bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of immediate initiation of antiretroviral therapy on HIV patient satisfaction
Authors: Ogbuoji Osondu , Geldsetzer Pascal , Wong Cebele , Khan Shaukat , Mafara Emma , Lejeune Charlotte , Walsh Fiona , Okello Velephi , Bärnighausen Till 
Published: October 2019

Objectives:
Immediate ART (or early access to ART for all, EAAA) is becoming a national policy in many countries in sub-Saharan Africa. It is plausible that the switch from delayed to immediate ART could either increase or decrease patient satisfaction with treatment. A decrease in patient satisfaction would likely have detrimental consequences for long-term retention and adherence, in addition to the value lost because of the worsening patient experience itself. We conducted a pragmatic stepped-wedge cluster-randomized controlled trial (SW-cRCT) to determine the causal impact of immediate treatment for HIV on patient satisfaction.

Design:
This seven-step SW-cRCT took place in 14 public-sector health facilities in Eswatini's Hhohho region, from September 2014 to August 2017.

Methods:
During each step of the trial, we randomly selected days for data collection at each study facility. During these days, a random sample of HIV patients were selected for outcome assessment. In total, 2629 patients provided data on their overall patient satisfaction and satisfaction with the following four domains of the patient experience using a five-point Likert scale: wait time, consultation time, involvement in treatment decisions, and respectful treatment. Higher values on the Likert scale indicated lower patient satisfaction. We analyzed the data using a multilevel ordered logistic regression model with individuals at the first level and health facilities at the second (cluster) level.

Results:
The proportional odds ratio (OR) comparing EAAA to control was 0.91 (95% CI 0.66–1.25) for overall patient satisfaction. For the specific domains of the patient experience, the ORs describing the impact of EAAA on satisfaction were 1.04 (95% CI 0.61–1.78) for wait time, 0.90 (95% CI 0.62–1.31) for involvement in treatment decisions, 0.86 (95% CI 0.61–1.20) for consultation time, and 1.35 (95% CI 0.93–1.96) for respectful treatment. These results were robust across a wide range of sensitivity analyses. Over time – and independent of EAAA – we observed a worsening trend for both overall patient satisfaction and satisfaction in the four domains of the patient experience we measured.

Conclusion:
Our findings support the policy change from delayed to immediate ART in sub-Saharan Africa. Immediate (versus delayed) ART in public-sector health facilities in Eswatini had no effect on either overall patient satisfaction or satisfaction with four specific domains of the patient experience. At the same time, we observed a strong secular trend of decreasing patient satisfaction in both the intervention and the control arm of the trial. Further implementation research should identify approaches to ensure high patient satisfaction as ART programs grow and mature.
Development and validation of the first point-of-care assay to objectively monitor adherence to HIV treatment and prevention in real-time in routine settings
Authors: Gandhi Monica , Wang Guohong , King Roger , Rodrigues Warren C. , Vincent Michael , Glidden David V. , Cressey Tim R. , Bacchetti Peter , Spinelli Matthew A. , Okochi Hideaki , Siriprakaisil Oraphan , Klinbuayaem Virat , Mugo Nelly R. , Ngure Kenneth , Drain Paul K. , Baeten Jared M. 
Published: October 2019

Objective:
HIV prevention and treatment studies demonstrate that pharmacologic adherence metrics are more accurate than self-report. Currently available metrics use liquid-chromatography/tandem-mass-spectrometry (LC-MS/MS), which is expensive and laboratory-based. We developed a specific and sensitive antibody against tenofovir, the backbone of treatment and prevention, but conversion to a lateral flow assay (LFA) – analogous to a urine pregnancy test – is required for point-of-care testing. We describe the development of the first LFA to measure antiretroviral adherence in real-time.

Methods:
Previous work in a directly observed therapy study of providing tenofovir disoproxil fumarate (TDF) to HIV-noninfected volunteers at various simulated adherence patterns defined the appropriate cut-off for the LFA (1500 ng tenofovir/ml urine). We developed the LFA using a sample pad for urine; a conjugate pad coated with TFV-specific antibodies conjugated to colloidal gold nanoparticles; a nitrocellulose membrane striped with tenofovir-antigen (test line) and a control line; with an absorbent pad to draw urine across the reaction membrane.

Results:
We tested 300 urine samples collected from the directly observed therapy study by this LFA and the gold-standard method of LC-MS/MS. The LFA demonstrated 97% specificity (95% CI 93–99%) and 99% sensitivity (94–100%) compared with LC-MS/MS. The LFA accurately classified 98% of patients who took a dose within 24 h as adherent.

Conclusion:
We describe the development and validation of the first point-of-care assay to measure short-term adherence to HIV prevention and treatment in routine settings. The assay is low-cost, easy-to-perform and measures the breakdown product (tenofovir) of both TDF and tenofovir alafenamide (TAF). This assay has the potential to improve HIV and PrEP outcomes worldwide by triggering differentiated service delivery with further study merited.
Comparison of guidelines for HIV viral load monitoring among pregnant and breastfeeding women in sub-Saharan Africa
Authors: Lesosky Maia , Raboud Janet M. , Glass Tracy , Brummel Sean S. , Ciaranello Andrea L. , Currier Judith S. , Essajee Shaffiq , Havlir Diane V. , Koss Catherine A. , Ogwu Anthony , Shapiro Roger L. , Abrams Elaine J. , Myer Landon 
Published: October 2019

Background:
Intensified viral load monitoring for pregnant and breastfeeding women has been proposed to help address concerns around antiretroviral therapy (ART) adherence, viraemia and transmission risk, but there have been no systematic evaluations of existing policies.

Methods:
We used an individual Monte Carlo simulation to describe longitudinal ART adherence and viral load from conception until 2 years’ postpartum. We applied national and international guidelines for viral load monitoring to the simulated data. We compared guidelines on the percentage of women receiving viral load monitoring and the percentage of women monitored at the time of elevated viral load.

Results:
Coverage of viral load monitoring in pregnancy and breastfeeding varied markedly, with between 14% and 100% of women monitored antenatally and 38–98% monitored during breastfeeding. Specific recommendations for testing at either a fixed gestation or a short, fixed period after ART initiation achieved more than 95% testing in pregnancy but this was much lower (14–83%) among guidelines with no special stipulations. By the end of breastfeeding, only a small proportion of simulated episodes of elevated viral load more than 1000 copies/ml were successfully detected by monitoring (range, 20–50%).

Discussion:
Although further research is needed to understand optimal viral load frequency and timing in this population, these results suggest that current policies yield suboptimal detection of elevated viral load in pregnant and breastfeeding women.
CD4+CD19+ conjugates favor HIV-1 infection and latency during chronic HIV-1 infection
Authors: Zhang He-Qian , Xia Peng , Huang Hui-Huang , Zhang Chao , Song Jin-Wen , Jin Lei , Jiao Yan-Mei , Shi Ming , Zhang Ji-Yuan , Wang Fu-Sheng 
Published: October 2019

Objective:
CD4+CD19+ conjugates play an important role in regulating antibody responses and follicular helper T cells development in animal models. However, little is known regarding the characteristic of CD4+CD19+ conjugates in humans with chronic HIV-1 infection.

Methods:
The numbers of CD4+CD19+ conjugates were counted in 86 HIV-1-infected patients, including 66 typical progressors and 20 complete responders. CD4+CD19+ conjugates were sorted by flow cytometry and dissociated into CD4+ T singlets and CD19+ B singlets. The phenotypes of these cells were analyzed in both typical progressors and complete responders, and the levels of HIV-1 DNA in CD4+CD19+ conjugates were measured in 10 complete responders.

Results:
We identified CD4+CD19+ cells as one type of T–B conjugate in peripheral blood, and the numbers and percentages of CD4+CD19+ conjugates decreased with HIV-1 disease progression. Phenotypic analysis showed CD4+CD19+ conjugates expressed higher levels of surface CD32. mRNA analysis found that the mRNA levels for CD32b were significantly higher compared with CD32a in CD4+CD19+ conjugates. Further analysis found that CD4+CD19+ conjugates expressed higher levels of CCR7 and CXCR5 than CD4+ T and CD19+ B singlets. A virus infectivity assay showed that CD4+CD19+ conjugates expressed higher levels of HIV-1-p24Gag than CD4+CD19− cells. CD4+CD19+ conjugates in lymph node from typical progressors expressed higher levels of HIV-1-p24Gag than CD4+CD19+ conjugates in respective peripheral blood. Importantly, CD4+CD19+ conjugates from complete responders contained higher levels of HIV-1 DNA than total CD4+ T cells.

Conclusion:
Our study indicates that CD4+CD19+ conjugates actively participate in HIV-1 infection and latency, and may serve as a new cellular target to eliminate latency.
Plasma inflammatory biomarkers link to diffusion tensor imaging metrics in virally suppressed HIV-infected individuals
Authors: Chang Kevin , Premeaux Thomas A. , Cobigo Yann , Milanini Benedetta , Hellmuth Joanna , Rubin Leah H. , Javandel Shireen , Allen Isabel , Ndhlovu Lishomwa C. , Paul Robert , Valcour Victor 
Published: October 2019

Objective:
Inflammation may contribute to brain white matter health in people living with HIV who report cognitive symptoms despite adherence to combination antiretroviral therapy and viral suppression. We explored relationships between diffusion tensor imaging (DTI) metrics of white matter, plasma biomarkers of immune activation, and cognitive function in the HIV-infected population.

Design:
Retrospective study of older adults living with HIV who are combination antiretroviral therapy adherent, virally suppressed, and self-report cognitive symptoms.

Methods:
MRI, blood draws, and standardized neuropsychological test scores were collected from HIV-infected individuals. DTI metrics (fractional anisotropy, mean diffusivity, radial diffusivity, axial diffusivity) and plasma biomarkers (soluble CD163, soluble CD14, neopterin, IFN γ-induced protein 10, monocyte chemoattractant protein 1) were quantified. Statistical analysis explored associations between biomarker levels or neuropsychological test scores and DTI metrics using region of interest analyses and a voxelwise approach.

Results:
A total of 43 participants with median (interquartile range) age of 64 (62–66 years), CD4+ cell count of 600 (400–760 cell/μl) who were all virally suppressed (<100 copies/ml) were selected. Higher levels of monocyte chemoattractant protein 1 associated with lower fractional anisotropy and higher mean diffusivity (P < 0.05) across white matter tracts including corpus callosum, corona radiata, and superior longitudinal fasciculus. Higher neopterin associated with higher mean diffusivity in the genu of corpus callosum, and higher soluble CD14 associated with lower fractional anisotropy in the bilateral superior corona radiata (P < 0.05). Worse global performance and speed domain scores associated with higher mean diffusivity and lower fractional anisotropy, and worse executive domain scores associated with lower fractional anisotropy (P < 0.05).

Conclusion:
Elevated inflammatory plasma biomarkers link to white matter abnormalities among virally suppressed individuals. DTI abnormalities associate to cognitive performance. We conclude that inflammatory processes impact clinically relevant brain health indices despite viral suppression.
Platysmaplasty: Is it Possible to Pull the Platysma Effectively in the Medial or Lateral Direction?
Authors: Choi Jeongho , Hwang Kun , Han Seung Ho , Kim Hun 
Published: October 2019

Abstract
The aim of this study was to investigate whether it is possible to pull the platysma effectively in the medial or lateral direction (medial platysmaplasty and lateral platysmaplasty) and to explore the anatomical basis of those findings.
Six hemifaces from 3 fresh cadavers were dissected. After skin removal, the platysma was pulled upward and in the medial or lateral direction with the ulnar side of the palm. Its mobility was checked. In 2 volunteers, using wooden bar, the skin overlying platysma was pulled in superomedial and superolateral direction.
The platysma ran diagonally from the acromio-deltoid region to the perioral and submental area. In all hemifaces, the platysma was attached to the mandible along its course. The platysma inserted into the mandibular body. At its medial portion (approximately halfway medially from the mentum to the angle; 4–5 cm), the attachment was so firm that it could not be moved horizontally. The posterolateral portion of the platysma was indirectly attached to the mandible and movable. In cadaver, platysma did not move much when it was pulled in the medial direction. In the lateral direction, however, platysma did move well. In living body, when skin overlying platysma was pulled in superomedial direction and superolateral direction, 3 points marked on mandibular border moved about 1.5–2.0 cm and 2.0–2.5 cm respectively.
It is thought that medial platysmaplasty can correct anterior neck deformities and redistribute neck skin mainly in the submental area, while that lateral platysmaplasty can pull the cheek skin in superolateral direction.
Filler Migration and Florid Granulomatous Reaction to Hyaluronic Acid Mimicking a Buccal Tumor
Authors: Kaczorowski Maciej , Nelke Kamil , Łuczak Klaudiusz , Hałoń Agnieszka 
Published: October 2019

Abstract
Hyaluronic acid is among the most commonly used cosmetic fillers. Although considered biocompatible and safe, it may rarely cause a wide range of complications. The authors report a case of migration of hyaluronic acid concomitant with granulomatous inflammatory response that mimicked a buccal tumor. A 52-year-old female presented with a solid painless mass of the right buccal area. The patient denied any history of trauma and cosmetic procedures of the affected area. Skin and mucosal membrane were intact and the lesion was firm and well fixed in the deep plane. Due to worrisome clinical presentation and the patient's history of breast cancer, the lesion was excised radically. Histopathological examination revealed multiple granulomas surrounding amorphous lakes of hyaluronic acid. During repeated, thorough anamnesis the patient admitted having underwent lip augmentation and nasolabial fold correction with HA two years before, after which the filler must have migrated posteriorly. Physicians need to be aware of various complications associated with cosmetic fillers as they may mimic severe clinical conditions.
Metastasis of Prostate Adenocarcinoma in the Mandible: Rare Occurrence in Maxillary Bones
Authors: Lombardo Eduardo Madruga , Ponce Kryssis , Tregnago Lara , Pagnoncelli Rogério Miranda , Heitz Cláiton , Brücker Márcia Rejane , Maito Fábio Luiz Dal Moro 
Published: October 2019

Objective:
This article describes the case report of a prostate adenocarcinoma in the mandible.

Background:
Prostate adenocarcinoma is a malignant tumor common in men from the fourth decade of life. The occurrence of oral metastatic lesions is rare.

Case Report:
A 78-year-old male patient was referred to the oral and maxillofacial surgery service of the Pontifical Catholic University of Rio Grande do Sul for complaints of painless volume increase in the mandible. The diagnosis through the association of clinical, radiographic, and histopathological examination with the patient's health history determined that the lesion was prostatic adenocarcinoma metastasis.

Conclusion:
Despite the rare occurrence of metastases in the oral region, the dental surgeon should be aware of the possibility for correct diagnostic conduction and, subsequently, the institution of treatment in the early stages of disease.
Orbital Blowout Fracture and Orbital Emphysema caused by Nose Blowing
Authors: Sarbajna Tushar , Valencia Ma. Regina Paula , Kakizaki Hirohiko , Takahashi Yasuhiro 
Published: October 2019

Abstract
A 76-year-old man presented with 1 day history of eyelid swelling and decreased vision on the left side. History reveals nose blowing the night prior to the occurrence of the symptoms. Initial examination of the left eye showed decreased visual acuity, increased intraocular pressure, and limited ocular motility with presence of air bubbles under the bulbar conjunctiva. Imaging studies showed medial orbital wall fracture with severe emphysema. The patient was observed for a week and no active surgical intervention was performed. Thereafter, spontaneous resolution of symptoms was observed. Eyelid swelling, dramatic improvement in visual acuity, intraocular pressure, and extraocular movements were noted.
Surgical Approach in a Patient With Agnathia-Otocephaly Complex: Three-Stage Mandibular Distraction Protocol
Authors: Gonzalez Santiago R. , Jones John K. , Golinko Michael S. 
Published: October 2019

Abstract
Agnathia-otocephaly complex (AOC) is a rare malformation complex of the first pharyngeal arch that is characterized by agnathia/dysgnathia, microstomia, aglossia/hypoglossia and variable displacement of the ears. Only 11 post-infancy patients with severe AOC have been described in the literature, and the incidence of this malformation complex is estimated to be 1 per 70,000 births. In this brief clinical study, the authors describe the case of an 18-year-old female diagnosed with AOC who underwent a 3-step mandibular distraction protocol with an external distraction device. The surgical protocol the authors used was unique in that we first placed a tissue expander in the submental area to enlarge the skin envelope in an effort to mitigate skeletal relapse from soft tissue forces. Furthermore, the way in which the authors slowed the activation of the distraction device to allow for soft tissue healing behind the pins was a novel component of the patient's treatment. The 3-step mandibular distraction protocol the authors present in this study increased the length of the mandible by 20 mm, and nearly doubled the size of the patient's mandible from an initial volume of 3.62 cm3 to a post-operative volume of 6.89 cm3. Future surgeries will aim to improve the function of our patient's expanded mandible. Most important of all, the surgical treatment authors are presenting led to a significant improvement in our patient's physical appearance and 3d quality of life.
Michelassi II Strictureplasty for Crohn's Disease
Authors: Mege Diane , Michelassi Fabrizio 
Published: October 2019

Objective:
We report on a new side-to-side isoperistaltic strictureplasty (SSIS), the Michelassi II or end-to-side-to-side-to-end strictureplasty, performed with discontinuous bowel loops.

Summary Background Data:
The SSIS Michelassi strictureplasty was described a quarter of a century ago to avoid massive bowel resections in patients with extensive fibrostenosing Crohn's jejuno-ileitis.

Methods:
The end-to-side-to-side-to-end strictureplasty is performed in patients presenting with 3 severely fibrotic and deformed bowel loops separated by 2 diseased segments with sequential strictures. After the resection of the 3 severely diseased segments, the remaining 2 discontinuous segments are used to perform a SSIS, according to the original description. The 2 ends of the SSIS are then anastomosed with the proximal and the distal bowel, respectively. In the presence of discrepancy in length between the 2 discontinuous segments, the proximal small bowel is recruited to equalize the length and aid in the performance of the SSIS.

Conclusions:
The Michelassi II, or the end-to-side-to-side-to-end strictureplasty, is a variant of the original SSIS technique to address severe and extensive small bowel Crohn's disease presenting with 3 severely fibrotic and deformed bowel loops separated by 2 diseased segments with sequential strictures.
OpTrust
Authors: Sandhu Gurjit , Thompson-Burdine Julie , Dombrowski Janet , Sutzko Danielle C. , Nikolian Vahagn C. , Boniakowski Anna , Georgoff Patrick E. , Matusko Niki , Prabhu Kaustubh , Minter Rebecca M. 
Published: October 2019

Objective:
The purpose of this study was to measure the efficacy of a novel faculty and resident educational bundle focused on development of faculty-resident behaviors and entrustment in the operating room.

Summary Background Data:
As surgical training environments are orienting to entrustable professional activities (EPAs), successful transitions to this model will require significant faculty and resident development. Identifying an effective educational initiative which prepares faculty and residents for optimizing assessment, teaching, learning, and interacting in this model is critical.

Methods:
From September 2015 to June 2017, an experimental study was conducted in the Department of Surgery at the University of Michigan Health System (UMHS). Case observations took place across general, plastic, thoracic, and vascular surgical specialties. A total of 117 operating room observations were conducted during Phase I of the study and 108 operating room observations were conducted during Phase II following the educational intervention. Entrustment behaviors were rated for 56 faculty and 73 resident participants using OpTrust, a validated intraoperative entrustment instrument.

Results:
Multiple regression analysis showed a significant increase in faculty entrustment (Phase I = 2.32 vs Phase II = 2.56, P < 0.027) and resident entrustability (Phase I = 2.16 vs Phase II = 2.40, P < 0.029) scores following exposure to the educational intervention.

Conclusions:
Our study shows improved intraoperative entrustment following implementation of faculty and resident development, indicating the efficacy of this innovative educational bundle. This represents a crucial component in the implementation of a competency-based assessment framework like EPAs.