bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder
Authors: Assayag Naama , Bonneh Yoram , Parush Shula , Mell Haim , Kaplan Neeman Ricky , Bar-Shalita Tami 
Published: October 2019

AbstractObjectiveThis comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD.MethodsTherapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire–Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)–Revised.ResultsThe SUD group scored higher on the PSQ (P &lt; 0.0001), BAS-R aversiveness (P &lt; 0.0001), BAS-R-unpleasantness (P &lt; 0.0001), and on the aftersensation of auditory aversiveness (P &lt; 0.0001) and unpleasantness (P &lt; 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P &lt; 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ.ConclusionsThis is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.
Tocilizumab monotherapy for large vessel vasculitis: results of 104-week treatment of a prospective, single-centre, open study
Authors: Saito Shuntaro , Okuyama Ayumi , Okada Yusuke , Shibata Akiko , Sakai Ryota , Kurasawa Takahiko , Kondo Tsuneo , Takei Hirofumi , Amano Koichi 
Published: October 2019

Abstract

Objective
To evaluate the efficacy and safety of tocilizumab (TCZ) monotherapy for large vessel vasculitides (LVV), including Takayasu arteritis (TAK) and GCA.

Methods
Twelve patients with a newly diagnosed LVV (eight GCA, four TAK) were enrolled. One TAK patient withdrew consent, so 11 (eight GCA, three TAK) were analysed in a prospective, open-label study. TCZ (8 mg/kg) monotherapy, without glucocorticoids or immunosuppressants, was administered every 2 weeks for 2 months and then every 4 weeks for 10 months. Patients were followed for 1 year after the final TCZ dose. Complete and partial responses were defined as disappearance or improvement of all clinical symptoms and normalization of CRP. Relapse was defined as the worsening or recurrence of clinical symptoms, increase in CRP attributable to vasculitis, and/or the need for initiation of glucocorticoids and/or immunosuppressants. Poor clinical response described patients who did not fit the definition of complete response or partial response.

Results
Complete and partial responses rates were 75/66% and 25/0% in GCA/TAK patients, respectively, at week 24 and week 52. Five GCA patients and one TAK patient remained disease-free for 1 year after therapy. One GCA patient required TCZ discontinuation due to heart failure at week 24.

Conclusion
TCZ monotherapy showed a high response rate for newly diagnosed LVV patients, and the majority of patients did not relapse for 1 year after TCZ cessation. Result of this study could help us to understand the crucial role of IL-6 in the pathogenesis of LVV.
A non-parametric analytic framework for within-host viral phylogenies and a test for HIV-1 founder multiplicity
Authors: Lewitus Eric , Rolland Morgane 
Published: October 2019

AbstractPhylogenetics is a powerful tool for understanding the diversification dynamics of viral pathogens. Here we present an extension of the spectral density profile of the modified graph Laplacian, which facilitates the characterization of within-host molecular evolution of viruses and the direct comparison of diversification dynamics between hosts. This approach is non-parametric and therefore fast and model-free. We used simulations of within-host evolutionary scenarios to evaluate the efficiency of our approach and to demonstrate the significance of interpreting a viral phylogeny by its spectral density profile in terms of diversification dynamics. The key features that are captured by the profile are positive selection on the viral gene (or genome), temporal changes in substitution rates, mutational fitness, and time between sampling. Using sequences from individuals infected with HIV-1, we showed the utility of this approach for characterizing within-host diversification dynamics, for comparing dynamics between hosts, and for charting disease progression in infected individuals sampled over multiple years. We furthermore propose a heuristic test for assessing founder heterogeneity, which allows us to classify infections with single and multiple HIV-1 founder viruses. This non-parametric approach can be a valuable complement to existing parametric approaches.
Pattern of Cross-Reactivity Between Mycobacterial Immunohistochemical Stain and Normal Human Eosinophils: A Potential Pitfall in the Diagnosis of Cutaneous Mycobacterial Infections
Authors: Baker Catherine , Sriharan Aravindhan 
Published: October 2019

Abstract:
Cutaneous tuberculosis (CTB) is a challenging diagnosis that often requires tissue biopsy and the use of immunohistochemical (IHC) staining, among other special stains. The mycobacterium tuberculosis IHC stain is believed to be specific for mycobacteria and closely related organisms, without documented reactivity to normal human tissue. In this study, we document 4 cases of previously unreported cross-reactivity between the mycobacterium tuberculosis IHC polyclonal antibody and normal eosinophil granules in patients without other evidence of CTB infection. Such cross-reactivity represents a potential pitfall for the use of IHC in the diagnosis of CTB.
Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study
Authors: Reinders Edouard F.H. , Klaassen Karlijn M.G. , Pasch Marcel C. 
Published: October 2019

BACKGROUND
Glomus tumors are rare benign painful tumors, frequently found in the subungual region. Complete surgical excision is essential for relief of symptoms. The main postoperative complications are tumor recurrence and nail dystrophy.

OBJECTIVE
To evaluate the long-term outcome and the impact on quality of life (QoL) of glomus tumors after a transungual approach.

MATERIALS AND METHODS
A retrospective cohort study was conducted. Twenty-six patients underwent transungual excision of subungual glomus tumors. A self-administered questionnaire was sent to evaluate the postoperative outcome. Glomus tumor-related QoL was investigated using modified nail psoriasis (NPQ10) and onychomycosis questionnaires.

RESULTS
A response rate of 85% was achieved. After a mean follow-up of 63 months after transungual excision of the tumor, the mean Numeric Pain Rating Score had improved from 7.9 (±SD 1.8) preoperatively, to 0.8 (±SD 1.9) (p < .000). Quality of life improved significantly: the mean NPQ10-score improved from 5.5 (±SD 3.4) to 0.64 (±SD 2.1) (p < .000). Nail-related sequelae were not reported in any of the patients.

CONCLUSION
Our study showed that glomus tumors cause impairment on QoL, mostly due to severe pain. Surgical excision with the transungual approach is an effective treatment, without permanent damage to the nail unit that gives relief of pain and improves QoL.
Intrasubunit V-Y Muscle Sling Myocutaneous Island Advancement Flap for Small Defects Isolated to the Nasal Ala
Authors: Guzman Anthony K. , Bhatt Mehul D. , Sobanko Joseph F. , Etzkorn Jeremy R. , Shin Thuzar M. , Cosulich Michael T. , Miller Christopher J. 
Published: October 2019

BACKGROUND
The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae.

OBJECTIVE
To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects.

MATERIALS AND METHODS
A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS).

RESULTS
A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm2. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes.

CONCLUSION
The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.
Successful Treatment of Multiple Common Warts With Intralesional Ozone
Authors: Ibrahim Alshimaa M. , Elkot Reham A. , Khashaba Shrook A. 
Published: October 2019

BACKGROUND
Although there are multiple treatments for warts, wart management remains a challenge. Ozone therapy is an emerging treatment for infectious and noninfectious dermatological diseases.

OBJECTIVE
To assess intralesional ozone gas safety and efficacy in multiple warts management.

MATERIALS AND METHODS
Seventy-four adult patients with multiple common warts were included in this study. They were randomly assigned into 2 groups: first group comprised 44 patients treated with intralesional ozone gas, and the second group comprised 30 patients who received intralesional saline injection. In both groups, warts in all patients were directly injected weekly until complete clearance occurred or for a maximum of 10 treatment sessions. The subjects were followed for 6 months to record any recurrences.

RESULTS
In the ozone group, 25 patients (56.8%) had a complete response with an excellent cosmetic outcome, 15 patients (34.1%) showed a partial response, and 4 patients (9.1%) had no response. More subjects responded to ozone than to saline (p < .001). Ozone therapy was associated with mild side effects, including pain at time of injection, numbness, and fatigue.

CONCLUSION
Intralesional ozone is effective and safe for the treatment of multiple warts.
Interrelation between midwall mechanics and longitudinal strain in newly diagnosed and never-treated hypertensive patients without clinically defined hypertrophy
Authors: Lembo Maria , Santoro Ciro , Sorrentino Regina , Canonico Mario E. , Fazio Valeria , Trimarco Bruno , Tadic Marijana , Galderisi Maurizio , Esposito Roberta 
Published: October 2019

Background:
In hypertensive patients, an impairment of midwall myocardial mechanics was described in presence of left ventricular (LV) concentric geometry. Under these circumstances, also LV longitudinal dysfunction was found.

Purpose:
Our aim was to evaluate longitudinal and circumferential systolic function and correlations between these two functional components in newly diagnosed hypertensive patients without clinically defined LV hypertrophy (LVH). One hundred and thirty-eight newly diagnosed, never-treated hypertensive patients without LVH and a control group of 105 healthy normotensive individuals underwent two-dimensional and speckle tracking echocardiography. Global longitudinal strain (GLS) was derived (in absolute value) and midwall fractional shortening (MFS) computed. In addition, the hypertensive population was divided into two groups according to GLS: normal GLS (≥20%, n = 94) and reduced GLS (<20%, n = 44).

Results:
Hypertensive patients had lower MFS (P < 0.001) and GLS (P < 0.0001) than healthy controls. By dividing hypertensive patients according to GLS thresholds of normalcy, MFS was lower in patients with GLS less than 20% (P < 0.0001) while no significant difference was found in LV geometry, ejection fraction and diastolic parameters in comparison with patients with GLS at least 20%. In the pooled hypertensive population, GLS resulted positively related to MFS (r = 0.33, P < 0.0001). By a multiple linear regression analysis, after adjusting for female sex, age, BMI, circumferential end-systolic stress, average e′, ejection fraction and relative wall thickness, MFS remained independently associated with GLS (β = 0.222, P < 0.005).

Conclusion:
In newly diagnosed and never-treated hypertensive patients without LVH, an early LV systolic dysfunction is testified by the reduction of both MFS and GLS. These two parameters resulted independently associated after adjusting for several confounders.
Biological convergence of three human and animal model quantitative trait loci for blood pressure
Authors: Deng Alan Y. , Ménard Annie 
Published: October 2019

Objectives:
Blood pressure (BP) is comparable among different mammalian orders, despite their evolution divergence. Because of it, fundamental mechanisms should connect humans and rodents by their shared BP physiology. We hypothesized that similar quantitative trait loci (QTLs) function in both humans and rodents in controlling BP.

Methods:
We utilized inbred hypertensive Dahl salt-sensitive rats (DSS) as a functional proxy to evaluate the relevance of human genome-wide association studies (GWAS) genes in BP regulation.

Results:
First, three DSS BP QTLs functionally captured three specific human GWAS genes. Each QTL has a major biological impact, not a miniscule effect, on BP, in causation by function. Second, noncoding single-nucleotide polymorphisms (SNPs) found in GWAS are by products of primate evolution, instead of mechanistic drivers in regulating BP, because their absence did not impact on BP of mammals. Third, a missense mutation, rather than a noncoding GWAS SNP marking it nearby, is the priority functional basis for a given QTL. Depleting such a noncoding GWAS SNP had no impact, whereas eliminating the muscarinic cholinergic receptor 3 (M3R) signaling decreased BP. Finally, epistatic modularity biologically organizes multiple QTLs with redundant functions, and is the genetic mechanism that modulates the BP homeostasis when QTLs function collectively.

Conclusions:
Two pathogenic pathways of hypertension biologically unify mechanisms of BP regulations for humans and their functional surrogates. The mechanism-based biology for the M3R-mediated pathway in raising BP has established M3R as a novel pathogenesis-driven target for antihypertension therapies.
Phenotypes of masked hypertension: Isolated ambulatory, isolated home and dual masked hypertension
Authors: Stergiou George S. , Kyriakoulis Konstantinos G. , McManus Richard J. , Andreadis Emmanuel A. , Jula Antti , Kollias Anastasios , Lindroos Annika , Ntineri Angeliki , Schwartz Claire , Niiranen Teemu J. 
Published: October 2019

Objectives:
Masked hypertension (MH) is defined as normal office blood pressure (OBP) and elevated ambulatory (ABP) or home blood pressure (HBP). This study assessed MH identified by each of these two methods.

Methods:
A retrospective analysis of cross-sectional data in treated and untreated adults from Greece, Finland and UK who had OBP, HBP and 24-h ABP measurements was performed. Dual MH was defined as normal OBP and elevated HBP and ABP, isolated ambulatory MH as normal OBP and HBP and elevated ABP and isolated home MH as normal OBP and ABP and elevated HBP.

Results:
Of 1971 participants analyzed, 445 (23%) had MH on ABP and/or HBP (age 57.1 ± 10.8 years, men 55%, treated 49%). Among participants with any MH, 215 had dual MH (48%), 132 isolated ambulatory MH (30%) and 98 isolated home MH (22%). Moreover, 55% had high-normal, 35% normal and 10% optimal OBP. In logistic regression analysis isolated ambulatory MH was predicted by younger age (OR 0.35, P < 0.01 per 10 years increase), whereas isolated home MH was predicted by older age (OR 2.05, P < 0.01 per 10 years increase).

Conclusion:
Masked hypertension diagnosed by ABP and not HBP monitoring or the reverse is not uncommon. Age appears to be the most important determinant of isolated ambulatory or home MH, with the former being more common in younger participants and the latter in older ones. Only half of participants with MH have high-normal OBP, whereas the rest have lower levels.
AN ATYPICAL CASE OF OPTIC DISK PSEUDO-DUPLICATION WITH PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Bloom Steven M. , Adeniran Janelle F. , Mandava Anupa , Singal Inder P. 
Published: October 2019

Purpose:
To present a unique case of optic disk pseudo-duplication with proliferative diabetic retinopathy.

Methods:
Case report.

Results:
A 63-year-old white diabetic man presented with an apparent duplicated optic disk in the superonasal midperiphery of his left eye. A large flat frond of neovascularization fanned out from this structure. Optical coherence tomography scanning showed a noncolobomatous scar with a large plume of blood vessels sprouting from the choroid, thru the retina and branching out into the vitreous. Magnetic resonance imaging scanning revealed a normal left globe and orbit with a single optic nerve. The neovascularization regressed after panretinal photocoagulation and anti–vascular endothelial growth factor therapy.

Conclusion:
We describe a unique case of proliferative diabetic retinopathy associated with pseudo-duplication of the optic disk. This case is unique in the peripheral location of the pseudo-duplication, the presence of spontaneous choroidovitreal neovascularization in proliferative diabetic retinopathy, and the appearance of neovascularization elsewhere mimicking neovascularization of the duplicated disk.
Health Insurance Coverage of Gender-Affirming Top Surgery in the United States
Authors: Ngaage Ledibabari M. , Knighton Brooks J. , McGlone Katie L. , Benzel Caroline A. , Rada Erin M. , Bluebond-Langner Rachel , Rasko Yvonne M. 
Published: October 2019

Background:
Despite the medical necessity, legislative mandates, and economic benefits of gender-affirming surgery, access to treatment remains limited. The World Professional Association for Transgender Health (WPATH) has proposed guidelines for transition-related surgery in conjunction with criteria to delineate medical necessity. The authors assessed insurance coverage of “top” gender-affirming surgery and evaluated the differences between insurance policy criteria and WPATH recommendations.

Methods:
The authors conducted a cross-sectional analysis of insurance policies for coverage of top gender-affirming surgery. Insurance companies were selected based on their state enrollment data and market share. A Web-based search and individual telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from publicly available policies.

Results:
Of the 57 insurers evaluated, bilateral mastectomy (transmasculine) was covered by significantly more insurers than breast augmentation (transfeminine) (96 percent versus 68 percent; p < 0.0001). Only 4 percent of companies used WPATH-consistent criteria. No criterion was universally required by insurers. Additional prerequisites for coverage that extended beyond WPATH guidelines for top surgery were continuous living in congruent gender role, two referring mental health professionals, and hormone therapy before surgery. Hormone therapy was required in a significantly higher proportion of transfeminine policies compared with transmasculine policies (90 percent versus 21 percent; p < 0.0001).

Conclusions:
In addition to the marked intercompany variation in criteria for insurance coverage that often deviated from WPATH recommendations, there are health care insurers who categorically deny access to top gender-affirming surgery. A greater evidence base is needed to provide further support for the medical necessity criteria in current use.
Nationwide Cost Variation for Thumb Replantation: A Population Study
Authors: Billig Jessica I. , Zhong Lin , Chung Kevin C. 
Published: October 2019

Background:
Health care reforms aimed at bundling payments attempt to contain costs. Uncovering variation in spending provides one strategy for decreasing expenditure. This study aims to investigate interhospital cost variation for thumb replantation.

Methods:
A retrospective cross-sectional analysis of patients undergoing thumb replantation using data from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2001 to 2011 was performed. Univariate and multivariable logistic regression models were used to investigate associations between patient-level and hospital-level characteristics and cost.

Results:
A total of 778 patients were included in the study, with a mean cost for thumb replantation of $20,965. Thumb replantations performed at high-volume hospitals were significantly more expensive than those performed at low-volume hospitals (median cost, $20,395 versus $13,463; p < 0.001), with longer lengths of stay (5 days versus 4 days), despite having similar surgical complication rates (p = 0.07). Thumb replantations performed in the West were significantly more expensive than those performed in the South (median cost, $22,579 in the West versus $14,823 in the South; p < 0.001), with longer lengths of stay (5 days versus 4 days; p = 0.005) and similar surgical complications (p = 0.239). In multivariable logistic regression, hospital volume (p < 0.001), hospital region (p < 0.001), and increased length of stay (p < 0.001) were predictive of higher cost.

Conclusions:
High-volume hospitals and hospitals in the West are more expensive, with longer lengths of stay, despite having similar complications. Expedited discharge may be one avenue for decreasing expenditure without compromising care.
Early Postoperative Application of Botulinum Toxin Type A Prevents Hypertrophic Scarring after Epicanthoplasty: A Split-Face, Double-Blind, Randomized Trial
Authors: Huang Ru-Lin , Ho Chia-Kang , Tremp Mathias , Xie Yun , Li Qingfeng , Zan Tao 
Published: October 2019

Background:
Postoperative hypertrophic scarring of the medial canthal area is a common phenomenon and deterrent for patients considering epicanthoplasty. Botulinum toxin type A has been reported for hypertrophic scar and keloid treatment. However, there is a lack of high-level evidence regarding the effects of botulinum toxin type A in the medial canthal area.

Methods:
In this split-face, double-blind, randomized trial, 43 consecutive consenting patients undergoing Park Z-epicanthoplasty were randomized to receive 5 U of botulinum toxin type A or the same volume of saline injections at days 6 to 7 postoperatively. Scars were assessed independently using the Vancouver Scar Scale, the visual analogue scale, and patient satisfaction rating at the 1-, 3-, and 6-month follow-ups.

Results:
Overall, 30 patients completed this trial. The botulinum toxin type A–treated side achieved significantly improved Vancouver Scar Scale scores. The most obvious improvements were observed at the 3-month follow-up visit. Among the four subscores of the Vancouver Scar Scale, the most significantly improved subscores were the height and pliability. The visual analogue scale scores also decreased significantly on the botulinum toxin type A–treated side at all three follow-up visits. Approximately 86.7 percent of the patients were satisfied with the scar and epicanthoplasty outcomes. No severe complications were reported.

Conclusions:
Early postoperative botulinum toxin type A injection in the medial canthal region efficiently reduces hypertrophic scarring and improves the outcome of epicanthoplasty. Therefore, botulinum toxin type A injection can be used as a routine method to prevent hypertrophic scarring and improve the outcome of epicanthoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.