and SMAS elevation were faster than with traditional methods, averaging 10 to 15 minutes per hemiface. Bleeding was reduced (average estimated blood loss, 12 mL) and the skin flaps appeared better perfused with less venous engorgement and ecchymosis than achieved with sharp scissor dissection. In general, patients appeared to have shorter postoperative recovery courses and less social downtime secondary to bruising and edema.

Conclusions
The ABC facelift addresses facial laxity, volume loss, and skin aging with 3 simple steps: anatomic and regenerative fat grafting, combined with power-assisted dissection of the skin and cautery elevation of the SMAS. The use of more advanced hydrodissection tools to achieve further improvements in layer separation is currently being investigated.

Level of Evidence: 4
Enhancing the Lateral Orbital “C-Angle” With Calcium Hydroxylapatite: An Anatomic and Clinical Study
Authors: Alghoul Mohammed S , Vaca Elbert E , Bricker Jonathan T , Mioton Lauren M 
Published: July 2020

Abstract

Background
Deliberate injection of specific facial subunits may improve aesthetic outcomes in facial rejuvenation. We contend that the lateral orbital area (LOA) is a key anatomic subunit in the perception of eye attractiveness, with a C-shaped distribution of fat contributing to the formation of a distinct angle in the lateral orbit.

Objectives
The aim of this study was to describe the anatomy of the LOA that constitutes the C-shaped angle and to investigate the safety and cosmetic outcomes of nonsurgical enhancement of that area with calcium hydroxylapatite (CaHA).

Methods
Four injected fresh-frozen cadaver heads were dissected. Twenty patients were enrolled in a prospective clinical study. Participants were seen on the day of injection, and at 2 weeks and 3 months postinjection. Two-dimensional and 3D photographs were analyzed to quantify the volumetric changes between pretreatment and postinjection time points. Secondary outcomes included Global Aesthetic Improvement Scale score and subject satisfaction at 3 months.

Results
Cadaver dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit. In the clinical study, a mean of 1.88 mL of CaHA was injected into each lateral periorbital region. There was 97% and 76% volume retention at 2 weeks and 3 months, respectively, with 70% of patients being “very satisfied” at 3 months. The average Global Aesthetic Improvement Scale rating at 3 months was 3.95. There were no complications.

Conclusions
The LOA is a distinct facial subunit that can be enhanced safely by CaHA injection with good cosmetic outcomes. Focusing on the C-angle can improve periorbital aesthetics.

Level of Evidence: 4
“Myocardial inflammatory changes before and after antiretroviral therapy initiation in people with advanced HIV disease”
Authors: Piñeirua-Menéndez A , Flores-Miranda R , Sánchez-Nava D , Ortega-Pérez R , Belaunzaran-Zamudio P F , Pérez-Patrigeon S , Cárdenas-Ochoa A , Oseguera-Moguel J , Galindo-Uribe J , Orihuela-Sandoval C , Vázquez-Ortiz Z , Vázquez-Lamadrid J , Morelos-Guzmán M , Rosales-Uvera S , Crabtree-Ramírez B , Sierra-Madero J 
Published: July 2020

Abstract
Because high frequency and late presentation of HIV disease in our population, we decided to explore the presence of myocarditis among people with HIV-infection and advanced immunosuppression (less than 200 CD4+ cells/μL), and to describe the inflammatory changes observed after combined antiretroviral therapy (cART) initiation in an observational, longitudinal, prospective cohort performing cardiovascular MRI (cMRI) and doppler trans-thoracic echocardiogram (TTE).
Roles of fragment crystallizable-mediated effector functions in broadly neutralizing antibody activity against HIV
Authors: Danesh Ali , Ren Yanqin , Brad Jones R. 
Published: July 2020

Purpose of review
‘Broadly neutralizing antibodies’ (bNAbs), are rare HIV-specific antibodies which exhibit the atypical ability to potently neutralize diverse viral isolates. While efforts to elicit bNAbs through vaccination have yet to succeed, recent years have seen remarkable preclinical and clinical advancements of passive immunization approaches targeting both HIV prevention and cure. We focus here on the potential to build upon this success by moving beyond neutralization to additionally harness the diverse effector functionalities available to antibodies via fragment crystallizable-effector (Fc) functions.

Recent findings
Recent studies have leveraged the ability to engineer bNAb Fc domains to either enhance or abrogate particular effector functions to demonstrate that activities such as antibody-dependent cell-mediated cytotoxicity contribute substantially to in-vivo antiviral activity. Intriguingly, recent studies in both nonhuman primates and in humans have suggested that passive bNAb infusion can lead to durable immunity by enhancing virus-specific T-cell responses through a ‘vaccinal effect’.

Summary
The combination of antibody engineering strategies designed to enhance effector functions, with the broad and potent antigen recognition profile of bNAbs, has the potential to give rise to powerful new therapeutics for HIV. We aim to provide a timely review of recent advances to catalyze this development.
Galectin-3, IL-1A, IL-6, and EGF Levels in Corneal Epithelium of Patients With Recurrent Corneal Erosion Syndrome
Authors: Candar Tuba , Asena Leyla , Alkayid Husamadden , Altınörs Dilek D. 
Published: July 2020

Purpose:
To determine the galectin-3 (Gal3), interleukin-1 (IL-1), interleukin-6 (IL-6), and epidermal growth factor (EGF) levels in corneal epithelium of patients with recurrent corneal erosion (RCE) syndrome and compare them with healthy controls.

Methods:
In this prospective interventional case control study, 32 eyes of 32 patients with RCE syndrome who had corneal epithelial erosions and 28 eyes of 28 healthy participants scheduled for photorefractive keratectomy (control group) were included. Exclusion criteria included corneal dystrophies, ectasia, dry eye, previous ocular surgery or topical medications, and systemic diseases. Epithelial samples were obtained during epithelial debridement in the study group and mechanical epithelial keratectomy in the control group. Galectin-3 levels were studied by the chemiluminescent microparticle immunoassay method. IL-1, IL-6, and EGF levels were determined using corresponding ELISA kits.

Results:
The median Gal3 levels were 132.25 ng/mL in the study group and 106.50 ng/mL in the control group. The median IL-1 and IL-6 levels were 6.24 pg/mL and 10.16 pg/mL, respectively, in the study group which were higher than that in the control group. The median EGF level in the study group was lower than that the control group with 1.30 pg/mL versus 2.67 pg/mL. In the control group, there was a significant positive correlation between EGF and IL-6 (r = 0.554; P = 0.040). A similar correlation was not observed in patients with RCE (r = −0.071; P = 0.794).

Conclusions:
The lack of increased EGF expression and the imbalance between growth factors, adhesion molecules, and interleukins may be the reason for the impaired wound healing response in RCE syndrome.
Complications and Management of Prestripped Descemet Membrane Endothelial Keratoplasty Grafts
Authors: Gadhvi Kunal A. , Pagano Luca , Parekh Mohit , Levis Hannah J. , Romano Vito 
Published: July 2020

Abstract:
Prestripped Descemet membrane endothelial keratoplasty is a relatively new technique that offers advantages in reduced surgical time and reduced tissue wastage compared with surgeon-stripped graft. Here, we report the following 2 types of prestripped Descemet membrane endothelial keratoplasty graft complications and their management: 1 free floating in the transport media and the other graft mispositioned.
Diagnostic Criteria for Terrien Marginal Degeneration: Nordic Terrien Degeneration Study
Authors: Ruutila Minna , Fagerholm Per , Lagali Neil , Hjortdal Jesper , Bram Thue , Moilanen Jukka , Kivelä Tero T. 
Published: July 2020

Purpose:To refine the diagnostic criteria for Terrien marginal degeneration (TMD) based on experience in 3 Nordic countries.Methods:This is a retrospective, multicenter, hospital-based cross-sectional study of 49 eyes of 29 white patients in tertiary referral centers in Finland, Sweden, and Denmark from 1998 to January 2018. The median follow-up was 3 years. Symptoms, best corrected visual acuity, astigmatism, corneal thickness, curvature and cavities, stage, and progression were analyzed.Results:TMD was diagnosed equally likely between 15 and 86 years of age (median, 47 years). Twenty patients (69%) had bilateral disease, and 62% were men. Seventeen patients (59%) had symptoms including blurred vision and ocular surface disease symptoms without inflammatory signs. Eight patients (28%) had slightly reduced corneal sensitivity. Median best corrected visual acuity was 20/25 (range, 20/16–20/200) and astigmatism was 2.6 diopters (D) (range, 0–10) with a mean progression of 0.41 D per year (range, 0–5.4). Age and astigmatism were not correlated. All eyes had peripheral vascularization, lipid deposits, and hyperreflectivity throughout thinned peripheral stroma and its anterior edge. The thinning progressed in 15 patients (52%). Of 26 patients, 8 (31%) had single or confluent paralimbal intrastromal cavities, most commonly superiorly. By Süveges classification, the stage was 2 (92%) or 3 (8%). Minimum corneal thickness and corneal curvature were loosely associated, leading to different stages in Wang classification in 34 eyes (69%).Conclusions:TMD is defined by peripheral corneal thinning, superficial neovascularization, lipid deposition at the leading edge, absence of ulceration and inflammation, and frequently cavitation. The most sensitive way to follow its progression is anterior segment optical coherence tomography.
Assessment of Long-Term Anterior and Posterior Topographic Changes in the Cornea After Ptosis Surgery Using Fourier Harmonic Analysis
Authors: Yamamoto Risako , Ono Takashi , Toyono Tetsuya , Shirakawa Rika , Noda Mika , Yoshida Junko , Miyai Takashi 
Published: July 2020

Purpose:
We aimed to assess the corneal refractive changes induced by ptosis surgery in patients with acquired ptosis using Fourier harmonic analysis.

Methods:
This retrospective observational study enrolled consecutive patients who underwent levator aponeurotic surgery for acquired ptosis at the Department of Ophthalmology in the University of Tokyo Hospital from May 2016 to January 2018. Best corrected visual acuity, central corneal thickness, average keratometric corneal power (AvgK), corneal astigmatism, and topographic data using Fourier analysis were analyzed preoperatively and 6 months postoperatively.

Results:
Thirty-two eyes of 32 patients (age, 72.6 ± 8.5 years) were included in this study. There were no significant differences in best corrected visual acuity and central corneal thickness. However, there were significant decreases in anterior AvgK, anterior corneal astigmatism, and posterior corneal astigmatism 6 months postoperatively (all, P < 0.001). Fourier harmonic analysis showed that the anterior spherical component significantly decreased 6 months postoperatively (P < 0.001). There were no significant differences in other components of the anterior and posterior cornea. There was a significant negative correlation between preoperative posterior AvgK and changes in posterior AvgK (r = −0.891, P < 0.001) and between preoperative posterior corneal astigmatism and changes in posterior corneal astigmatism at 6 months (r = −0.858, P < 0.001).

Conclusions:
Anterior and posterior corneal keratometry and posterior corneal astigmatism significantly changed 6 months after ptosis surgery for acquired ptosis.
The Effect of the Coronavirus Pandemic on Physician Assistant Educators
Authors: Neary Stephanie , Van Rhee James , Roman Christopher 
Published: July 2020

Purpose
The coronavirus (COVID-19) pandemic has presented physician assistant (PA) educators with unprecedented challenges in delivering content remotely with minimal time to develop new pedagogical strategies. We surveyed faculty about their experience during the early weeks of adapting to these new instructional techniques.

Methods
An anonymous quantitative and qualitative survey was distributed to all individuals registered by programs as Physician Assistant Education Association members.

Results
The survey response rate was 22.3% (667/2991) with 32% of program directors (PD), and 23.7% of faculty reporting they had taught online synchronous content prior to COVID-19 adaptations. Prior experience with technology was associated with significantly lower levels of faculty stress during the pivot to online instruction. A majority of the respondents felt educational quality had remained consistent despite the transition to online teaching, and a majority of both faculty and program directors anticipate only minor changes to program structure once they are able to return to traditional classroom learning. Concerns about technology were most commonly cited as stressors and as causes of decreased quality of instruction.

Conclusion
Educational challenges and stress during the pandemic were most prominently associated with unfamiliar technology. It remains to be seen what changes persist when the pandemic subsides.
Recent advances in the treatment of uremic pruritus
Authors: Trachtenberg Aaron J. , Collister David , Rigatto Claudio 
Published: July 2020

Purpose of review
This article provides a focused update on uremic pruritus, highlighting the latest evidence concerning the epidemiology, pathophysiology, and treatment options for this common and bothersome condition.

Recent findings
Half of dialysis patients and a quarter of those with nondialysis chronic kidney disease experience bothersome itch that reduces quality of life and is increasingly recognized to be associated with poor outcomes including mortality. The KALM-1 trial, which reported effective symptomatic relief with difelikefalin, has bolstered support for the role of an imbalance of μ and κ-opioid receptor activity in pruritogenesis. The role of a chronic inflammatory state, increased cytokine levels and altered immune signaling in pruritogenic nerve activation continues to be elucidated with basic science, which paves the wave for future novel therapeutics. In the meantime, gabapentin appears to be the most evidence-based widely available uremic pruritus treatment, as long as care is taken with dosing and monitoring of side-effects.

Summary
Uremic pruritus remains a top research priority. Patients with uremic pruritus may be able to look forward to a new decade of understanding, knowledge, and novel treatment options for this burdensome condition. As difelikefalin and other potential agents come to market, cost-effectiveness assessments of these interventions will help determine if the widespread use of them is feasible amongst renal programs.
Molecular and functional characteristics of megakaryocytes and platelets in aging
Authors: Esparza Orlando , Higa Kelly , Davizon-Castillo Pavel 
Published: July 2020

Purpose of review
Advances in medical care and preventive measures have contributed to increasing life expectancy. Therefore, it is critical to expand our understanding of the physiological and pathophysiological adaptations of the hematological system in aging. We highlight and review the findings from recent investigations aimed at understanding the effects of aging on megakaryocytes and platelets.

Recent findings
Biochemical and transcriptomic studies of megakaryocytes and platelets from older humans and mice have advanced our understanding of the molecular and functional characteristics of megakaryocytes and platelets during aging. These studies have led to the identification of metabolic and inflammatory pathways associated with the generation of hyperreactive platelets that may significantly contribute to the high incidence of thrombosis in aging.

Summary
By increasing our research efforts to understand and identify the characteristics of megakaryocytes and platelets in aging, we will increase our potential to develop novel therapies aimed at decreasing the incidence of aging-associated thrombosis. These efforts will also serve as a foundation to better understand the role of megakaryocytes and platelets in other age-related hematological conditions with high thrombotic risk such as clonal hematopoiesis of indeterminate potential and myeloproliferative neoplasms.
Insurance Denials in Reduction Mammaplasty: How Can We Serve Our Patients Better?
Authors: Boukovalas Stefanos , Boson Alexis L. , Padilla Pablo L. , Sljivich Michaela , Tran Jacquelynn P. , Spratt Heidi , Phillips Linda G. 
Published: July 2020

Background:
Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization.

Methods:
The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies.

Results:
Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial.

Conclusions:
Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.
Oncologic Safety and Surveillance of Autologous Fat Grafting following Breast Conservation Therapy
Authors: Hanson Summer E. , Kapur Sahil K. , Garvey Patrick B. , Hernandez Mike , Clemens Mark W. , Hwang Rosa F. , Dryden Mark J. , Butler Charles E. 
Published: July 2020

Background:
Autologous fat grafting is a useful adjunct following breast reconstruction. The impact of autologous fat grafting on oncologic safety and surveillance remains questionable, particularly following breast conservation therapy.

Methods:
The authors performed a retrospective review of patients who underwent delayed fat grafting following breast conservation therapy between 2006 and 2016. A control group of conservatively managed patients without grafting was matched for cancer stage, age, body mass index, and follow-up. Outcomes included locoregional recurrence and oncologic surveillance.

Results:
Seventy-two patients were identified per cohort. There were no differences in median age (50 years versus 51 years; p = 0.87), body mass index (28.2 kg/m2 versus 27.2 kg/m2; p = 0.38), or length of follow-up (61.9 months versus 66.8 months; p = 0.144) between controls and grafted patients, respectively. Overall, four patients in each cohort experienced recurrence (5.6 percent; p = 1.00) with similar cumulative incidence estimates observed (log-rank test, p = 0.534). There were no significant differences in palpable mass (9.7 percent versus 19.4 percent; p = 0.1), fat necrosis (34.7 percent versus 33.3 percent; p = 0.86), calcifications (37.5 percent versus 34.7 percent; p = 0.73), or indication for breast biopsy (15.3 percent versus 22.2 percent; p = 0.23) between breast conservation and breast conservation therapy plus autologous fat grafting cohorts, respectively.

Conclusions:
Overall, the authors found no difference in recurrence rates after breast conservation with or without delayed fat grafting. Furthermore, there were no differences in the rates of fat necrosis, palpable mass, and abnormal radiographic findings. This study represents the longest follow-up to date in in a large matched study of autologous fat grafting with breast conservation therapy demonstrating oncologic safety and no interference with follow-up surveillance.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Male Aesthetics for the Gluteal Area: Anatomy and Algorithm for Surgical Approach for Dynamic Definition Body Contouring
Authors: Hoyos Alfredo E. , Perez Mauricio E. , Domínguez-Millán Rodrigo 
Published: July 2020

Background:
Gluteal prominence is a unique characteristic that is widely acknowledged in female contouring but ignored in the male population. This study focuses on male gluteal aesthetics based on a muscular anatomical approach.

Methods:
A retrospective review of gluteal contouring in men from January of 2012 to September of 2019 was conducted. Male body sculpting surgery in the gluteal area was performed in most cases. Patients were included according to preoperative assessment and the American Heart Association risk analysis. The gluteal area was divided into four main anatomical contouring zones and classified according to the procedure type. The follow-up period of 3 months to 6 years was included with photographs and medical assessment data. A nonstandardized satisfaction survey was performed postoperatively.

Results:
The analysis included data from 374 consecutive gluteal dynamic definition liposculptures performed in men (mean age, 38.2 years; range, 20 to 66 years). Patients were treated according to the authors’ new classification of deformities. Fat extraction, liposhifting, and fat grafting were performed on a regular basis to enhance and define the gluteal area. A satisfaction index of 92.5 percent was reported. Minor complications were reported: seroma, 0.2 percent; prolonged bruising, 1.3 percent; and swelling, 1.8 percent. No necrosis, burns, or infections were reported.

Conclusions:
Men have been increasingly requesting improvement and definition of the buttocks, and our novel algorithm allows for a reliable method in this regard. The high satisfaction index supports the natural and athletic results accomplished with our new approach.