bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema
Authors: Gustafsson Jonas , Chu Sung-Yu , Chan Wen-Hui , Cheng Ming-Huei 
Published: July 2018

Background:
Vascularized lymph node transfer has shown promising results in the treatment of lower limb lymphedema, but little is known about the number of lymph nodes needed for the transfer to achieve optimal results. This study investigated the correlation between number of transferred lymph nodes in submental vascularized lymph node transfer and outcomes regarding limb circumference reduction and cellulitis incidence.

Methods:
Thirty-five patients who had received vascularized submental lymph node transfer to an ankle for lower limb lymphedema following gynecologic cancer treatment were included in the study. Limb circumference was determined by means of tape measurement preoperatively and postoperatively and was used to calculate the circumferential difference. Ultrasonography was performed postoperatively to determine the number of lymph nodes within the transferred flap. Patients were divided into groups A through C depending on the number of transferred lymph nodes: 1 or 2 (n = 10), 3 or 4 (n = 14), and 5 to 8 (n = 11), respectively.

Results:
The mean age of the patients was 60.0 ± 9.2 years. All flaps survived. The mean improvement of circumferential difference for the whole cohort was 19.8 ± 9.2 percent. Groups B and C both had significantly higher improvements in the circumferential difference than group A (p = 0.04 and p = 0.02, respectively), but when compared to each other, the difference was nonsignificant. All groups had significant reductions in the incidence of cellulitis postoperatively.

Conclusions:
Submental vascularized lymph node transfer for lower limb lymphedema reduced the incidence of cellulitis, regardless of the number of transferred lymph nodes. The transfer of three or more lymph nodes provided significantly better outcome regarding limb circumference reduction than the transfer of two or fewer lymph nodes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Incidents of Mandibular Distraction Osteogenesis for Hemifacial Microsomia
Authors: Wang Xuan , Feng Shi , Tang Xiaojun , Shi Lei , Yin Lin , Liu Wei , Yin Hongyu , Yang Yinan , Zhang Zhiyong 
Published: July 2018

Background:
This study focused mainly on the safety and unexpected incidents of mandibular distraction osteogenesis in treating patients with hemifacial microsomia.

Methods:
Records of 71 patients with hemifacial microsomia treated by mandibular distraction osteogenesis from February of 2010 to March of 2015 were examined in this retrospective study. The modified mandibular osteotomy was conducted under the assistance of three-dimensional reconstruction, computer-aided design, and rapid prototyping technique. Distraction was conducted 4 to 7 days postoperatively at a frequency of 1 mm/day; moreover, the distractor was kept in place for 4 to 13 months after the first operation before it was removed. The scope of distraction ranged from 20 to 40 mm. All incidents encountered during and after the mandibular distraction process were documented in the medical records of patients. The patients were followed up for an average of 34.4 months after the second-stage operation.

Results:
The overall rate of incidents was 36.6 percent. Of them, minor incidents, which could be resolved with or without noninvasive therapy, were observed in 18.3 percent of all procedures in this series. Meanwhile, the rate of moderate incidents necessitating invasive therapy was reported to be 12.7 percent, whereas that of major incidents that could not be resolved with invasive therapy was 5.6 percent.

Conclusions:
Mandibular distraction osteogenesis is a widely used procedure for treating patients with hemifacial microsomia. It is extremely important to be fully aware of a variety of incidents occurring during and after the surgical procedure to minimize the frequency of occurrence of such incidents.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Brief Report: The Amsterdam Symptom and Risk-Based Score Predicts for Acute HIV Infection in Men Who Have Sex With Men in San Diego
Authors: Lin Timothy C. , Dijkstra Maartje , De Bree Godelieve J. , Schim van der Loeff Maarten F. , Hoenigl Martin 
Published: July 2018

Objective:
Dijkstra et al recently described a risk- and symptom-based score moderately predictive for HIV seroconversion in the preceding 6–12 months in men who have sex with men (MSM) in Amsterdam. Our objective was to determine whether this “Amsterdam Score” could also predict for acute HIV infection (AHI) in MSM.

Design and Setting:
This study is a case–control analysis of a prospectively enrolled cohort of MSM who voluntarily presented for HIV testing in San Diego. The study sample was composed of MSM who screened HIV antibody-negative and then either tested positive with AHI [HIV nucleic acid test (NAT)-positive] or tested HIV NAT-negative.

Methods:
The Amsterdam Score was calculated for each participant in the study sample. Score performance was assessed using receiver operating characteristic curves and their area under the curve (AUC). An optimal cutoff was determined using the Youden index.

Results:
Seven hundred fifty-seven MSM (110 AHI and 647 HIV NAT-negative) were included in the analysis. AHI and HIV-negative cases were similar in age [median 32 years (interquartile range 26–42) vs 33 (27–45), respectively, P = 0.082]. The Amsterdam Score yielded a receiver operating characteristic curve with an AUC of 0.88 (95% confidence interval: 0.84 to 0.91). An optimal cutoff of ≥1.6 was 78.2% sensitive and 81.0% specific.

Conclusions:
The risk- and symptom-based Amsterdam Score was highly predictive (AUC of 0.88) of AHI in MSM in San Diego. The Amsterdam Score could be used to target NAT utilization in resource-poor settings among MSM who test HIV antibody-negative, although the potential cost-savings must be balanced with the risk of missing AHI diagnoses.
Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guidelines
Authors: Arevalo Octavio , Riascos Roy , Rabiei Pejman , Kamali Arash , Nelson Flavia 
Published: July 2018

AbstractThe advent of magnetic resonance imaging has improved our understanding of the pathophysiology and natural course of multiple sclerosis (MS). The ability of magnetic resonance imaging to show the evolution of MS lesions on sequential scans has brought it to be one of the endpoints in clinical trials for disease-modifying therapies. Based on the most updated consensus guidelines from the American (Consortium of MS Centers) and European (Magnetic Resonance Imaging in MS) boards of experts in MS, this document shows the most relevant landmarks related to imaging findings, diagnostic criteria, indications to obtain a magnetic resonance, scan protocols and sequence options for patients with MS. Although incorporating the knowledge derived from the research arena into the daily clinical practice is always challenging, in this article, the authors provide useful recommendations to improve the information contained in the magnetic resonance report oriented to facilitate communication between radiologists and specialized medical teams involved in MS patients' multidisciplinary care.
Measurement of Vascular Diameter in Computed Tomography Angiography With Reduced Iodine Load: Comparison of Virtual Monochromatic Imaging in Dual-Energy Computed Tomography and Conventional Polychromatic Scan In Vitro
Authors: Sugawara Haruto , Suzuki Shigeru , Katada Yoshiaki , Ishikawa Takuya , Fukui Rika , Yamamoto Yuzo , Abe Osamu 
Published: July 2018

Objectives
The aim of this study was to compare accuracy of measurement between virtual monochromatic imaging (VMI) in dual-energy computed tomography and conventional polychromatic 120-kVp computed tomographic scan in vascular models containing various densities of contrast material.

Methods
We evaluated measured diameters of 12 models of vessels of 4 inner diameters containing high, intermediate, and low densities of contrast material using software automation.

Results
Measurement errors with 70-keV VMI were significantly larger than or comparable to errors with 120-kVp scan for all models, and those with 50-keV VMI were significantly smaller than errors with 120-kVp scan for low-density models and larger for high-density models.

Conclusions
Acquisition of images by VMI at low energy facilitates accurate measurement of diameters of poorly enhanced vessels with reduced iodine load but can increase measurement errors in other situations by decreasing spatial resolution, so VMI should be applied carefully to evaluate vessel diameter.
Prospective Serial FDG PET/CT During Treatment of Extrapulmonary Tuberculosis in HIV-Infected Patients
Authors: Martin Charlotte , Castaigne Catherine , Vierasu Irina , Garcia Camilo , Wyndham-Thomas Chloe , de Wit Stéphane 
Published: July 2018

Purpose
The aim of this study was to prospectively describe evolution of 18F-FDG uptake of extrapulmonary tuberculosis (TB) throughout the course of TB treatment in HIV patients to evaluate 18F-FDG PET/CT as a monitoring tool of treatment response.

Methods
We performed baseline FDG PET/CT, PET-2 after 2 months, and PET-3 at the end of TB treatment in 18 HIV/TB patients. We correlated evolution of FDG uptake with clinical outcome of patients.

Results
After 2 months of treatment, 78% of the patients had a significant metabolic response. Lymph node (LN) metabolic response was heterogeneous, with 57% of LN sites showing decreased SUVmax and 41% showing unchanged FDG uptake. Organs other than LNs showed more homogeneous response. The FDG PET/CT performed at the end of TB treatment showed a complete response of all infected organs and a drastic response in terms of active LNs in 95% of the patients (SUVmax mean decrease = 85%, median = 100%). A complete metabolic response after TB treatment was seen in only 47% of patients.

Conclusions
In difficult-to-treat entities such as extrapulmonary TB in HIV patients, FDG PET/CT is a potential tool in monitoring TB treatment response and should be explored in larger studies.
Causes of the Removal of High-Density Polyethylene Sheets (Medpor) in Revision Rhinoplasty
Authors: Kim Jae Hoon , Hwang Kun 
Published: July 2018

Abstract
The aim of this study was to identify the causes of complications in rhinoplasties using Medpor. The medical records of 71 patients who had undergoing a reoperation after a rhinoplasty using Medpor were reviewed. From each patient's history, examination records, and operative records, the method of the previous rhinoplasty using Medpor was extracted. The previously inserted Medpor and the septal mucosa covering it were removed during the reoperation and observed in 3 cases. A turned-up or short nose (43.8%) and tip stiffness (25.3%) were significantly more common than other complaints (P < 0.05). The strut type (49.2%) and the septal extension type (43.8%) were significantly more common than the spreader type (P < 0.001). In the reoperation, extension grafts (47.1%) and by tip grafts (39.7%) were significantly more common than other procedures (P < 0.001). Grossly, the specimens were covered with septal mucosa and multiple ball-like granulation tissues (cobblestone appearance) at the “pores” of the Medpor. Microscopically, Medpor was covered with fibrous collagenous tissue, partially bridging through the pores. Inflammatory cells had infiltrated around the polyethylene. The authors classify the patients in the present series as: those with a long columella strut to the anterior nasal spine, those with Medpor inserted onto the membranous septum (septal extension graft or too large), and those with Medpor used as spreader graft covered with nasal mucosa (causing weakness of the nasal septum and thinning or necrosis of the mucosa). Using Medpor as a strut graft seems to be relatively safe if the floating type is used.
Nerve Switch for Reducing Synkinesis After Gracilis Muscle Transfer Innervated Via the Masseter Nerve
Authors: Ota Tomoyuki , Matsumoto Hiroshi , Yamada Kiyoshi , Kimata Yoshihiro 
Published: July 2018

Background:
In surgical treatment for longstanding facial paralysis, muscle transplantation is considered a useful and important method. To obtain a spontaneous smile, the use of the facial nerve of the healthy side as a motor source is better, but use of the masseter nerve allows prompt reinnervation and powerful movement. However, in some patients in whom the masseter nerve is used, separating masticatory movement and commissure contraction is difficult. Solutions for such patients have not been determined.

Case History and Discussion:
A 46-year-old female patient presented with longstanding complete facial paralysis after resection of a right acoustic neurinoma. As initial surgery, free gracilis transfer was performed on the cheek, but the patient experienced commissure movement during meals postsurgery. Secondary corrective surgery was performed to detach the motor nerve of the gracilis from the masseter nerve and suture it to the facial nerve of the healthy side via cross-face nerve graft. The symptom improved but partially recurred. Improvement in synkinetic movement can be obtained by performing cross-face nerve grafting and subsequent nerve switch.
Facial Growth Changes Induced by Orthodontic Treatment in Patients With Unilateral Cleft Lip and Palate
Authors: Lacerda Filho Rosa Helena Wanderley , Ramos Tânia Braga , Filho Valdécio Vasconcelos Lacerda , Chaves Ana Maria Barros , Furtado Paulo Germano Cavalcanti , Ozawa Terumi Okada 
Published: July 2018

Abstract
The aim of this study was to investigate the effect of orthodontic treatment on the maxillofacial growth of patients with unilateral cleft lip and palate. The Great Ormond Street, London and Oslo (GOSLON) yardstick was used for a longitudinal evaluation of 24 patients with cleft lip and palate treated at the Cleft Center of the Lauro Wanderley University Hospital, Paraiba State, northeastern Brazil. Dental casts were evaluated by 3 orthodontists and classified according to the GOSLON yardstick. The evaluation was performed at 2 different stages: T1 (before orthodontic treatment) and T2 (follow-up evaluation) after a 6-year mean follow-up interval. The Kappa test was used to evaluate intra- and interexaminer agreement, and paired t-test was used to compare the differences between T1 and T2, with a 99% confidence interval. The average intraexaminer Kappa was 0.979, ranging from 0.971 to 0.990. The interexaminer Kappa value was 0.926 at T1, ranging from 0.885 to 0.964, and 0.896 at T2, ranging from 0.696 to 1.0. The mean GOSLON yardstick found at T1 was 2.5 ± 1.18 with 50% in G1 + G2, 29.18% in G3, and 20.82% in G4 + G5. At T2, the GOSLON average was 1.71 ± 1.12, with 79.18% in G1 + G2, 12.5% in G3, and 8.32% in G4 + G5. A statistically significant difference was found between T1 and T2. The results suggest that orthodontic treatment improves facial growth in patients with unilateral cleft lip and palate.
Craniofacial Microsomia: Orthodontic Surgical Treatment of Growing Patients
Authors: Agurto Veas Pamela , Castellón Zirpel Loreto , Morovic Carmen Gloria 
Published: July 2018

Abstract
Craniofacial microsomia covers a set of morphogenetic anomalies that affect structures arising from the first and second brachial arches. Due to the vast phenotypic variation and complexity of the malformation, a global treatment that is coordinated by a multidisciplinary team is imperative. Herein, the authors describe 3 clinical patients and discuss the different therapies used according to the type of microsomia present. It was concluded that early and integrated treatment, which considers all the affected and potentially affected soft and hard tissue, is needed, and that patients must be monitored until they have finished growing.
Management of nonmetastatic castration-resistant prostate cancer
Authors: Traboulsi Samer L. , Saad Fred 
Published: July 2018

Purpose of review
The widespread use of prostate-specific antigen (PSA) resulted in stage migration of prostate cancer where androgen deprivation therapy (ADT) is administered for biochemical recurrence in patients following primary treatment. A proportion of these patients progress to a disease state termed nonmetastatic castration-resistant prostate cancer (nmCRPC), with a rising PSA despite ADT and without evidence of metastases on conventional imaging. We will review the treatment options in nmCRPC, especially in light of recent trials showing significant improvement in metastasis-free survival with newer agents.

Recent findings
Historically, nmCRPC patients were followed-up if PSA doubling-time (PSADT) exceeded 10 months. Treatment options for patients with shorter PSADT included hormonal manipulations that often resulted in transient PSA decline. Denosumab was found to delay the onset of bone metastasis but did not impact survival. Recently, phase 3 trials showed that second-generation antiandrogens resulted in a significant delay in metastasis and a trend toward survival improvement in a select group of nmCRPC patients.

Summary
The importance of reducing mortality and morbidity associated with metastasis has led to the acceptance of new primary endpoints in the design of trials for nmCRPC and might result in widespread approval of new agents for this disease state.
A contemporary review about the management of radiation-induced hemorrhagic cystitis
Authors: Dautruche Antoine , Delouya Guila 
Published: July 2018

Purpose of review
There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018.

Recent findings
During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery.

Summary
Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.
Chikungunya on Kidney Transplant Recipients: Is It the Same?
Authors: Tavares Bruno M. , Fernandes Paula FCBC , Oliveira Cláudia Maria C. , Silva Sônia L. , Mota Márcia U. , Andrade Tacilla HS , Cunha Samuel F. , Girão Evelyne S. 
Published: July 2018

Background
Chikungunya virus (CHIKV) infection is an acute febrile illness with polyarthralgia and arthritis. There are few data about CHIKV infection in kidney transplant recipients (KTR). We report the largest case series of CHIKV infection in this population.

Methods
We retrospectively analyzed 32 cases of CHIKV infection in KTR between January 2016 and December 2017 at Hospital Universitário Walter Cantídio of Federal University of Ceará.

Results
All patients had been in endemic areas before the beginning of the symptoms. All presented arthralgia, 15 (46.9%) with joint inflammatory symptoms and 14 (43.8%) evolved to chronic arthralgia. Seven (21.9%) showed acute kidney injury (AKI) by Kidney Disease: Improving Global Outcomes criteria during the acute phase. Acute kidney injury was not related to prednisone use (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.04-2.61, P = 0.3) nor chronic arthralgia (OR, 1.2; 95% CI, 0.2-8.4, P = 0.8) as well as male sex, chronic kidney disease and older than 60 years (OR, 1.7; 95% CI, 0.3-10.3, P = 0.58; OR, 0.4; 95% CI, 0.1-2.7, P = 0.4; and OR, 2.1; 95% CI, 0.3-14.9, P = 0.45, respectively). Hospitalization was associated to AKI (OR, 44.0; 95% CI, 3.8-503.1; P = 0.002), probably due to diarrhea or dehydration. One patient died throughout the study, possibly unassociated with CHIKV infection.

Conclusions
KTR with CHIKV infection have a clinical presentation and evolution similar to those seen in the general population. Kidney function is generally well preserved, with transitory graft dysfunction without negative impact after 3 months from the beginning of the symptoms. Previous costicosteroids use did not relate with AKI or chronic arthralgia.
Procurement Biopsy Findings Versus Kidney Donor Risk Index for Predicting Renal Allograft Survival
Authors: Hall Isaac E. , Parikh Chirag R. , Schröppel Bernd , Weng Francis L. , Jia Yaqi , Thiessen-Philbrook Heather , Reese Peter P. , Doshi Mona D. 
Published: July 2018

Background
Efforts to maximize transplantation by matching organ quality to recipient longevity require reliable tools. The US kidney allocation system uses the Kidney Donor Risk Index (KDRI) for this purpose, and many centers additionally rely on donor biopsies. The Leuven score combines donor age with procurement histology (glomerulosclerosis and interstitial fibrosis/tubular atrophy) to predict allograft survival.

Methods
We compared KDRI with Leuven scores for associations with kidney discard, delayed graft function, and allograft function and survival. We used Cox, modified Poisson, and linear regression to calculate risks based on KDRI and (separately) Leuven scores, adjusting for important transplant and recipient variables.

Results
From 890 donors, 1729 kidneys were procured and biopsied. Five hundred eighty-five (34%) kidneys were discarded. Median donor age was 53 years (interquartile range [IQR], 44-61 years). Median KDRI and Leuven scores were 1.56 (IQR, 1.28-1.90) and 59 (IQR, 49-69). Relative risk for discard was 1.21 (95% confidence interval [CI], 1.17-1.24) per 0.2-unit increase in KDRI and 1.38 (1.31-1.46) per 10-unit increase in Leuven score. Adjusted relative risks for delayed graft function were 0.98 (95% CI, 0.94-1.02) and 0.94 (95% CI, 0.90-0.99), adjusted hazard ratios for graft failure were 1.10 (95% CI, 1.04-1.16) and 1.11 (95% CI, 1.02-1.21), and adjusted linear regression coefficients for 3-year estimated glomerular filtration rate were −3.88 (−4.63 to −3.13) and -5.18 (−6.19 to −4.18).

Conclusions
In kidneys clinically selected for procurement biopsy, the Leuven score was more strongly associated with discard but performed similarly to KDRI for predicting transplant outcomes, suggesting the need to reevaluate current procurement biopsy practices. Given modest associations for both tools; however, neither KDRI nor the Leuven score should be used in isolation for individual organ acceptance decisions.