bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship Gender Equality and Couples' Uptake of Oral Human Immunodeficiency Virus Self-Testing Kits Delivered by Pregnant Women in Kenya
Authors: Vrana-Diaz Caroline J. , Korte Jeffrey E. , Gebregziabher Mulugeta , Richey Lauren , Selassie Anbesaw , Sweat Michael , Gichangi Anthony 
Published: July 2019

BackgroundHigher gender equality is associated with many human immunodeficiency virus (HIV) preventive behaviors, including HIV testing. HIV self-testing is a relatively new testing technology that could assist with HIV prevention. However, there are no studies examining gender equality and HIV self-testing. We examined the associations between gender equality and couples' uptake of HIV self-testing among heterosexual couples expecting a child in central Kenya.MethodsThis analysis used data from a HIV self-testing randomized intervention trial among pregnant women attending antenatal care and their male partners. The primary exposures were gender equality (measured by the male partner's attitudes toward intimate partner violence, and the woman's report on her household decision making power), and the primary outcome was couples' uptake of HIV self-testing. Generalized linear mixed models framework was used to account for site-level clustering.ResultsIn comparison to male partners reporting high acceptance of intimate partner violence, couples with male partners reporting medium acceptance (odds ratio, 2.36; 95% confidence interval, 0.99–5.63) or low acceptance (odds ratio, 2.50; 95% confidence interval, 1.20–5.21) were significantly more likely to use HIV self-testing. Gender equality measured by decision making power was not associated with couples' uptake of HIV self-testing.ConclusionsThis study is the first of its kind to examine the association between gender equality and couples' HIV self-testing. This holds important implications for HIV self-testing as we strive to achieve the United Nations Programme on HIV/acquired immune deficiency syndrome goal that 90% of individuals living with HIV should know their status.
Prevalence and Correlates of Trichomonas vaginalis Infection Using the OSOM Rapid Point-of-Care Test Among Women Attending New York City Sexual Health Clinics, May–July 2016
Authors: Fallon Susan A. , Pathela Preeti , Mikati Tarek 
Published: July 2019

Abstract
Using electronic medical record data and OSOM Trichomonas Rapid Tests, Trichomonas vaginalis prevalence was 9.3% among women attending New York City sexual health clinics in 2016. Positivity was associated with black race (adjusted odds ratios 3.73; 95% confidence interval, 1.9–7.1) and vaginal pH of 4.5 or greater (adjusted odds ratios, 1.9; 95% CI, 1.2–3.3).
Repetitive Transcranial Magnetic Stimulation on Motor Recovery for Patients With Stroke
Authors: He Yanjin , Li Kaiting , Chen Qing , Yin Jingyang , Bai Dingqun 
Published: July 2019

Objective
A systematic review and meta-analysis were conducted to determine the efficacy of repetitive transcranial magnetic stimulation in recovering motor function in patients with stroke.

Design
A comprehensive literature search was performed to identify studies published before September 20, 2018. Electronic databases were searched. Standard mean differences and 95% confidence intervals were used to evaluate the effects of repetitive transcranial magnetic stimulation. The stability and sensitivity of the results and sources of heterogeneity were also analyzed. The Cochrane Risk of Bias Tool was used to determine the quality of the studies.

Result
Twenty randomized controlled trials (N = 841 patients) were included. The results showed that repetitive transcranial magnetic stimulation is beneficial to patients with poststroke hemiplegia, as demonstrated by the following four scales: the Fugl-Meyer Assessment (standard mean difference = 0.635, 95% confidence interval = 0.421 to 0.848); grip strength (standard mean difference = 1.147, 95% confidence interval = 0.761 to 1.534); Barthel Index (Standard mean difference = 0.580, 95% confidence interval = 0.377 to 0.783); and National Institutes of Health Stroke Scale (standard mean difference = −0.555, 95% confidence interval = −0.813 to −0.298). Few adverse events were observed.

Conclusions
The analysis showed that low-frequency repetitive transcranial magnetic stimulation has a positive effect on grip strength and lower limb function as assessed by FMA.
A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors After Curative-Intent Treatment
Authors: Ha Duc , Kerr Jacqueline , Ries Andrew L. , Fuster Mark M. , Lippman Scott M. , Murphy James D. 
Published: July 2019

Objective
The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors.

Design
We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I–IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses.

Results
The base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold.

Conclusions
A simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.
Comparison of Surgical Encounter Direct Costs for Three Methods of Cubital Tunnel Decompression
Authors: Kazmers Nikolas H. , Lazaris Evangelia L. , Allen Chelsea M. , Presson Angela P. , Tyser Andrew R. 
Published: July 2019

Background:
In situ decompression, subcutaneous transposition, and submuscular transposition for cubital tunnel syndrome have historically yielded similar outcomes. The authors’ null hypothesis is that no differences exist in surgical encounter total direct costs for in situ decompression, subcutaneous transposition, and submuscular transposition.

Methods:
Adult patients treated surgically for cubital tunnel syndrome by four fellowship-trained hand surgeons between August of 2011 and December of 2016 were identified by CPT code (64718) at their tertiary academic institution. Patients with prior elbow surgery or fracture/dislocation and those undergoing revision or additional simultaneous procedures were excluded. Using their institution’s information technology value tools, the authors extracted prospectively collected surgical encounter total direct costs data for each surgical encounter. Costs were compared between groups and modeled using univariate and multivariable gamma regression.

Results:
In situ decompression, subcutaneous transposition, and submuscular transposition were performed on 45, 62, and 14 unique surgical encounters, respectively, with mean surgical times of 28.0, 46.5, and 50.0 minutes, respectively. Costs differed significantly between surgical methods. Surgical method and provider significantly affected surgical encounter total direct costs in the univariate model. Multivariable modeling demonstrated that subcutaneous transposition was 1.18-fold more costly than in situ decompression and submuscular transposition was 1.55-fold more costly than in situ decompression while controlling for age, sex, and provider.

Conclusions:
Surgical costs differed significantly between in situ decompression, subcutaneous transposition, and submuscular transposition. Given historically similar outcomes reported for these techniques, cost differences should be considered in addition to clinical factors to inform surgical decision-making for cubital tunnel syndrome patients.
Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis
Authors: Cansancao Alvaro Luiz , Condé-Green Alexandra , David Joshua A. , Vidigal Rafael A. 
Published: July 2019

Summary:
In recent years, gluteal fat augmentation has exhibited some of the most significant growth among all plastic surgery procedures. However, as the popularity of and media attention to gluteal fat augmentation continue to rise, reports of fatalities, largely attributed to fat embolism, have raised valid concerns. Many plastic surgeons inject fat in the intramuscular plane and claim better graft take in the muscles and the possibility of injecting more volume in the gluteal region. Because of the large caliber of vessels, subcutaneous fat augmentation has been a preference of many. However, the long-term outcome of fat injected into the subcutaneous layer has been questionable, and there is a lack of prospective quantitative studies of subcutaneous-only fat grafting. Therefore, the authors evaluated the long-term maintenance of gluteal adipose thickness when fat was injected only subcutaneously. Fifty consecutive female patients were evaluated in this prospective clinical study. All patients underwent gluteal fat augmentation in the subcutaneous plane only. Ultrasound analysis of the adipose tissue thickness of the gluteal region was performed preoperatively, immediately postoperatively, and at 12 months postoperatively. Immediate postoperative measurements revealed an average increase in gluteal subcutaneous layer thickness of 56.51 percent (range, 39.5 to 108.6 percent) (p < 0.0001). At 12 months postoperatively, the gluteal adipose tissue thickness decreased by an average of 18.16 percent (range, 6.8 to 24.8 percent) (p < 0.0001). Subcutaneous-only gluteal fat augmentation is shown to be as effective as previous studies reporting intramuscular fat injection with regard to long-term fat retention in the buttocks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Making Sense of Stem Cells and Fat Grafting in Plastic Surgery: The Hype, Evidence, and Evolving U.S. Food and Drug Administration Regulations
Authors: Rohrich Rod J. , Wan Dinah 
Published: July 2019

Summary:
Autologous fat grafting and adipose-derived stem cells are two distinct entities with two different risk profiles, and should be regulated as such. Autologous fat grafting prepared with the additional step of stromal vascular fraction isolation is considered a form of “stem cell therapy” given the high concentration of stem cells found in stromal vascular fraction. Much ambiguity existed in the distinction between autologous fat grafting and stromal vascular fraction initially, in terms of both their biological properties and how they should be regulated. The market has capitalized on this in the past decade to sell unproven “stem cell” therapies to unknowing consumers while exploiting the regulatory liberties of traditional fat grafting. This led to a Draft Guidance from the U.S. Food and Drug Administration in 2014 proposing stricter regulations on fat grafting in general, which in turn elicited a response from plastic surgeons, who have safely used autologous fat grafting in the clinical setting for over a century. After a series of discussions, the U.S. Food and Drug Administration released its Final Guidance in November of 2017, which established clear distinctions between autologous fat grafting and stromal vascular fraction and their separate regulations. By educating ourselves on the U.S. Food and Drug Administration’s final stance on fat grafting and stem cell therapy, we can learn how to navigate the regulatory waters for the two entities and implement their clinical use in a responsible and informed manner.
Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Patients with Dupuytren’s Disease
Authors: Roy Mélissa , Okrainec Karen , Novak Christine B. , von Schroeder Herbert P. , Urbach David R. , McCabe Steven J. 
Published: July 2019

Background:
Health literacy represents the degree to which patients can understand and act on health information. The relevance of health literacy to health care delivery, outcomes, and overall surgical care is unambiguous. This study aimed (1) to determine the prevalence of limited health literacy in patients diagnosed with Dupuytren’s contracture and (2) to identify independent predictors of limited health literacy.

Methods:
This cross-sectional study included patients with Dupuytren’s disease and with self-reported English fluency. The Newest Vital Sign, a rapid, validated, and reliable screening tool, was selected to measure health literacy. An exploratory multivariable logistic regression model was used to identify possible predictors of limited health literacy.

Results:
A total of 185 patients met eligibility criteria and were included. From those, 82 (44 percent) were found to have limited health literacy, defined as a score of 3 or less on the Newest Vital Sign. The domain of prose literacy was most highly scored compared to numeracy and document literacy. Lower household income was associated with a 4.7-fold increase in the odds of having limited health literacy. Being an immigrant also increased the odds of having limited health literacy by a factor of 3.6. Sensitivity analyses and subgroup analyses (based on education, maternal language, and immigration status) corroborated these independent predictor findings.

Conclusions:
Limited health literacy is common among patients with Dupuytren’s contracture. System level changes are necessary such as the access and integration to clinical care of universal measures of support to promote productive patient-surgeon interactions.
Effective Application of Mixed Reality Device HoloLens: Simple Manual Alignment of Surgical Field and Holograms
Authors: Mitsuno Daisuke , Ueda Koichi , Hirota Yuka , Ogino Mariko 
Published: July 2019

Summary:
The technology used to add information to a real visual field is defined as augmented reality technology. Augmented reality technology that can interactively manipulate displayed information is called mixed reality technology. HoloLens from Microsoft, which is a head-mounted mixed reality device released in 2016, can display a precise three-dimensional model stably on the real visual field as hologram. If it is possible to accurately superimpose the position/direction of the hologram in the surgical field, surgical navigation-like use can be expected. However, in HoloLens, there was no such function. The authors devised a method that can align the surgical field and holograms precisely within a short time using a simple manual operation. The mechanism is to match the three points on the hologram to the corresponding marking points of the body surface. By making it possible to arbitrarily select any of the three points as a pivot/axis of the rotational movement of the hologram, alignment by manual operation becomes very easy. The alignment between the surgical field and the hologram was good and thus contributed to intraoperative objective judgment. By using the method of this study, the clinical usefulness of the mixed reality device HoloLens will be expanded.
The Use of Botulinum Toxin Type A in the Healing of Thyroidectomy Wounds: A Randomized, Prospective, Placebo-Controlled Study
Authors: Phillips Timothy J. , Fung Elaine , Rigby Matthew H. , Burke Emily , Hart Robert D. , Trites Jonathan R. B. , Gassner Holger G. , Taylor S. Mark 
Published: July 2019

Background:
Recent research has indicated that botulinum toxin type A may have an inhibitory effect on the formation of fibroblasts and thus possibly decreases the severity of scar formation. Therefore, a trial was designed to assess the effects of botulinum toxin type A on scar formation after thyroid surgery.

Methods:
A double-blind, randomized, controlled trial was designed. All patients underwent a preoperative survey to assess scar history. All patients underwent a total thyroidectomy, hemithyroidectomy, or parathyroidectomy through a standardized incision. At the conclusion of the case, one half of the incision was injected with botulinum toxin type A, and the other half was injected with saline (placebo). The scars were then evaluated at 4 weeks, 6 months, and 1 year postoperatively using subjective scar analysis scales.

Results:
A total of 40 patients were enrolled. There was no significant difference in scarring at any of the time points between the botulinum toxin type A–treated and placebo sides of the incision. A subgroup analysis was performed that examined the effects of botulinum toxin type A on those with a severe scar history. This demonstrated a significant decrease in scarring at 6 months postoperatively on the botulinum toxin type A–treated side.

Conclusions:
This study indicates that botulinum toxin type A administration immediately after surgical closure of a thyroid incision does not demonstrate a difference in scar outcomes compared with the control side. However, there was less scarring in subjects who had a severe scar history. This study found opposite results to a similarly designed study. Further study is required to determine the optimal use of botulinum toxin type A for wound healing.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Injectable Allograft Adipose Matrix Supports Adipogenic Tissue Remodeling in the Nude Mouse and Human
Authors: Kokai Lauren E. , Schilling Benjamin K. , Chnari Evangelia , Huang Yen-Chen , Imming Emily A. , Karunamurthy Arivarasan , Khouri Roger K. , D’Amico Richard A. , Coleman Sydney R. , Marra Kacey G. , Rubin J. Peter 
Published: July 2019

Background:
Adipose tissue reaches cellular stasis after puberty, leaving adipocytes unable to significantly expand or renew under normal physiologic conditions. This is problematic in progressive lipodystrophies, in instances of scarring, and in soft-tissue damage resulting from lumpectomy and traumatic deformities, because adipose tissue will not self-renew once damaged. This yields significant clinical necessity for an off-the-shelf de novo soft-tissue replacement mechanism.

Methods:
A process comprising separate steps of removing lipid and cellular materials from adipose tissue has been developed, creating an ambient temperature-stable allograft adipose matrix. Growth factors and matrix proteins relevant to angiogenesis and adipogenesis were identified by enzyme-linked immunosorbent assay and immunohistochemistry, and subcutaneous soft-tissue integration of the allograft adipose matrix was investigated in vivo in both the athymic mouse and the dorsum of the human wrist.

Results:
Allograft adipose matrix maintained structural components and endogenous growth factors. In vitro, adipose-derived stem cells cultured on allograft adipose matrix underwent adipogenesis in the absence of media-based cues. In vivo, animal modeling showed vasculature formation followed by perilipin A–positive tissue segments. Allograft adipose matrix maintained soft-tissue volume in the dorsal wrist in a 4-month investigation with no severe adverse events, becoming palpably consistent with subcutaneous adipose.

Conclusions:
Subcutaneous implantation of allograft adipose matrix laden with retained angiogenic and adipogenic factors served as an inductive scaffold for sustaining adipogenesis. Tissue incorporation assessed histologically from both the subcutaneous injection site of the athymic nude mouse over 6 months and human dorsal wrist presented adipocyte morphology residing within the injected scaffold.
Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty: A 93-Case Experience
Authors: D’Arpa Salvatore , Claes Karel , Lumen Nicholas , Oieni Sebastiano , Hoebeke Piet , Monstrey Stan 
Published: July 2019

Background:
Urethral reconstruction in anterolateral thigh flap phalloplasty cannot always be accomplished with one flap, and the ideal technique has not been established yet. In this article, the authors’ experience with urethral reconstruction in 93 anterolateral thigh flap phalloplasties is reported.

Methods:
Ninety-three anterolateral thigh phalloplasties performed over 13 years at a single center were retrospectively reviewed to evaluate outcomes of the different urethral reconstruction techniques used: anterolateral thigh alone without urethral reconstruction (n = 7), tube-in-tube anterolateral thigh flap (n = 5), prelaminated anterolateral thigh flap with a skin graft (n = 8), anterolateral thigh flap combined with a free radial forearm flap (n = 29), anterolateral thigh flap combined with a pedicled superficial circumflex iliac artery perforator flap (n = 38), and anterolateral thigh flap combined with a skin flap from a previous phalloplasty (n = 6). Seventy-nine phalloplasties were performed for female-to-male sex reassignment surgery. The others were performed in male patients with severe penile insufficiency.

Results:
Urethral complication rates (fistulas and strictures) were as follows: tube-in-tube anterolateral thigh flap, 20 percent; prelaminated anterolateral thigh flap, 87.5 percent; free radial forearm flap urethra, 37.9 percent; superficial circumflex iliac artery perforator urethral reconstruction, 26.3 percent; and skin flap from previous phalloplasty, 16.7 percent.

Conclusions:
When tube-in-tube urethra reconstruction is not possible (94.2 percent of cases), a skin flap such as the superficial circumflex iliac artery perforator flap or the radial forearm flap is used for urethral reconstruction in anterolateral thigh phalloplasties. Flap prelamination is a second choice that gives high stricture rates. If a penis is present, its skin should be used for urethral reconstruction and covered with an anterolateral thigh flap. With these techniques, 91.86 percent of patients are eventually able to void while standing.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Elegance in Upper Lip Reconstruction
Authors: Salibian Ara A. , Zide Barry M. 
Published: July 2019

Summary:
Restoration of the upper lip provides a reconstructive challenge because of its anatomical and aesthetic requirements. This article provides a “where is it on the lip” approach to reconstruct small to subtotal defects of the upper lip that are feasible to perform in the office setting. Emphasis is placed on adherence to core principles, attention to macroaesthetic and microaesthetic landmarks, and technical refinements of well-established reconstructive techniques. These tenets include algorithms for central and lateral defects, precise use of the Abbe flap, use of local tissue rearrangement and skin grafts, and appropriate management of scars. A strong understanding of the anatomical and aesthetic nuances of the upper lip will allow for enhancement of conventional reconstructive procedures to optimize functional and aesthetic outcomes.