bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flavor Capsule Variants’ Performance in a “Dark Market”: Implications for Standardized Packaging
Authors: Haggart Kerri , Hoek Janet , Blank Mei-Ling 
Published: July 2018

Abstract

Background
By increasing excise taxes, eliminating tobacco marketing, and requiring standardized (plain) packaging of tobacco products, governments internationally have reduced smoking’s allure. Yet product innovations, such as flavor capsule variants (FCVs), remain unregulated and may appeal to non-smokers. We examined the growth of FCVs in a country with a progressive policy environment.

Methods
Each year, New Zealand tobacco companies must provide details of the number of cigarette sticks released for each brand and variant to the Ministry of Health. We used this information to analyze FCVs’ performance for British American Tobacco (BAT) and Philip Morris International (PMI), which account for a large proportion of New Zealand tobacco sales. We report the quantity released of each variant and share of parent brand portfolio, and examine growth patterns within the premium, everyday, and value market subsections.

Results
BAT introduced FCVs in 2012 and by 2014 offered FCVs in all market subsections; PMI introduced a Marlboro FCV in 2014. FCVs grew rapidly relative to unflavored variants and, by 2017, represented nearly 10% of BAT’s product portfolio and more than 3% of PMI’s product portfolio. By 2017, FCVs accounted for more than a third of the Dunhill sticks released, 14% of Holiday, and 17% of Pall Mall.

Conclusions
FCVs’ rapid growth may have reduced declines in the numbers of sticks released. Policy makers should disallow FCV innovations, which offer no health benefits to smokers and may instead attract non-smokers to smoking. Where timely, these regulations could be incorporated into standardized packaging policies.

Implications
FCVs have grown quickly in countries with comprehensive tobacco marketing restrictions, which suggests tobacco companies are now focusing on novel product designs to attract new smokers. Standardized packaging regulations could address both external packaging and stick design innovations, such as FCVs; alternatively, specific regulations prohibiting FCVs may be required.
Phenotypes, endotypes and biomarkers in anaphylaxis: current insights
Authors: Sala-Cunill Anna , Guilarte Mar , Cardona Victoria 
Published: July 2018

Purpose of reviewThe aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions.Recent findingsDifferent anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions. Underlying mechanisms differ and biomarkers of cells and systems involved are being identified (tryptase, IL-6, bradykinin etc.)SummaryIdentifying specific phenotypes/endotypes will allow the application of precision medicine in patients with anaphylaxis, providing insights to the most appropriate approach in each case.
ACUTE RETINAL NECROSIS ASSOCIATED WITH HERPES ZOSTER VACCINATION
Authors: Menghini Moreno , Raja Vignesh , Raiter Jeremy , Balaratnasingam Chandrakumar , Constable Ian J. 
Published: July 2018

Purpose:
To report a case of Zostavax-associated acute retinal necrosis in a patient with chronic lymphocytic leukemia.

Methods:
Case report.

Patients:
A 76-year-old white man.

Results:
Unilateral acute retinal necrosis with obliterative angiopathy developed in close proximity of a Zostavax vaccine. Treatment with valacyclovir hydrochloride (1 g orally three times a day) and intravitreal ganciclovir (4 mg/0.1 mL) was initiated on presentation. Because of continuous increase of the retinal necrosis, patient was switched to intravenous acyclovir (7.5 mg/kg body weight, adapted to reduced glomerular filtration rate) and given intravitreal foscarnet (2.4 mg/0.1 mL). Despite being on maximal antiviral therapy, the patient suffered a central retinal artery occlusion.

Discussion:
Acute retinal necrosis is a severe complication and potentially blinding disease of herpes zoster, and can occur in association with herpes zoster immunization, in particular, in immune suppressed patients.
Vision-Specific Quality of Life: Laser-Assisted in situ Keratomileusis Versus Overnight Contact Lens Wear
Authors: González-Pérez Javier , Sánchez García Ángel , Villa-Collar César 
Published: July 2018

Objectives:
To compare the visual-related quality of life in myopic subjects with different refractive treatments such as continuous wear of silicone-hydrogel contact lenses (CL), corneal refractive therapy (CRT), and laser-assisted in situ keratomileusis (LASIK).

Methods:
The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) questionnaire was administered to 96 subjects with a mean age of 30.0±7.9 years. There were 72 myopic subjects with a mean spherical equivalent of −2.74±0.98 D (−5.50 to −1.25 D). Subjects were corrected with LASIK (n=24), Paragon CRT orthokeratology lenses (n=24), and lotrafilcon A silicone-hydrogel CL under continuous wear (n=24). The NEI RQL-42 survey was used to compare differences between groups as well as with an emmetropic group (n=24).

Results:
After 1 year of treatment, significant differences were found among all groups in the subscales glare (P=0.017), symptoms (P=0.016), dependence on correction (P<0.001), and worry (P<0.001). The mean difference compared with emmetropes were −5.5% (P=0.063) for LASIK patients, −2.0% (P=0.212) for orthokeratology subjects, and +1.6% (P=0.934) for the silicone-hydrogel CL group.

Conclusions:
Myopic subjects analyzed in this study reported better vision-related quality of life when they were corrected with continuous wear silicone-hydrogel lenses. The average score reached by CRT was similar to emmetropes, which showed the main disadvantage in worry subscale. The patients who underwent LASIK had the lowest valuation, highlighting the decreases in scores of diurnal fluctuations, glare, and especially in expectations and worry subscales, due to the first and second subscales, but especially to the false expectations created about treatment.
Epstein-Barr Virus–Associated Genital Ulcers
Authors: Dylewski Joe 
Published: July 2018

Abstract
Acute Epstein-Barr virus (EBV) infection is most often associated with a clinical presentation of pharyngitis, fever, lymphadenopathy, and fatigue. There has been a recent recognition of the association of EBV with genital ulcers, predominately in females. Over 100 years ago, Lipschütz (Arch Dermatol Syph (Berlin). 1913;114:363–395) described a series of females with severe genital ulcers, which had 3 suspected causes: herpes simplex virus infection, Behçet syndrome, and what he termed ulcus vulvae acutum (UVA). I wish to present the case of a young female who presented with UVA in the context of an acute EBV infection. The possible pathogenic role of EBV in UVA will be reviewed.
Optimizing the Approach to Patients With Pleural Effusion and Radiologic Findings Suspect for Cancer
Authors: Alzghoul Bashar , Innabi Ayoub , Subramany Swathi , Boye Bradley , Chatterjee Kshitij , Koppurapu Vikas S. , Bartter Thaddeus , Meena Nikhil K. 
Published: July 2018

Background:
When patients present with pleural effusion and structural abnormalities consistent with malignancy on imaging, the traditional approach has been to perform a thoracentesis and await the results before proceeding to more invasive diagnostic procedures. The objective of this study was to evaluate whether concurrent thoracentesis and tissue biopsy is superior to sequential sampling.

Methods:
Retrospective chart review was performed for patients who had a pleural cytology from May 2014 until January 2017. Patients without parenchymal, pleural, or mediastinal abnormalities and those with a prior primary thoracic malignancy were excluded. Patients with an effusion and additional suspect findings were grouped based upon whether initial approach was concurrent versus sequential. The following outcomes were documented: lag time to diagnosis from thoracentesis, lag time to hematology/oncology (HONC) service consult, time to molecular study results, lag time to therapy, and time to death.

Results:
Of 565 cases, 45 met criteria, 28 (62%) having undergone concurrent and 17 (38%) sequential sampling. The median lag time to biopsy for the concurrent group, 3 days, was significantly shorter than the 9-day lag time for the sequential group (P=0.006). Five patients in the sequential group and one in the concurrent group were lost to follow-up. Patients in the concurrent group had earlier diagnosis and oncology visits (2 d, 7 d) than those in the sequential group (6.5 d, 16 d) (P<0.001 and <0.039, respectively). Time from diagnosis to death did not differ for the 2 groups.

Conclusion:
For patients presenting with pleural effusion accompanied by additional suspect findings, concurrent tissue sampling, and thoracentesis may both reduce loss to follow up and accelerate care.
Improvement of clinical management and outcome in hepatocellular carcinoma nowadays compared with historical cohorts
Authors: Schellhaas Barbara , Strobel Deike , Stumpf Miriam , Ganslmayer Marion , Pfeifer Lukas , Goertz Ruediger S. , Neurath Markus F. , Zopf Steffen 
Published: July 2018

Objectives
Therapeutic approaches in the treatment of hepatocellular carcinoma (HCC) depend on tumour stage, liver function and patient comorbidities. The aim of this study was to investigate the influence of tumour stage and therapeutic approach on overall survival in HCC.

Materials and methods
Two hundred and fourteen patients with HCC diagnosed between December 2012 and May 2017 were assessed retrospectively for tumour stage [Barcelona Clinic Liver Cancer (BCLC)], liver function (Child–Pugh score), therapeutic approach and outcome (mean survival time). The results were compared to two historical cohorts from our centre diagnosed between 1999 and 2013 and 1988 and 1999, respectively.

Results
Nowadays, HCC is diagnosed in earlier tumour stages and with better liver function compared with the historical cohorts (P<0.001). Survival times depend on both BCLC stages and liver function for all therapeutic approaches. The 1-year survival rate in the present cohort was 79.4% compared with 58.6% in the historical cohort.
In terms of BCLC stages, therapeutic approaches followed HCC guidelines in 43.9% of cases.
Whereas the percentage of patients receiving resection or ablation did not change between the historical and the present cohort, there was a tendency towards a decrease in transarterial chemoembolization, with a shift towards selective internal radiotherapy, accompanied by an increase in systemic therapy with sorafenib.
Also, the percentage of patients receiving single instead of multiple therapies was significantly higher in the present cohort compared with the historical cohort (P=0.016). In 62/83 patients receiving single therapy (64.7%), tumour remission was maintained during the period of follow-up.

Conclusion
HCC is increasingly being diagnosed in earlier stages, so that single therapy is often sufficient. Besides BCLC stages, therapy in HCC must consider liver function, tumour location, local expertise and patients’ comorbidities and preferences. Further research is needed to evaluate the benefit of early multimodal concepts. Therapeutic approaches in HCC remain individual decisions.
Persistence of Muscle‐bone Deficits Following Anti‐tumour Necrosis Factor Therapy in Adolescents With Crohn Disease
Authors: Altowati Mabrouka M.A. , Shepherd Sheila , McMillan Martin , McGrogan Paraic , Russell Richard , Ahmed S. Faisal , Wong Sze Choong 
Published: July 2018

ABSTRACTObjectives:The aim of the study is to assess change in the muscle‐bone unit in adolescents with Crohn disease (CD) on anti‐tumour necrosis factor (anti‐TNFα).Methods:Prospective study following anti‐TNFα in 19 adolescents with CD with a median age (range) of 15.1 years (11.2, 17.2). At baseline, 6 and 12 months, subjects had a biochemical assessment of insulin growth factor axis, bone turnover and muscle‐bone health by dual energy absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and dynamic isometry.Results:Significant clinical improvement in disease activity was observed by 2 weeks (P = 0.004 vs baseline) and maintained at 12 months (P = 0.038 vs baseline). Median bone specific alkaline phosphatase standard deviation score (SDS) increased from −1.7 (−3.6 to −1.0) to −1.2 (−3.6 to −0.5) by 6 weeks (P = 0.01). At baseline, DXA total body and lumbar spine bone mineral density (BMD) SDS was −0.9 (−2.3 to 0.5) and −1.1 (−2.9 to 0.4), respectively. At baseline, pQCT trabecular BMD SDS at 4% tibia and muscle cross‐sectional area SDS at 66% radius was −1.6 (−3.2 to 1.1) and −2.4 (−4.3 to −0.3), respectively. At baseline, maximal isometric grip force (MIGF) of the non‐dominant hand adjusted for height was −1.5 (−4.5 to 0.49). All these deficits in muscle‐bone persisted at 6 and 12 months.Conclusions:Despite improvement in disease and osteoblast activity, bone and muscle deficits, as assessed by DXA, pQCT, and grip strength in adolescents with CD did not improve following twelve months of anti‐TNFα.
Relationship of Initial Pancreatic Enzyme Replacement Therapy Dose With Weight Gain in Infants With Cystic Fibrosis
Authors: Schechter Michael S. , Michel Suzanne , Liu Shufang , Seo B. Woun , Kapoor Mudra , Khurmi Rupal , Haupt Mark 
Published: July 2018

ABSTRACTObjective:The aim of the study is to test the hypothesis of a positive relationship between initial dose of pancreatic enzyme replacement therapy (PERT) in infants with cystic fibrosis (CF) and optimal weight gain over the first 2 years of life.Methods:Using the CF Foundation Patient Registry, we identified 502 children born in 2010 and used multivariable models to compare as our primary analysis their 2‐year changes in weight‐for‐age z score (WAZ) and as our secondary analysis weight‐for‐length percentile (W/L%) by initial PERT dose. We focused on initial dose without reference to subsequent changes in treatment to avoid confounding by indication (severity).Results:Initial PERT dose demonstrated a linear relationship to change in WAZ and W/L% at age 2 years. An initial dose of >1500 lipase units/kg/largest meal resulted in a higher likelihood of attaining WAZ at 2 years at or above the birth WAZ (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.22–2.86) and at the top quartile for improvement over 2 years in WAZ (aOR 1.90, 95% CI 1.19–3.05). There was no correlation between initial PERT dose and weight at initial PERT encounter (P = 0.35). Findings were similar for W/L% and when the cohort was restricted to infants who began PERT in the first 3 months of life.Conclusions:Infants receiving higher initial PERT dose demonstrate better weight‐related outcomes, as reflected by attainment of favorable changes in WAZ and W/L%, at age 2 years.
In Screening for Celiac Disease, Deamidated Gliadin Rarely Predicts Disease When Tissue Transglutaminase Is Normal
Authors: Gould Michelle J. , Brill Herbert , Marcon Margaret A. , Munn Natalie J. , Walsh Catharine M. 
Published: July 2018

ABSTRACTObjective:While tissue transglutaminase (tTG) antibodies are the most established serological test for celiac disease, newer deamidated gliadin peptide (DGP) screening tests are increasingly being completed. No pediatric study has systematically assessed the incidence of celiac disease in patients with an isolated positive DGP result. We sought to determine the positive predictive value of DGP serology for biopsy‐confirmed celiac disease in pediatric patients with elevated DGP and normal tTG, to help guide clinicians’ decision making when screening for this common condition and avoid unnecessary invasive follow‐up diagnostic testing.Methods:A multicenter retrospective review of children, from birth to age 18, with isolated DGP immunoglobulin G (IgG) positive serology referred to 3 Canadian centers was completed. The positive predictive value of an isolated elevated DGP result was calculated.Results:Forty patients with DGP positive, tTG negative serology underwent endoscopy with duodenal biopsy. Of these, only 1 patient had biopsy‐confirmed celiac disease. This patient was IgA deficient. This yields a positive predictive value of 2.5% (95% confidence interval 0.1%–14.7%) for isolated DGP IgG positive serology.Conclusions:In isolation, DGP positive serology has a poor positive predictive value for celiac disease in children, especially in IgA sufficient individuals. Our findings suggest that DGP IgG testing should not be completed as part of the initial screening for celiac disease in the pediatric population as it does not effectively differentiate between individuals with and without the disease. Further research is needed to clarify to role of DGP IgG in children under the age of 2 and those with IgA deficiency.
Malignant Melanoma: Diagnostic and Management Update
Authors: Knackstedt Thomas , Knackstedt Rebecca W. , Couto Rafael , Gastman Brian 
Published: July 2018

Learning Objectives:
After studying this article, the participant should be able to: 1. Summarize the changes to the American Joint Committee on Cancer Eighth Edition Melanoma Staging System. 2. List advances in genetic, molecular, and histopathologic melanoma diagnosis and prognostication. 3. Recommend sentinel lymph node biopsy and appropriate surgical margins based on individualized patient needs. 4. Recognize the currently available treatments for in-transit metastasis and advanced melanoma. 5. Describe current and future therapies for melanoma with distant visceral or brain metastases.

Summary:
Strides in melanoma surveillance, detection, and treatment continue to be made. The American Joint Committee on Cancer Eighth Edition Cancer Staging System has improved risk stratification of patients, introduced new staging categories, and resulted in stage migration of patients with improved outcomes. This review summarizes melanoma advances of the recent years with an emphasis on the surgical advances, including techniques and utility of sentinel node biopsy, controversies in melanoma margin selection, and the survival impact of time-to-treatment metrics. Once a disease manageable only with surgery, a therapeutic paradigm shift has given a more promising outlook to melanoma patients at any stage. Indeed, a myriad of novel, survival-improving immunotherapies have been introduced for metastatic melanoma and more recently in the high-risk adjuvant setting.
Improving Safety after Abdominoplasty: A Retrospective Review of 1128 Cases
Authors: Dutot Marie-Charlotte , Serror Kevin , Al Ameri Omar , Chaouat Marc , Mimoun Maurice , Boccara David 
Published: July 2018

Background:
Over the course of several decades, abdominoplasty has undergone numerous improvements, thereby improving patient safety. The choice of the site of the incision and the extent of the detachment directly influence the occurrence of the main complications.

Methods:
A retrospective study was carried out involving 1128 patients who underwent abdominoplasty between January of 1990 and June of 2014. The main postoperative complications were analyzed.

Results:
The hematoma rate was 5.7 percent; in addition, infections (4.5 percent), cutaneous necrosis (2.7 percent), seromas (2.7 percent), disunions (1.3 percent), and deep venous thrombosis (0.2 percent) were observed. Three main risk factors for complications were highlighted: age older than 40 years, obesity, and smoking. The authors noted a significant variation in the rate of complications depending on the technique used, with a substantial rate of necrosis in case of inverted-T abdominoplasty. Liposuction was not a source of complications, regardless of the patient’s background or the type of intervention.

Conclusions:
Abdominoplasty is currently a reliable technique that allows the abdomen to be repaired and quality of life to be restored. Other means remain to be explored to improve the overall treatment and to move toward a maximal reduction of the risks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Medicare for the Plastic and Reconstructive Surgeon
Authors: Firouzbakht Peter K. , Israel Jacqueline S. , Chen Jenny T. , Rao Venkat K. 
Published: July 2018

Summary:
Medicare, a federally funded insurance program in the United States, is a complex program about which many physicians may not receive formal training or education. Plastic surgeons, residents, and advanced practitioners may benefit from at least a basic understanding of Medicare, its components, reimbursement methods, and upcoming health care trends. Medicare consists of Parts A through D, each responsible for a different form of insurance coverage. Medicare pays hospitals, physicians, and graduate medical education. Since the introduction of Medicare, several reforms and programs have been introduced, particularly in recent years with the implementation of the Affordable Care Act. Many of these changes are moving reimbursement systems away from the traditional fee-for-service model toward quality-of-care programs. The aim of this review is to provide a brief history of Medicare, explain the basics of coverage and relevant reforms, and describe how federal insurance programs relate to plastic surgery both at academic institutions and in a community practice environment.
Gluteal Ligamentous Anatomy and Its Implication in Safe Buttock Augmentation
Authors: Ghavami Ashkan , Villanueva Nathaniel L. , Amirlak Bardia 
Published: July 2018

Background:
The number of buttock augmentations with fat transfer is steadily increasing, but a number of fatalities caused as a direct result of gluteal fat grafting have been reported. The technical details relating to cannula size, injection angle or trajectory, and plane of injection are critical for avoiding morbidity and mortality. However, the ligamentous anatomy has not been thoroughly explored, particularly how the ligaments are encountered in the clinical setting of fat transfer by means of cannulas.

Methods:
The gluteal regions of five fresh cadavers were dissected, for a total of 10 hemidissections. All pertinent cutaneous ligaments in the region were identified. In addition, cannulas were used to simulate typical variations in injection planes.

Results:
The osseocutaneous and fasciocutaneous ligaments of the buttocks were identified.

Conclusions:
The authors describe important ligamentous structures consistently found in the region in cadaveric dissections and discuss the implications while safely performing gluteal augmentation. The anatomical features, boundaries, and soft-tissue attachment points may play a role in cannula-directed fat injection misguidance. The ligaments, when not released, can lead to undesired deep injection and therefore fat lobule migration into the venous system. The density, danger zones, and soft-tissue attachments must be clarified further as we continue to offer our patients improved buttock contour with a higher safety profile.