bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevations in High-Sensitive Cardiac Troponin T and N-Terminal Prohormone Brain Natriuretic Peptide Levels in the Serum Can Predict the Development of Anthracycline-Induced Cardiomyopathy
Authors: Bisoc Alina , Ciurescu Daniel , Rădoi Mariana , Tântu Monica M. , Rogozea Liliana , Sweidan Alexander J. , Bota Daniela A. 
Published: January 2019

Background:
Anthracyclines remain the cornerstone of the treatment in many cancers including lymphomas, leukemia and sarcomas, and breast cancer. The cardiomyopathy that develops from anthracyclines can lead to heart failure and decreased survival. Multiple mechanisms are involved in the pathophysiology of anthracycline-induced heart failure.

Study Question:
We hypothesize that anthracycline-induced cardiac (AIC) pathology can be monitored using a panel of blood biomarkers including high-sensitive cardiac troponin T (hs-cTnT) for myocyte necrosis and N-terminal prohormone brain natriuretic peptide (NT-proBNP) for parietal stress.

Study Design:
A prospective, institutionally approved study recruited all patients with cancer scheduled to start anthracycline chemotherapy in the Transylvania University cancer clinics.

Measures and Outcomes:
Transthoracic 2D echocardiography and the measurements of NT-proBNP and hs-cTnT plasma levels were performed at the beginning of the study and 3 months and 6 months after anthracycline treatment initiation.

Results:
The plasma levels of hs-cTnT at 3 months (rho = 0.439, P = 0.0001) and 6 months (rho = 0.490, P = 0.0001) are correlated with AIC occurrence. For a cutoff value of hs-cTnT at 3 months > 0.008 ng/mL, we obtained 66.7% sensitivity and 67.9% specificity for developing AIC at 6 months, with a 54.5% positive predictive value and a 87.8% negative predictive value. The NT-proBNP serum levels at 3 months (rho = 0.495, P = 0.0001) and 6 months (rho = 0.638, P = 0.0001) are correlated with an AIC diagnosis at 6 months. For a cutoff value of NT-proBNP at 3 months >118.5 pg/mL, we obtained 80% sensitivity and 79.2% specificity for evolution to AIC at 6 months, with 52.2% positive predictive value and 93.3% negative predictive value.

Conclusions:
In anthracycline-treated cancer patients, the increase in plasma levels of NT-proBNP and of hs-cTnT can predict the development of anthracycline-induced cardiomyopathy. Early identification of at-risk patients will potentially allow for targeted dose reductions and will diminish the number of patients developing cardiac pathology.
Subclinical coronary atherosclerosis and cardiovascular risk stratification in heterozygous familial hypercholesterolemia patients undergoing statin treatment
Authors: Miname Marcio H. , Bittencourt Marcio S. , Nasir Khurram , Santos Raul D. 
Published: January 2019

Purpose of review
To discuss the heterogeneity of atherosclerotic cardiovascular disease (ASCVD) risk in heterozygous familial hypercholesterolemia and evidence and limitations of clinical risk scores and subclinical coronary atherosclerosis (SCA) imaging to evaluate risk.

Recent findings
Risk evaluation in contemporary familial hypercholesterolemia cohorts needs to consider the cause of the familial hypercholesterolemia phenotype, for example the presence of autosomal molecular defects that impart a greater ASCVD risk than in polygenic hypercholesterolemia, prospective follow-up and the impact of statin treatment. As atherosclerosis is multifactorial, clinical scores like the Montreal familial hypercholesterolemia score and SAFEHEART risk equation have been proposed to stratify ASCVD in statin-treated, molecularly defined familial hypercholesterolemia individuals. However, these scores need further validation. SCA distribution in familial hypercholesterolemia individuals undergoing conventional lipid-lowering treatment is heterogeneous, with 45–50% of individuals not presenting any coronary artery calcification (CAC). One study suggests that the absence of CAC associates with no ASCVD events in asymptomatic familial hypercholesterolemia individuals undergoing statin therapy despite elevated residual LDL-cholesterol levels. In contrast, the presence of CAC was independently associated with ASCVD events.

Summary
ASCVD risk is heterogeneous in statin-treated familial hypercholesterolemia individuals. Further studies are necessary to determine how risk stratification, especially with SCA detection, impacts on prescription of proprotein convertase subtilisin kexin type 9 inhibitors within a cost-constrained environment.
Cost-Effectiveness of Accelerated HIV Response Scenarios in Côte d'Ivoire
Authors: Maheu-Giroux Mathieu , Diabaté Souleymane , Boily Marie-Claude , Jean-Paul Nedjéda , Vesga Juan F. , Baral Stefan , Abo Kouamé , Wognin Venance , Diouf Daouda , Alary Michel 
Published: January 2019

Background:
Despite Côte d'Ivoire epidemic being labeled as “generalized,” key populations (KPs) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached—or missed—the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSWs). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios.

Methods:
Costing was performed from the provider's perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life-years (DALY) averted were estimated over 2015–2030.

Results:
The 3 most cost-effective and affordable scenarios were the ones that projected current programmatic trends [ICER = $210; 90% uncertainty interval (90% UI): $150–$300], attaining the 90-90-90 objectives among KP and CFSW (ICER = $220; 90% UI: $80–$510), and among KP only (ICER = $290; 90% UI: $90–$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER = $710; 90% UI: $450–$1270). In comparison, the UNAIDS scenario had a net ICER of $570 (90% UI: $390–$900) per DALY averted.

Conclusions:
According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW seem most promising in Côte d'Ivoire.
Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study
Authors: Sherman Susan G. , Park Ju Nyeong , Galai Noya , Allen Sean T. , Huettner Steve S. , Silberzahn Bradley E. , Decker Michele R. , Poteat Tonia C. , Footer Katherine H.A. 
Published: January 2019

Objective:
To determine and compare risk factors for HIV infection among cisgender female sex workers (CFSWs) and transgender female sex workers (TFSWs).

Design:
Baseline data from a cohort study (SAPPHIRE) of street-based CFSW and TFSW in Baltimore, MD.

Methods:
Women were queried about individual (eg, drug use), interpersonal (eg, sexual abuse), and structural (eg, housing) risk factors and questioned on their sex work risk environment. Women were tested for HIV/sexually transmitted infections. We used logistic regression to identify key risk factors for prevalent HIV in each population.

Results:
We recruited 262 CFSW and 62 TFSW between 2016 and 2017. Compared with TFSW, CFSW were more likely to be white (66% vs. 0%), recently homeless (62% vs. 23%, P < 0.001), regularly gone to sleep hungry (54% vs. 16%, P < 0.001), and to inject drugs (71% vs. 4%, P < 0.001). HIV prevalence was 8 times greater in TFSW than in CFSW (40% vs. 5%, P < 0.001). All participants reported high rates of lifetime physical and sexual violence. Cocaine injection [adjusted odds ratio (aOR) = 3.65, 95% confidence interval (CI): 1.12 to 11.88], food insecurity (aOR = 1.92, 95% CI: 1.22 to 3.04), and >5 years in sex work (aOR = 5.40, 95% CI: 2.10 to 13.90) were independently associated with HIV among CFSW. Childhood sexual abuse (aOR = 4.56, 95% CI: 1.20 to 17.32), being in sex work due to lack of opportunities (aOR = 4.81, 95% CI: 1.29 to 17.90), and >5 years in sex work (aOR = 5.62, 95% CI: 1.44 to 21.85) were independently associated with HIV among TFSW.

Conclusions:
Although distinct, both populations share a history of extensive childhood abuse and later life structural vulnerability, which drive their engagement in street-based sex work and their HIV risk profiles.
New antibiotics for community-acquired pneumonia
Authors: Kollef Marin H. , Betthauser Kevin D. 
Published: January 2019

Purpose of review
This review provides the rationale for the development of new antibiotics to treat community-acquired pneumonia (CAP). It also provides an overview of the new antibiotics targeting CAP that have recently received approval by the regulatory agencies, and those antibiotics that are in the development pipeline.

Recent findings
CAP is one of the most common reasons for hospitalization and carries a significant morbidity and risk of mortality. Increasing antibiotic resistance amongst the common bacterial pathogens associated with CAP, especially staphylococci and Streptococcus pneumoniae, has made the empiric treatment of this infection increasingly problematic. Moreover, failure of initial empiric therapy to cover the causative agents associated with CAP can be associated with worse clinical outcomes. There have been several antibiotics newly approved or in development for the treatment of CAP. These agents include delafloxacin, omadacycline, lefamulin, solithromycin, nemonoxacin, and ceftaroline. Their major advantages include activity against methicillin-resistant Staphylococcus aureus and macrolide-resistant Strep. pneumoniae.

Summary
CAP continues to be an important infection because of its impact on patient outcomes especially in the elderly and immunocompromised hosts. The availability of new antibiotics offers an opportunity for enhanced empiric treatment of the antibiotic-resistant bacterial pathogens associated with CAP.
Understanding Symptoms of Muscle Tightness, Weakness, and Rigidity From a Nursing Perspective
Authors: Bhimani Rozina H. , Soomar Daanish 
Published: January 2019

Abstract

Purpose
This study examined the nature of muscle tightness from nurses' perspectives and explored how the symptoms of muscle tightness are communicated, managed, and differentiated from other conditions, such as muscle rigidity and muscle weakness.

Design
An exploratory, descriptive qualitative design was used.

Methods
Eight rehabilitation nurses described lexicons, care strategies, and communication for muscle tightness, weakness, and rigidity.

Findings
Nurses used conflicting terms to describe muscle tightness, weakness, and rigidity. They identified medications and range of motion as the best strategies to manage muscle conditions. Nurses approach care holistically and do not differentiate care strategies that are based only on a symptoms lens.

Conclusions
Nurses were unable to clearly differentiate between muscle tightness and rigidity.

Clinical Relevance
Nurses influence patients' choice of vocabulary; therefore, they must use simple but precise terminologies to educate their patients. Miscommunication between nurses and patients can lead to errors, which can have negative consequences.
The Impact of Resident Postgraduate Year Involvement in Body-Contouring and Breast Reduction Procedures
Authors: Malyar Masoud , Peymani Abbas , Johnson Anna Rose , Chen Austin D. , Van Der Hulst René R. W. J. , Lin Samuel J. 
Published: January 2019

Background
Given the rising popularity in body-contouring procedures (BCPs) in the United States, it is important to assess the currently unknown association between resident involvement and postoperative complications. As such, the aim of this study was to evaluate the impact of resident involvement on outcomes in BCPs using a large national database.

Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed (2006–2012) to identify patients undergoing BCPs, using relevant Current Procedural Terminology codes. Outcome measures included postoperative complications, hospital length of stay, and operation time.
Multivariate regression models were used to assess the impact of resident involvement and resident experience on outcomes.

Results
A total of 9638 cases were identified, of which 3311 involved resident participation.
Resident involvement was associated with significantly higher rates of complications (7.8% vs 4.4%; P = 0.003) and longer operation times (180.7 vs 171.9 minutes; P = 0.005). For each year increase of resident postgraduate year, there was a significant decrease in odds of complications (odds ratio, 0.906; P = 0.013) and operative time (−2.7 minutes; P = 0.001).

Conclusions
Resident involvement in BCPs was associated with an increased rate of overall complications in a large, national database. However, the clinical significance of these outcomes may be debated. Increased postgraduate year experience as a surgical resident was inversely associated with overall complications. Guided resident autonomy and earlier exposure to BCPs could lead to an optimization of clinical outcomes and resident education.
Repair of Sacral and Ischial Region Defects With Lateral Sacral Artery Perforator Flaps
Authors: Durgun Mustafa , Bas Soysal 
Published: January 2019

Background
Reconstructive choices for the defects of the sacral and ischial regions include various steps of the reconstructive ladder from primary closure to free flaps. This study aimed to present repair of sacral and ischial region defects with lateral sacral artery perforator (LSAP) flaps.

Methods
We enrolled a total of 18 patients with sacral and ischial region defects reconstructed with LSAP flaps in the study between September 2014 and October 2015. The patients were evaluated in terms of age, sex, neurological situation, etiology, defect size, defect region, flap size, perforator number, and postoperative complications.

Results
No patient had hematoma, seroma, and complications of the donor area. In the postoperative period, 2 patients were observed to have short-term complications (11.1%) including a partial flap loss (5.5%) due to distal venous failure (flap survival rate, 95%) and a wound site infection (5.5%). Duration of follow-up of the patients ranged between 26 and 38 months. Recurrence was observed from long-term complications of 4 patients' pressure sores (22%).

Conclusions
The LSAP flap has not been frequently described in the literature. We believe that LSAP flap is a flap of choice that should be considered preferably for sacral and ischial defects, which can be reliably elevated over pedicles and has short surgery duration and low surgical morbidity.
Autologous Breast Reconstruction With a Delay Procedure of the Deep Inferior Epigastric Artery Perforator Flap Because of Venous Congestion of the Flap on Pedicle
Authors: Hillberg Nadine S. , van Mulken Tom J. M. , Meesters-Caberg Marleen A. J. , Piatkowski Andrzej , Keuter Xavier A. H. , Hommes Juliette , van der Hulst René R. W. 
Published: January 2019

Abstract
The deep inferior epigastric artery perforator (DIEP) flap is one of the most used free flaps for the reconstruction of the breast after a mastectomy. Despite careful selection of the patients and preoperative imaging, difficulties in vascularization of the flap can occur in some cases. Although multiple vascular connections (bipedicled, turbocharged, or stacked) can be made in selected cases, there can still be venous congestion before the flap is transferred.
Between 2016 and 2018, 4 cases in our series of 281 patients experienced such problems. Three of 4 patients had undergone preoperative imaging of the perforators by a magnetic resonance angiography or computed tomography angiography, in which a good perforator was seen. All 4 patients had a venous problem of blood circulation in the flap intraoperatively. The flaps were left to rest to decide on its venous status. Without improvement after this period of 20 to 30 minutes, the surgeons decided to withhold the translocation of the flap to the chest wall and sutured the flap back into the donor side. The final anastomosis of the DIEP flap occurred on average 8 days after the prefabrication. The translocation of the DIEP flap to the chest in this second operation went uncomplicated in all cases. Postoperatively, all patients had adequate arterial inflow and venous outflow of the flap. There were no postoperative complications.
In case a DIEP flap shows venous problems before translocation, a delay procedure can be applied. In this way, the vascularization of the flap can be improved, and the translocation of the DIEP flap in a second operation can be successfully performed.
Graciloplasty for Anal Incontinence—Is Electrical Stimulation Necessary?
Authors: Gohil Amish Jayantilal , Gupta Ashish Kumar , Jesudason Mark Ranjan , Nayak Sukria 
Published: January 2019

Introduction
Anal incontinence brings lot of social embarrassment, mental distress, dignity loss, anxiety, low confidence, and eventually a low self-esteem with a restricted social life to the affected person. Surgical repair is the mainstay of treatment for anal incontinence. However, some patients need additional procedures such as gluteoplasty, graciloplasty (adynamic and dynamic), artificial bowel sphincter, and sacral nerve stimulation, which help to reinforce or augment the anal sphincter.

Methods
A retrospective analysis of 17 patients who underwent adynamic graciloplasty for reconstruction of anal sphincter from January 2008 to December 2017 was done. Demographic profile, fecal incontinence scores (Wexner score and KAMM score), and anal manometric findings were recorded pregraciloplasty and postgraciloplasty.

Results
Of the total 17 patients, 9 were males and 8 were females. Satisfactory continence was achieved in 13 patients out of 17 (76.47%). Continence was defined as satisfactory for patients having a postoperative Wexner score of 2 or less and KAMM score of 4 or less. It was considered to be poor if the Wexner score was greater than 6 and KAMM score was greater than 8 in the follow-up period or if the stoma was not reversed.

Conclusions
Unstimulated or adynamic graciloplasty is a relatively safe procedure, has a short learning curve, is affordable, and avoids the additional implant-related complications. We feel that the unstimulated graciloplasty still has a significant role in the management of anal incontinence.
Gluteal Flaps Revisited
Authors: Myers Paige L. , Krasniak Peter J. , Day Serena J. , Bossert Ronald P. 
Published: January 2019

Background
Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity.

Methods
A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed.

Results
A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm2. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11).

Conclusions
This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.
The Effect of Chyle Fat Injection on Human Hypertrophic Scars in an Animal Model
Authors: Chen Junnan , Lai Linying , Ma Kui , Xu Xiao , Huang Zhenya , Zhou Guiwen , Zhou Yunchao , Liang Liming , Chen Minliang 
Published: January 2019

Background
Chyle fat transplantation has shown positive effects on preexisting human hypertrophic scars (HSs) in a nude mouse HS graft model.

Methods
Hypertrophic scar fragments were obtained from 5 surgically treated burn patients and implanted into the backs of nude mice in 3 groups: group A, control; group B, triamcinolone; and group C, chyle fat. The specimens were implanted after the corresponding intralesional injection in each group, and the mice were observed for 4 weeks. In total, 18 mice and 72 scar specimens were studied. After 4 weeks, the HSs were removed from the mice. Then, the scar weights, histology, and decorin staining were assessed to evaluate the therapeutic efficacy.

Results
An obviously significant difference was observed in the HS weight reduction between groups A and C (P < 0.01), and a significant difference in the HS weight reduction was observed between groups A and B (P < 0.05). However, there was no significant difference between groups B and C. The treatment groups (groups B and C) showed strong decorin staining. Furthermore, the decorin staining was much stronger in group C than in group B (P < 0.05). Significant differences in extracellular matrix deposition were observed among the 3 groups, as determined by Masson trichrome staining. Both groups B and C showed significant therapeutic efficacy compared with group A, and group C exhibited a significant therapeutic effect compared with group B (P < 0.05).

Conclusions
This study indicates that chyle fat grafting is beneficial for treating HSs.