bluuebunny/crossref_metadata_2025_split huggingface dataset:
27-GAUGE SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENSES WITH HAPTIC FLANGING
Authors: Stem Maxwell S. , Wa Christianne A. , Todorich Bozho , Woodward Maria A. , Walsh Mark K. , Wolfe Jeremy D. 
Published: July 2018

Purpose:
To determine whether haptic flanging during 27-gauge sutureless intrascleral fixation of intraocular lenses (IOLs) increases IOL stability and to report the short-term clinical outcomes of sutureless intrascleral surgery using 27-gauge trocar cannulas with haptic flanging.

Methods:
Retrospective surgical case series using live and cadaveric human eyes.

Results:
In the cadaveric experiment using five eyes, flanged haptics required more force to dislocate the IOL compared with unflanged haptics (14 ± 4 vs. 3 ± 1 g, P = 0.03). The clinical series included 52 eyes from 52 patients. The average age at the time of surgery was 73 ± 14 years, with a mean follow-up of 27 ± 19 weeks. The most common indication for surgery was IOL dislocation/subluxation (n = 43, 83%). Mean visual acuity improved from 20/140 preoperatively to 20/50 at postoperative Month 1 (P < 0.001). The most common postoperative issue was intraocular pressure elevation (n = 12, 23%). Two patients (4%) needed a reoperation for IOL dislocation.

Conclusion:
Haptic flanging during 27-gauge sutureless intrascleral surgery creates a more stable scleral-fixated IOL compared with the traditional unflanged technique based on a cadaveric human eye study. In addition, this variation of sutureless intrascleral surgery seems safe and effective for patients who require secondary IOLs.
Acute Lower Leg Heating Increases Exercise Capacity in Patients With Peripheral Artery Disease
Authors: Pellinger Thomas K. , Neighbors Catherine B. , Simmons Grant H. 
Published: July 2018

Background/Objective:
In this pilot study, we tested the hypothesis that acute lower leg heating (LLH) increases postheating popliteal artery blood flow and 6-minute walk distance in patients with peripheral artery disease (PAD).

Methods:
Six patients (5 male, 1 female) with PAD (69 ± 6.9 years; claudication: ankle-brachial index < 0.90) participated in 3 randomized treatment sessions (2–7 days apart): control or bilateral LLH conducted via water bath immersion (42°C; ~40-cm depth) for either 15 or 45 minutes. Popliteal artery blood flow (Doppler ultrasound) and arterial pressure were measured before and after LLH. Six-minute walk distance was measured on the control day and each experimental day 35 minutes post-LLH.

Results:
Popliteal artery blood flow increased after heating in a duration-dependent manner (P < .05, postheating vs control for both heating conditions and between them). Six-minute walk distance increased by 10% and 12% after 15- and 45-minute heating treatments, respectively (P < .05 vs control session).

Conclusions:
Lower leg heating, for as short as 15 minutes, increases postheating leg perfusion and exercise capacity in patients with PAD.
Sex differences in metabolism and cardiometabolic disorders
Authors: Chella Krishnan Karthickeyan , Mehrabian Margarete , Lusis Aldons J. 
Published: July 2018

Purpose of review
Sex differences are pervasive in metabolic and cardiovascular traits, yet they have often been ignored in human and animal model research. Sex differences can arise from reversible hormonal effects, from irreversible organizational (developmental) processes, and from gene expression differences from the X and Y chromosomes. We briefly review our current understanding of the impact of these factors in metabolic traits and disorders, with an emphasis on the recent literature.

Recent findings
Novel sex differences continue to be identified for metabolic and cardiovascular traits. For example, it is now clear that gut microbiota tend to differ between men and women, with potentially large implications for disease susceptibility. Also, tissue-specific gene regulation differs between men and women, contributing to differential metabolism. These new insights will open up personalized therapeutic avenues for cardiometabolic diseases.

Summary
Sex differences in body fat distribution, glucose homeostasis, insulin signaling, ectopic fat accumulation, and lipid metabolism during normal growth and in response to hormonal or nutritional imbalance are mediated partly through sex hormones and the sex chromosome complement. Most of these differences are mediated in a tissue-specific manner. Important future goals are to better understand the interactions between genetic variation and sex differences, and to bring an understanding of sex differences into clinical practice.
The many faces of CD8+ T cells in atherosclerosis
Authors: van Duijn Janine , Kuiper Johan , Slütter Bram 
Published: July 2018

Purpose of review
Atherosclerosis and the clinical consequence of cardiovascular disease remain the leading cause of death worldwide. Both an increase in cholesterol levels, as well as immune responses drive the pathogenesis of this disease. Although much is known about the role of many immune cell subsets in atherogenesis, research into the role of CD8+ T cells is limited.

Recent findings
Both atheroprotective and atherogenic functions of CD8+ T cells have been reported. On the one hand, the inflammatory cytokines produced by CD8+ T cells exacerbate inflammatory responses, and the cytotoxic activity of these cells toward lesion-stabilizing cells such as endothelial cells drives the progression and instability of atherosclerotic lesions. On the other hand, cytotoxic activity toward antigen presenting cells and the presence of regulatory CD8+ T-cell subsets dampen immunity and can limit atherosclerosis.

Summary
Here we review the different roles of CD8+ T cells in atherosclerosis and discuss possible treatment strategies targeting these cells to reduce atherosclerotic lesion burden.
Pearls for the middle fossa approach in acoustic neuroma surgery
Authors: Peng Kevin A. , Lekovic Gregory P. , Wilkinson Eric P. 
Published: July 2018

Purpose of review
To discuss the use of the middle fossa craniotomy for resection of vestibular schwannomas; to present pearls of and modifications to the approach.

Recent findings
The middle fossa craniotomy allows for hearing preservation in the resection of intracanalicular vestibular schwannomas. Over recent years, the approach has been modified to address larger tumors with a limited cerebellopontine angle component. Positive identification of the superior semicircular canal allows for rapid exposure of the internal auditory canal (IAC). Removal of cerebrospinal fluid from the posterior fossa during exposure of the IAC allows for removal of the middle fossa retractor; reinforced silicone sheeting is used to protect the middle fossa dura during further drilling. The use of the endoscope has allowed for more complete dissection at the fundus of the IAC, including tumors lateral to the transverse crest.

Summary
Technical modifications to the middle fossa craniotomy have allowed for a shorter duration of temporal lobe retraction intraoperatively and more complete resection of tumors with fundal involvement.
Pancreatic Fat Content Detected by Computed Tomography and Its Significant Relationship With Intraductal Papillary Mucinous Neoplasm
Authors: Kashiwagi Kazuhiro , Seino Takashi , Fukuhara Seiichirou , Minami Kazuhiro , Horibe Masayasu , Iwasaki Eisuke , Takaishi Hiromasa , Itoh Kazunari , Sugino Yoshinori , Inoue Nagamu , Iwao Yasushi , Kanai Takanori 
Published: July 2018

Objectives
Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions of pancreatic ductal adenocarcinomas (PDACs). Fat accumulation in the pancreas is increasingly recognized as a cause of PDAC. We aimed to identify factors that are relevant between IPMN and metabolic-related factors, including pancreatic fat.

Methods
The database for 781 subjects who underwent a health checkup and upper abdominal magnetic resonance imaging was searched and computed tomography attenuation indexes (pancreatic and spleen attenuation, pancreas-to-spleen attenuation ratio) were decided by measuring the regions of interest in the pancreas and spleen on nonenhanced images, using Hounsfield units. Eighty-five subjects from each of the IPMN and noncyst groups were matched for age, sex, and glycemic status and statistically compared in clinical characteristics.

Results
There was no difference in metabolic-related factors except for apolipoprotein A1 and high-density lipoprotein cholesterol between the 2 groups in univariate analysis. Multivariate logistic regression analysis showed that both indexes were significantly associated with IPMN (odds ratio, 0.905 [95% confidence intervals, 0.851–0.963; P = 0.002]; odds ratio, 0.006 [95% confidence intervals, 0.000–0.152; P = 0.002]).

Conclusions
Pancreatic fat content measured by computed tomography was significantly associated with IPMN. These results suggest that IPMN may develop secondary to pancreatic steatosis that could be an overlapping risk factor for PDAC and IPMN.
Cholecystectomy During Index Admission for Acute Biliary Pancreatitis Lowers 30-Day Readmission Rates
Authors: Krishna Somashekar G. , Kruger Andrew J. , Patel Nishi , Hinton Alice , Yadav Dhiraj , Conwell Darwin L. 
Published: July 2018

Objectives
Few studies have evaluated national readmission rates after acute pancreatitis (AP) in the United States. We sought to evaluate modifiable factors impacting 30-day readmissions after AP hospitalizations.

Methods
We used the Nationwide Readmission Database (2013) involving all adults with a primary discharge diagnosis of AP. Multivariable logistic regression models assessed independent predictors for specific outcomes.

Results
Among 180,480 patients with AP index admissions, 41,094 (23%) had biliary AP, of which 10.5% were readmitted within 30 days. The 30-day readmission rate for patients who underwent same-admission cholecystectomy (CCY) was 6.5%, compared with 15.1% in those who did not (P < 0.001). Failure of index admission CCY increased the risk of readmissions (odds ratio [OR], 2.27; 95% confidence interval [CI], 2.04–2.56). Same-admission CCY occurred in 55% (n = 19,274) of patients without severe AP. Severe AP (OR, 0.73; 95% CI, 0.65–0.81), sepsis (OR, 0.63; 95% CI, 0.52–0.75), 3 or more comorbidities (OR, 0.74; 95% CI, 0.68–0.79), and admissions to small (OR, 0.76; 95% CI, 0.64–0.91) or rural (OR, 0.78; 95% CI, 0.65–0.95) hospitals were less likely to undergo same-admission CCY.

Conclusions
Same-admission CCY should be considered in patients with biliary AP when feasible. This national appraisal recognizes modifiable risk factors to reduce readmission in biliary AP and reinforces adherence to major society guidelines.
Morning Fatigue Severity Profiles in Oncology Outpatients Receiving Chemotherapy
Authors: Wright Fay , Dunn Laura B. , Paul Steven M. , Conley Yvette P. , Levine Jon D. , Hammer Marilyn J. , Cooper Bruce A. , Miaskowski Christine , Kober Kord M. 
Published: July 2018

Background
Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability.

Objectives
The aims of this study were to identify subgroups with distinct morning fatigue profiles and evaluate how these subgroups differed by demographic, clinical, and symptom characteristics.

Methods
Outpatients (N = 1332) with breast, gastrointestinal, gynecological, or lung cancer completed questionnaires 6 times over 2 cycles of chemotherapy. Morning fatigue was assessed with the Lee Fatigue Scale. Latent profile analysis was used to identify distinct morning fatigue profiles.

Results
Four morning fatigue profiles (ie, very low, low, high, and very high) were identified. In the high and very high classes, all 6 morning fatigue scores were higher than the clinical cutoff score. Compared with those in the very low and low classes, patients in the very high class were younger and not married/partnered; lived alone; had higher incomes, higher comorbidity, and higher body mass index; and did not exercise regularly. Across the 4 classes, functional status and attentional function scores decreased and anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue scores increased across the 2 cycles.

Conclusion
Results provide insights into modifiable risk factors for morning fatigue. These risk factors can be used to develop more targeted interventions.

Implications for Practice
Patients in the high and very high morning fatigue classes experienced high symptom and comorbidity burdens and significant decrements in functional status. Using this information, clinicians can identify patients who are at an increased risk for higher levels of morning fatigue and prescribe interventions to improve this devastating symptom.
Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis
Authors: Garland Jack , Kesha Kilak , Vertes Dianne , Modahl Lucy , Milne David , Ruder Thomas , Stables Simon , Tse Rexson 
Published: July 2018

AbstractCerebral venous thrombosis is a rare condition which constitutes 0.5% to 2% of all types of stroke and carries a mortality of up to 20% to 50%. It leads to cerebral edema, infarction, hemorrhage and venous hypertension. Clinically the diagnosis is confirmed using enhanced computed tomography (CT) angiography which demonstrates an empty delta sign in cerebral veins, particularly in the superior sagittal sinus. However, postmortem CT (PMCT) findings on cerebral venous thrombosis have not been documented in the literature. We present a case report of a 69-year-old man who on unenhanced PMCT scan showed an empty delta sign in the cerebral veins. The empty delta sign was able to be demonstrated in unenhanced PMCT which can be explained by hyper attenuation of the dural veins at postmortem forming an internal contrast highlighting the thrombus.
Effects of long-term opioid analgesics on cognitive performance and plasma cytokine concentrations in patients with chronic low back pain: a cross-sectional pilot study
Authors: Richards Georgia C. , Lluka Lesley J. , Smith Maree T. , Haslam Catherine , Moore Brendan , O'Callaghan James , Strong Jenny 
Published: July 2018

Abstract

Introduction:
Cognitive performance and inflammation are altered in people with chronic low back pain (CLBP). Yet, the magnitude of these changes has been unclear because of the potential influence of opioid analgesics.

Objectives:
This cross-sectional pilot study aimed to explore whether patients with CLBP receiving long-term opioid analgesics differed from patients not taking opioids on measures of cognitive performance and plasma cytokine concentrations.

Methods:
Patients with CLBP who were either taking (N = 18) or not taking (N = 22) opioids daily for 3 or more months were recruited from a tertiary care private hospital and compared with healthy adults (N = 20). All groups were administered validated questionnaires to assess depression, anxiety, and stress; a cognitive test of memory, attention, and executive function; and a peripheral blood draw to measure proinflammatory (IL-1β, IL-2, IL-8, IL-12p70, TNF-α, and IFN-γ), anti-inflammatory (IL-4, IL-10, and IL-13), and pleiotropic (IL-6) cytokine concentrations. Patients also completed pain-specific questionnaires.

Results:
Patients receiving opioid analgesics performed significantly (P < 0.05) worse in attention and had significantly (P < 0.05) lower pain self-efficacy beliefs than those patients not taking opioids. Patient groups did not differ in mean pain severity or pain interference scores, tests of memory and executive function, and mean plasma cytokine concentrations, despite long-term opioid analgesics.

Conclusion:
Patients receiving long-term opioid analgesics for CLBP have minor differences when compared with patients not taking opioids. This has important clinical implications when considering long-term treatment for patients with CLBP.
Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions
Authors: Padula William V. , Black Joyce M. , Davidson Patricia M. , Kang So Yeon , Pronovost Peter J. 
Published: July 2018

Objective
Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others.
Our objective was to evaluate the time-dependent rates of HACs between 2013 and 2016 to assess the association of funding models on adverse events, particularly pressure injury.

Methods
We analyzed a retrospective observational cohort of patients hospitalized in US Academic Medical Centers observed by the Vizient CDB/RM pre-post PSI90 implementation. Changes in HAC component rates of PSI90 between 2013 and 2016 were measured longitudinally using mixed-effects negative binomial regression modeling.

Results
Regardless of whether the composite measure of patient outcomes was PSI90 or all HACs, in general, there was significant decrease after PSI90 was implemented, reflecting an association between PSI90 and CMS reimbursement policy. However, pressure injury rates increased by 29.4% (SE = 0.08; P < 0.05) during this time frame, the only HAC observed to increase related to PSI90.

Conclusions
Patient safety in hospitals will only thoroughly improve when hospitals are fully incentivized to practice prevention of all HACs rather than work around the harms that result from failed prevention efforts.
The Application of Three-Dimensional Simulation Program and Three-Dimensional Printing in Secondary Rhinoplasty
Authors: Khan Galina , Choi Yean Su , Park Eun Soo , Choi Yim Don 
Published: July 2018

Background:
In recent years, efficacy of 3-dimensional (3D) simulation, in preoperative planning of aesthetic and reconstructive surgeries and prediction of the postoperative result, has been reported in many clinical studies. Especially in rhinoplasty, it can be used not only for prediction the outcome but also for fabricating implants that will strictly match with the anatomical needs of patient.

Clinical Report:
A 30-year-old male after traffic accident visited emergency room complaining on painful swelling and contour deformity of nose. Under the diagnosis of nasal bone fracture and deviated nose, he had been admitted to our hospital. Considering his medical history of rhinoplasty, which was performed in the local aesthetic clinic 6 years ago, the authors decided to perform the operation with 3D simulation program and 3D printed implant. There were no specific complications, such as hematoma, infection, or necrosis. Patient was discharged on fourth postoperation day.

Discussion:
There is no doubt that creating an ideal dorsal aesthetic line is critically important in rhinoplasty. Therefore creating individual implants for certain patient's anatomical nasal structure is highly significant in the rhinoplasty. Although usefulness of primary rhinoplasty using patient-specific 3D implant is introduced in previous study, the authors successfully applied the patient-specific 3D implant to patient who has fracture of nasal bone and primary rhinoplasty history. It means that the patient-specific implants are stable and can be used not only in primary rhinoplasty patients but also for the patients who had primary rhinoplasty previously.
Reduction of Supraorbital Fractures via a Short Sub-Brow Incision
Authors: Hwang Kun , Joong Kim Dae 
Published: July 2018

Abstract
The authors report a short-incision supraorbital approach through an upper eyebrow skin incision that was used to treat supraorbital rim fractures in 2 patients.
With the patient in the supine position, short incision lines were designed. Their length was usually less than 1 cm (1 or 2 mm medial to the frontal nerve and lateral to the supraorbital nerve), and they were designed at the inferior margin of the eyebrow to avoid injuring the frontal, supraorbital, or supratrochlear nerve. The skin was incised and blunt dissection was performed to reach the supraorbital rim. The periosteum was incised and a cleft palate periosteal elevator was introduced below the fracture segments. Gentle forward and upward traction was applied through the elevator and a click could be heard when the segment was reduced into its anatomical position. An intraoperative skull lateral X-ray was taken and the reduction was confirmed. The skin was repaired layer by layer.
In supraorbital rim fractures, this short-incision supraorbital approach through an upper eyebrow skin incision could be applied without injuring the supraorbital nerve, instead of the bicoronal approach.
An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population
Authors: Chattha Anmol , Lee Johnson C. , Johnson Philip K. , Patel Ashit 
Published: July 2018

Abstract
Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects, <5 cm bone grafting was preferred. Delaying bone grafting does not worsen patient outcomes. Surgical treatment of ballistic facial trauma requires thorough preparation and precise planning. An algorithm that summarizes the approach to the main decision points of surgical management and reconstruction after ballistic facial trauma has been presented in this study.
Cleft Alveolus Reconstruction Using a Three-Dimensional Printed Bioresorbable Scaffold With Human Bone Marrow Cells
Authors: Ahn Geunseon , Lee Jeong-Seok , Yun Won-Soo , Shim Jin-Hyung , Lee Ui-Lyong 
Published: July 2018

Abstract
Bone tissue engineering technology based on scaffold has been applied for cleft lip and palate treatment. However, clinical applications of patient-specific three-dimensional (3D) scaffolds have rarely been performed. In this study, a clinical case using patient-specific 3D-printed bioresorbable scaffold with bone marrow stromal cells collected from iliac crest in the operating room has been introduced. At 6-month after transplantation, the bone volume of the newly regenerated bone was approximately 45% of the total defect volume. Bone mineral density of the newly regenerated bone was about 75% compared to the surrounding bone. The Hounsfield unit value was higher than that of cancellous maxillary alveolar bone and lower than that of the cortical maxillary alveolar bone. Bone-marrow-derived mesenchymal stem cells-seeded 3D-printed patient-specific polycaprolactone scaffolds offer a promising alternative for alveolar cleft reconstruction and other bony defects.