bluuebunny/crossref_metadata_2025_split huggingface dataset:
High national rates of high-dose dopamine agonist prescribing for restless legs syndrome
Authors: Winkelman John W 
Published: August 2021

Abstract

Study Objectives
Long-term dopamine agonist (DA) use in restless legs syndrome (RLS) is associated with augmentation, a dose-related symptom worsening leading to further dose escalation to manage RLS. This study investigated rates and factors of high-dose DA prescribing in US RLS patients.

Methods
This retrospective analysis examined data from a US longitudinal prescriptions database (October 2017–September 2018). Patients diagnosed with RLS (ICD-10 G255.81) without Parkinson’s disease who were prescribed ropinirole, pramipexole, and/or rotigotine were included. Daily DA dosage was categorized: LOW/MID (US Food and Drug Administration [FDA]-approved/guideline or slightly above FDA-approved [pramipexole]); HIGH (101%–149%); VERY HIGH (&gt;150%). Patient counts were converted to US national estimates. Logistic regression of patient counts evaluated factors associated with HIGH/VERY HIGH DA dosing.

Results
Of 670,404 RLS patients (131,289,331 therapy days), 58.8% were prescribed DA therapy. Overall, 19.1% of RLS patients were prescribed DAs above maximum FDA-approved/guideline daily doses—over half of these were &gt;150% maximum recommended doses; 67.6% of HIGH/VERY HIGH-dose prescriptions were pramipexole (OR [95% CI] pramipexole vs ropinirole, 5.8 [5.7 to 6.0]). The highest 1% of DA prescriptions were ≥10× the FDA-recommended maximum daily dose. Rates of HIGH/VERY HIGH DA dosing increased with patient age. Twice as many neurologists (31.1%) prescribed HIGH/VERY HIGH doses vs other specialties (OR [95% CI], 2.1 [1.2 to 2.0]).

Conclusions
Approximately 20% of DA-treated RLS patients were prescribed doses above the approved and guideline daily maximum. Pramipexole, Neurology as specialty, and patient age were independently associated with HIGH/VERY HIGH DA dosing. Increased education is warranted regarding risks of high-dose DA exposure in RLS.
Effects of various doses of lubabegron on calculated ammonia gas emissions, growth performance, and carcass characteristics of beef cattle during the last 56 days of the feeding period
Authors: Kube John C , Holland Ben P , Word Alyssa B , Allen Janet B , Calvo-Lorenzo Michelle , McKenna David , Vogel Gary 
Published: August 2021

Abstract
Lubabegron (LUB; Experior, Elanco, Greenfield, IN, USA) was approved by the U.S. Food and Drug Administration in 2018 and is indicated for the reduction of ammonia (NH3) gas emissions·kg−1 body weight (BW) and hot carcass weight (HCW) when fed to feedlot cattle during the final 14 to 91 d of the finishing period. LUB demonstrates antagonistic behavior at the β 1 and β 2 receptor subtypes and agonistic behavior at the β 3 receptor subtype in cattle and is classified by the Center for Veterinary Medicine as a “beta-adrenergic agonist/antagonist.” This report describes a randomized complete block study that evaluated LUB dose (0, 1.5, 3.5, and 5.5 mg·kg−1 dry matter) during the last 56 d of the feeding period on calculated NH3 gas emissions, live weight, carcass weight, and associated ratios in beef feedlot cattle. Carcass characteristics, mobility, and health were also evaluated. All cattle received monensin and tylosin throughout the study. Ammonia gas emissions were calculated using the equation developed by Brown et al. (Brown, M. S., N. A. Cole, S. Gruber, J. Kube, and J. S. Teeter. 2019. Modeling and prediction accuracy of ammonia gas emissions from feedlot cattle. App. Anim. Sci. 35:347–356). The reduction in calculated cumulative NH3 gas emissions with LUB ranged from 1.3% to 11.0% (85 to 708 g/hd). When NH3 gas emissions were expressed on a live weight (unshrunk) and carcass weight basis, calculated NH3 gas emissions decreased by 3.0% to 12.8% and 3.8% to 14.6%, respectively. Daily dry matter intake was 2.3% greater (Ptrt &lt; 0.05) for steers that received LUB. Average daily gain was 13.7% greater (Ptrt &lt; 0.05; 1.68 vs. 1.91 kg), while gain efficiency was 10.8% greater (Ptrt &lt; 0.05; 0.167 vs. 0.185) for steers fed LUB. Animal mobility was scored in the pen approximately 1 wk prior to harvest, when cattle were loaded on trucks scheduled for harvest, and at antemortem inspection during lairage. No treatment differences (Ptrt ≥ 0.170) were observed at any time for the percent of cattle receiving mobility scores of 1 or 2 (normal or minor stiffness but moving with the normal cattle, respectively). Cattle mobility scored as a 1 or 2 equaled or exceeded 92% at all times. Final BW and HCW increased (Ptrt &lt; 0.05) 11.6 to 15.7 kg and 11.3 to 17.1 kg, respectively, in cattle receiving LUB compared to cattle receiving monensin plus tylosin alone.
Pseudotumor Cerebri Syndrome as a Neurologic Involvement of Multisystem Inflammatory Syndrome in Children: A Case Report
Authors: Sofuoğlu Ayşe İrem , Akçay Nihal , Şevketoğlu Esra , Bektaş Gonca 
Published: August 2021

Abstract

Background
Coronavirus disease 2019 may have neurological manifestations including meningitis, encephalitis, post-infectious brainstem encephalitis and Guillain-Barre syndrome. Neuroinflammation has been claimed as a possible cause. Here, we present a child with multisystem inflammatory syndrome in children (MIS-C) who developed pseudotumor cerebri syndrome (PTCS) during the disease course.

Case
A 11-year-old girl presented with 5 days of fever, headache and developed disturbance of consciousness, respiratory distress, conjunctivitis and diffuse rash on her trunk. Immunoglobulin M and G antibodies against severe acute respiratory syndrome coronavirus 2 were positive in her serum. She was diagnosed with MIS-C. On day 10, she developed headache and diplopia. Left abducens paralysis and bilateral grade 3 papilledema were observed. Brain magnetic resonance imaging revealed optic nerve head protrusion, globe flattening. She was diagnosed with secondary PTCS. Papilledema and abducens paralysis improved under acetazolamide and topiramate. Neurological examination became normal after 2 months.

Conclusion
PTCS may emerge related to MIS-C.
Adenosine A2A receptor antagonism protects against hyperoxia‐induced retinal vascular loss via cellular proliferation
Authors: Zhong Ding‐Juan , Zhang Yu , Zhang Shuya , Ge Yuan‐Yuan , Tong Mengyun , Feng Yijia , You Feng , Zhao Xinyue , Wang Ke , Zhang Liping , Liu Xiaoling , Chen Jiang‐Fan 
Published: August 2021

AbstractRetinopathy of prematurity (ROP) remains one of the major causes of blindness in children worldwide. While current ROP treatments are mostly disruptive to reduce proliferative neovascularization by targeting the hypoxic phase, protection against early hyperoxia‐induced retinal vascular loss represents an effective therapeutic window, but no such therapeutic strategy is available. Built upon our recent demonstration that the protection against oxygen‐induced retinopathy by adenosine A2A receptor (A2AR) antagonists is most effective when administered at the hyperoxia (not hypoxic) phase, we here uncovered the cellular mechanism underlying the A2AR‐mediated protection against early hyperoxia‐induced retinal vascular loss by reversing the inhibition of cellular proliferation via possibly multiple signaling pathways. Specifically, we revealed two distinct stages of the hyperoxia phase with greater cellular proliferation and apoptosis activities and upregulation of adenosine signaling at postnatal 9 day (P9) but reduced cellular activities and adenosine‐A2AR signaling at P12. Importantly, the A2AR‐mediated protection at P9 was associated with the reversal of hyperoxia‐induced inhibition of progenitor cells at the peripheral retina at P9 and of retinal endothelial proliferation at P9 and P12. The critical role of cellular proliferation in the hyperoxia‐induced retinal vascular loss was validated by the increased avascular areas by siRNA knockdown of the multiple signaling molecules involved in modulation of cellular proliferation, including activin receptor‐like kinase 1, DNA‐binding protein inhibitor 1, and vascular endothelial growth factor‐A.
“Nobody Knows How You’re Supposed to Interpret it:” End-user Perspectives on Prescription Drug Monitoring Program in Massachusetts
Authors: Hong Mina , Seymour Sarah , Stopka Thomas J. , Bandanza Lane , Crocker Erin , Morgan Allison , Beletsky Leo 
Published: August 2021

Objectives
America’s overdose crisis spurred rapid expansion in the number and scope of prescription drug monitoring programs (PDMPs). As their public health impact remains contested, little is known about PDMP user experiences and perspectives. We explore perspectives of PDMP end-users in Massachusetts.

Methods
Between 2016 and 2017, we conducted semi-structured qualitative interviews on overdose crisis dynamics and PDMP experiences with a purposive sample of 18 stakeholders (prescribers, pharmacists, law enforcement, and public health regulators). Recordings were transcribed and double-coded using a grounded hermeneutic approach.

Results
Perspectives on prescription monitoring as an element of overdose crisis response differed across sectors, but narratives often critiqued PDMPs as poorly conceived to serve end-user needs. Respondents indicated that PDMP: (1) lacked clear orientation towards health promotion; (2) was not optimally configured or designed as a decision support tool, resulting in confusion over interpreting data to guide health care or law enforcement actions; and, (3) problematized communication and relationships between prescribers, pharmacists, and patients.

Conclusions
User insights must inform design, programmatic, and policy reform to maximize PDMP benefits while minimizing harm.
Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy
Authors: Marin Terri , Williams Bryan L. , Mansuri Asifhusen , Mundy Cynthia , Cockfield Christy , Mann Paul C. , Stansfield Brian K. 
Published: August 2021

Background:
Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO2) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application.

Purpose:
To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants.

Methods:
We prospectively observed rSO2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests.

Results:
Average daily rSO2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO2 slopes were significantly lower among males and infants 29 weeks' or less gestation.

Implications for Practice:
Renal rSO2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO2 patterns. Population estimates provide parameters for renal rSO2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur.

Implications for Research:
We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury.
Combined Motor and Sensory Intraoperative Neuromonitoring for Cervical Spondylotic Myelopathy Surgery Causes Confusion
Authors: Taylor Adam J. , Combs Kristen , Kay Robert D. , Bryman Jason , Tye Erik Y. , Rolfe Kevin 
Published: August 2021

Study Design.
Level-1 diagnostic study.

Objective.
The purpose of this study was to evaluate the sensitivity and specificity of combined motor and sensory intraoperative neuromonitoring (IONM) for cervical spondylotic myelopathy (CSM).

Summary of Background Data.
Intraoperative neuromonitoring during spine surgery began with sensory modalities with the goal of reducing neurological complications. Motor monitoring was later added and purported to further increase sensitivity and specificity when used in concert with sensory monitoring. Debate continues, however, as to whether neuromonitoring reliably detects reversible neurologic changes during surgery or simply adds set-up time, cost, or mere medicolegal reassurance.

Methods.
Neuromonitoring data using combined motor and sensory evoked potentials for 540 patients with CSM undergoing anterior or posterior decompressive surgery were collected prospectively. Patients were examined postoperatively to determine the clinical occurrence of new neurologic deficit which correlated with monitoring alerts recorded per established standard criteria.

Results.
The overall incidence of positive IONM alerts was 1.3% (N = 7) all of which were motor alerts. All were false positives as no patient had clinical neurological deterioration post-operatively. The false-positive rate was 1.4% (N = 146) for anterior surgeries and 1.3% (N = 394) for posteriors with no statistical difference between them (P = 1.0, Fisher exact test). There were no false-negative alerts, and all negatives were true negatives (N = 533). The overall sensitivity of detecting a new neurologic deficit was 0%, overall specificity 98.7%.

Conclusion.
Combined motor and sensory neuromonitoring for CSM patients created a confusing choice between the motor or sensory data when in disagreement in 1.3% of surgical patients. Criterion standard clinical examinations confirmed all motor alerts were false positives. Surgical plan was negatively altered by following false motor alerts early on, but disregarded in later cases in favor of sensory data. Neuromonitoring added set-up time and cost, but without clear benefit in this series.

Level of Evidence: 4
Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients
Authors: Kanayama Koji , Kato Harunosuke , Mori Masanori , Sakae Yuki , Okazaki Mutsumi 
Published: August 2021

BACKGROUND
Recent advances in robotic surgery have extended to hair restoration surgery, using a robotic recipient site creation device.

OBJECTIVE
This study aimed to assess the surgical safety and postoperative clinical outcomes of using this robotic system.

MATERIALS AND METHODS
Thirty-one men diagnosed with androgenetic alopecia, who underwent hair transplantation with robotic recipient site creation, were retrospectively reviewed. Their mean age was 38.7 ± 9.5 (range, 22‒67) years.

RESULTS
The total number of robotically created recipient sites was 36,273. The average site creation speed was 1,593 ± 544 sites per hour. Postoperative crusting (54.8%) was the most frequent complication in the recipient area, followed by pruritus (12.9%), asymmetry (6.5%), and folliculitis (6.5%). The mean score of cosmetic outcomes and patient satisfaction, scored on a 5-point scale, was 4.10 ± 0.54 and 4.13 ± 0.85, respectively. No significant differences in cosmetic outcomes and patient satisfaction were found between 3 operators.

CONCLUSION
The current device can automatically make slit incisions in the recipient area with speed and consistency noninferior to manual site creation. It is both safe and reliable for clinical use, and it is also easily managed by different hair surgeons without a long learning curve.
Risk Factors for Infection After Minor Dermatologic Procedures: A Case–Control Study
Authors: Matos Sophia , Sturm Brea , Buhnerkempe Michael , Larson Rebecca , Wilson Morgan 
Published: August 2021

BACKGROUND
There are limited published data regarding the incidence and risk factors for infection after minor dermatologic procedures, such as skin biopsy, shave, and curettage. Prior studies of infection risk after dermatologic procedures have often not specified the method of preparation of local anesthetic.

OBJECTIVE
To assess the incidence and risk factors for infection after minor procedures performed in a general dermatology clinic using buffered lidocaine prepared in office.

MATERIALS AND METHODS
In this retrospective case–control study, the medical record was searched for cases of infection after skin biopsies, shaves, conventional excisions, and destructions performed in a general dermatology clinic over a 4-year period. Patient and procedure characteristics were compared with uninfected controls.

RESULTS
Of 9,031 procedures performed during the study period, there were 34 infections (0.4%). The odds of infection for procedures on the arm and leg were 5.29 and 9.28 times higher, respectively, than those on the head/neck. There was no significant effect of age, sex, smoking, immunosuppression, diabetes, or anticoagulation.

CONCLUSION
The incidence of infection is low after minor dermatologic procedures performed with local anesthesia using buffered lidocaine prepared in office. There is a higher risk of infection on the arm and leg compared with the head and neck.
Timing of Adjuvant Radiotherapy After Keloid Excision: A Systematic Review and Meta-Analysis
Authors: Hsieh Chin-Ling , Chi Kuan-Yu , Lin Wan-Ying , Lee Leon Tsung-Ju 
Published: August 2021

BACKGROUND
No consensus exists regarding the appropriate timing of adjuvant radiotherapy administration after surgical excision of keloids.

OBJECTIVE
This study investigated the appropriate timing of adjuvant radiotherapy.

MATERIALS AND METHODS
A systematic review and meta-analysis of randomized controlled trials and observational cohort studies was performed. A pooled estimate of the incidence rate was performed using a random-effects model. Subgroup analyses based on different anatomic region, biologically effective dose, keloid length, and radiotherapy regimen were also conducted.

RESULTS
Sixteen observational cohort studies (1,908 keloid lesions) met the inclusion criteria. The incidence rate was significantly lower in the group treated with electron beam therapy more than 24 hours after surgery (3.80%; 95% confidence interval [CI], 1.78%–8.13%) than that in the group treated with the same therapy within 24 hours of surgery (37.16%; 95% CI, 20.80%–66.37%; p < .0001), but no significant difference was observed between the groups regarding brachytherapy and x-ray treatments.

CONCLUSION
Immediate adjuvant radiotherapy did not significantly reduce the incidence rate of recurrent keloids.
A Cadaveric Study of Dye Spreading: Determining the Ideal Injection Pattern for Masseter Hypertrophy
Authors: Sermswan Peerada , Tansatit Tanvaa , Meevassana Jiraroch , Panchaprateep Ratchathorn 
Published: August 2021

BACKGROUND
Masseter hypertrophy is the main cause of an asymmetrical and squared lower facial contour in the Asian community. Botulinum toxin injection technique is crucial to treat this condition.

OBJECTIVE
To improve injection techniques for masseter hypertrophy by elucidating the distribution of the injections within the masseter.

METHODS
Thirty masseter muscles were divided into 6 groups of 5 muscles each. Each group received one 0.2- or 0.3-mL injection at Point A, B, or C according to a three-point technique. Muscle dimensions and dye of the primary and secondary dye spreading were measured.

RESULTS
The average muscle length, width, and thickness were 69.87, 33.50, and 11.23 mm, respectively. The average primary longitudinal and horizontal spreading was 36.56 and 15.60 mm, respectively. No statistically significant difference was found between 0.2- and 0.3-mL injections at each point.

CONCLUSION
The three-point technique best fits in the safe zone and should be the standard injection technique for masseter hypertrophy. Injection at Points B and C may create secondary spreading that affect the risorius muscle and the parotid gland which are the cause of asymmetrical smiling and xerostomia, respectively. The dosage should be adjusted according to the muscle volume and not only the thickness.
Safety of Cohesive Polydensified Matrix Cross-Linked Hyaluronic Acid Volumizing Gel in Temporal Hollows and Cheeks: A Prospective, Open-Label, Postmarket Study
Authors: Pavicic Tatjana , Sattler Gerhard , Prager Welf , Fischer Tanja , Gauglitz Gerd , Hofmann Matthias , Dersch Hanna , Riaz Shahbaz , Kerscher Martina 
Published: August 2021

BACKGROUND
Facial aging is characterized by volume loss and progressive hollowing of temples and cheeks. Biodegradable filler materials are preferred over nonabsorbable materials; of these, hyaluronic acid (HA) fillers are the most often used because of their favorable effectiveness and safety profile.

OBJECTIVE
To confirm the safety and effectiveness of Cohesive Polydensified Matrix (CPM)-HA26 gel in the treatment of volume deficiency.

METHODS
Subjects received up to 2 treatments in the temples and/or cheeks. A blinded investigator assessed improvement according to the Merz Temple Volume Scale (MTVS) and Merz Cheek Fullness Assessment Scale (MCFAS). Subjects were followed for 48 weeks after the last treatment.

RESULTS
In total, 87 healthy subjects were enrolled. The proportion of subjects achieving at least a 1-grade improvement on MTVS and/or MCFAS was above 70% for each (MTVS: Weeks 4, 24, and 48 = 95.4%, 94.2%, and 77.0%; MCFAS: Weeks 4, 24, and 48 = 92.3%, 83.1%, and 71.8%). Based on MTVS and MCFAS scores at Visit 5, improvement remained visible at up to 48 weeks. No treatment-related serious AEs occurred.

CONCLUSION
CPM-HA26 demonstrated both a favorable safety and effectiveness profile, with improvement in facial volume evident for up to 48 weeks. It was well tolerated and had a positive, long-lasting effect.
Efficacy and Safety of High-Intensity, High-Frequency, Parallel Ultrasound Beams for Fine Lines and Wrinkles
Authors: Wang Jordan V. , Ferzli Georgina , Jeon Hana , Geronemus Roy G. , Kauvar Arielle 
Published: August 2021

BACKGROUND
Ultrasound energy has been used for cutaneous rejuvenation, including treatment of fine lines and wrinkles. Ultrasound waves of high intensity can induce thermal injury in the dermis, which causes tissue coagulation and remodeling.

OBJECTIVE
To examine the safety and utility of a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams to improve fine lines and wrinkles of the face and neck.

MATERIALS AND METHODS
A prospective, multicenter, clinical study investigated the utility of this novel ultrasound device to improve fine lines and wrinkles. Sixty subjects were enrolled for single treatment to the face and neck.

RESULTS
Fifty-eight subjects completed the study. The mean age was 58 years, and 87.9% were women. Fitzpatrick skin Types I to VI were represented. Assessments compared 12-week follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 78% of subjects. There was significant improvement of 1 to 3 Fitzpatrick Wrinkle and Elastosis Scale units in 86% of subjects. For investigator global improvement scores, 88% of subjects had improvement. Overall, 72% of subjects noted improvement, and the majority were satisfied. There were no device-related adverse events.

CONCLUSION
Treatment with a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams safely improved the clinical appearance of fine lines and wrinkles of the face and neck.