bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of scleroderma renal crisis
Authors: Nagaraja Vivek 
Published: March 2019

Purpose of review
Scleroderma renal crisis (SRC) is a life-threatening manifestation in systemic sclerosis (SSc) and is usually presented by an acute onset of severe hypertension together with an acute kidney injury. We can conceptualize SRC as a systemic syndrome with features that extend beyond the involvement of the kidney. The goal of this review is to inform clinicians about the risk factors for SRC in patients with SSc and to emphasize the importance of early identification and initiation of treatment.

Recent findings
For the past 3 decades, the use of angiotensin-converting enzyme inhibitors (ACE-I) to treat SRC, has been rightfully synonymized with a good outcome, and has changed the trajectory of mortality in SRC. Despite this, SRC still figures in one of the top four causes of mortality in patients with SSc. There is a need for additional therapeutic agents to treat SRC that is refractory to ACE-I. There has been a recent interest in combining ACE-I with endothelin receptor blockers and agents targeting the complement component 5. There is no role for using ACE-I prophylactically in high-risk patients.

Summary
Early diagnosis of SRC is the key, and early initiation of ACE-I is life-saving and associated with a better prognosis. We should consider renal transplantation in selected patients, especially those on long-term dialysis.
Defining Usage and Clinical Outcomes Following Perioperative Fresh Frozen Plasma and Platelet Administration in Spine Surgery Patients
Authors: Purvis Taylor E. , Wang Timothy Y. , Sankey Eric W. , Frank Steven M. , Goodwin C. Rory , Sciubba Daniel M. 
Published: March 2019

Study Design:
This was a retrospective study.

Objectives:
The main objectives of this study were to characterize the utilization of fresh frozen plasma (FFP) and platelets in spine surgery and the clinical outcomes following their administration.

Summary of Background Data:
Blood component transfusion is often a crucial therapy during spine surgery. Little is known about the association between transfusion with FFP and/or platelets and perioperative morbidity in patients undergoing spine surgery.

Materials and Methods:
At a single large tertiary medical center, the surgical billing database was retrospectively queried for patients undergoing spinal surgery from 2008 to 2015. A univariate analysis compared patient characteristics for those who received FFP and/or platelets perioperatively and those who did not. To determine independent predictors of FFP and platelet administration and independent predictors of perioperative complications, both univariate and multivariate analyses were used.

Results:
In total, 6931 patients met inclusion criteria. One thousand seven (14.5%) patients received perioperative FFP transfusion and 432 (6.2%) received platelets. In multivariate analysis, Charlson Comorbidity Index (CCI) ≥4, preoperative hemoglobin <12 g/dL, preoperative international normalized ratio (INR) ≥1.7, higher estimated blood loss, and receipt of packed red blood cell or platelet transfusion were associated with perioperative FFP administration (all P≤0.001). More than half of all patients received FFP with an INR trigger of <1.7. Those who received perioperative FFP were more likely to experience infection, increased length of stay, and ischemic, respiratory, thrombotic, and renal complications (all P<0.0001). Perioperative FFP [odds ratio (OR): 2.43], platelet transfusion (OR: 1.81), American Society of Anesthesiologists (ASA) grade 3 or 4 (OR: 1.84), CCI≥4 (OR: 1.75), and receipt of packed red blood cells (OR: 1.73) were independent predictors of experiencing any complication (all P≤0.008).

Conclusions:
The majority of patients were given FFP with a liberal INR trigger of >1.7. Perioperative FFP and platelet administration are independent predictors of perioperative complications following spine surgery.
Management of treatment-related toxicities in advanced medullary thyroid cancer
Authors: Tsang Venessa H.M. 
Published: March 2019

Purpose of review
Tyrosine kinase inhibitors (TKI), predominantly vandetanib and cabozantinib, are increasingly used for management of advanced medullary thyroid cancer. This review aims to discuss the major and serious adverse events associated with TKI.

Recent findings
The choice of TKI depends on the patient's existing comorbidities. Patients who have long QT interval should avoid vandetanib and those at risk of gastrointestinal perforation should avoid cabozantinib. Hypertension is common during the first 3 months. Treatments include ACE inhibitors, calcium channel blockers (avoiding verapamil and diltiazem, which are CYP3A4 inhibitors), and beta blockers. Diuretics should be second line because of derangement of electrolytes, which may exacerbate QT interval. As nitric oxide (NO) blockade and ET1 are implicated in the mechanism of hypertension, nitrates and endothelin receptor antagonists may be used. Thromboembolism may require anticoagulation or revascularization procedures. Prolonged QT interval should be treated by dose interruption and reduction, correction of electrolytes, and avoidance of medications, which prolong QTc interval. Diarrhoea is managed symptomatically and with electrolyte replacement, dermatological adverse events with avoidance of exacerbating factors and topical therapies. Thyroid function should be monitored.

Summary
Toxicities are common with TKI use, and management involves symptomatic treatment, avoidance of triggers, dose interruption, and dose reduction.
Mechanical Strain of the Nasal Bilobed Transposition Flap—Graduated Changes in Skin Thickness Superiorly Displace the Location of the Pivot Point
Authors: Gruber Paul J. , Armbrecht Eric , Pelster Michael W. , Maher Ian A. 
Published: March 2019

BACKGROUND
The bilobed transposition flap recruits the relatively thinner and laxer skin of the nasal dorsum and sidewall to reconstruct defects of the more sebaceous nasal tip and alae. There have been no studies performed to quantify how the material properties of skin alter the bilobed flap's performance during nasal reconstruction.

OBJECTIVE
To determine the effects of skin thickness and stiffness on bilobed flap mechanics to help guide flap design principles and optimize surgical outcomes.

MATERIALS AND METHODS
Two-dimensional artificial silicone skin models of varying thickness were created. The bilobed flap was incised, transposed, and secured in standard fashion. Digital image correlation was used to translate model deformation and displacement into local stress and mechanical strain forces within the bilobed flap pedicle.

RESULTS
Qualitatively, the center of rotation of the bilobed flap rotates superiorly up the flap pedicle as model skin thickness increased.

CONCLUSION
Location of the bilobed flap's pivot point may be dependent on local tissue characteristics—oversizing of the primary lobe can be considered in stiff, immobile tissue such as highly sebaceous Zone II nasal skin.
Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia
Authors: Gupta Aditya K. , Cole John , Deutsch David P. , Everts Peter A. , Niedbalski Robert P. , Panchaprateep Ratchathorn , Rinaldi Fabio , Rose Paul T. , Sinclair Rodney , Vogel James E. , Welter Ryan J. , Zufelt Michael D. , Puig Carlos J. 
Published: March 2019

BACKGROUND
Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation.

OBJECTIVE
The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA).

MATERIALS AND METHODS
A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols.

RESULTS
The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35–0.80) and 0.51 (95% CI: 0.23–0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively.

CONCLUSION
Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.
A 1064-nm Neodymium-doped Yttrium Aluminum Garnet Picosecond Laser for the Treatment of Hyperpigmented Scars
Authors: Koren Amir , Niv Roni , Cohen Sarit , Artzi Ofir 
Published: March 2019

BACKGROUND
Pigmentation is one of the few major characteristics according to which scars are evaluated. Data on the treatment of the hyperpigmented component of scars are sparse.

OBJECTIVE
The authors aimed at evaluating the efficacy of the fractional 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser in the treatment of the hyperpigmented component of scars.

METHODS
Sixteen patients with hyperpigmented scars underwent 3 to 8 treatment sessions at 3- to 6-week intervals with the 1,064-nm Nd:YAG picosecond laser (PicoWay, Candela, Resolve handpiece). The treatment response was evaluated by 2 noninvolved dermatologists on a global assessment scale (GAS) of 1 to 4. A Mexameter quantitatively evaluated the melanin content of the scar before and after laser treatments.

RESULTS
The average GAS score of the 2 noninvolved dermatologists was 3.31 ± 0.57. The patients assessed their level of tolerance as good or excellent and their satisfaction level as moderate or high. The Mexameter showed that the melanin index decreased considerably (by 39.11 ± 11.58%) in all patients after treatment.

CONCLUSION
The fractionated nonablative picosecond Nd:YAG laser was effective for the treatment of the hyperpigmented component of scars.
Fertility preservation options for transgender and gender-nonconforming individuals
Authors: Moravek Molly B. 
Published: March 2019

Purpose of review
To provide an overview of the current state of knowledge of fertility risks of gender-affirming therapy, review fertility preservation options for transgender individuals and ways to minimize gender dysphoria during fertility treatment, and identify gaps in knowledge.

Recent findings
Recent studies have corroborated older data that gender-affirming hormone therapy creates histopathological changes in the gonads; however, the newer data suggests that some function of the gametes may be preserved. One study in transgender men reported successful in-vitro maturation of testosterone-exposed oocytes with normal spindle structures, and recent studies in transgender women reveal early spermatogenesis in estradiol-exposed testes and some recovery of semen parameters following cessation of hormones. Particular attention has recently been given to fertility preservation in transgender adolescents, revealing unmet informational needs in this population and very few are actually pursuing fertility preservation, even with counseling.

Summary
There is currently a paucity of data on the fertility effects of gender-affirming hormones, necessitating fertility preservation counseling prior to initiation of therapy. Several modifications can be made to fertility preservation protocols and procedures to decrease gender dysphoria or distress in transgender individuals, but outcome data is still lacking. Achieving high-quality data collection will likely require cooperation across multiple institutions.
Endocrine and reproductive profile of boys and young adults conceived after ICSI
Authors: Belva Florence , Bonduelle Maryse , Tournaye Herman 
Published: March 2019

Purpose of reviewThe impact of intracytoplasmic sperm injection (ICSI), on the reproductive health of the offspring is largely unknown. Here we provide a comprehensive overview of the endocrine and reproductive profile in boys and young male adults born after ICSI using ejaculated spermatozoa alleviating male factor infertility in their parents.Recent findingsLevels of testosterone, anti-Müllerian hormone and inhibin B were found comparable in prepubertal and pubertal boys conceived by ICSI when compared with levels in boys conceived spontaneously. Also, at young adulthood, mean levels of reproductive hormones did not differ from control peers. However, semen analysis showed significantly lower sperm concentration, total sperm count and total motile sperm count when compared with controls. Furthermore, the risk of having sperm concentration and sperm count below the reference values was increased in ICSI offspring while sperm parameters did not correlate in paired father-son semen analysis.SummaryAlthough endocrine gonadal function was normal at puberty, exocrine function at young adulthood was not. We observed decreased semen quality and quantity in young adults conceived by ICSI performed to circumvent male factor infertility. The possibility of transgenerational transmission of impaired spermatogenesis after ICSI needs further investigation.
Successful Management of Herpes Simplex Keratitis With Oral Valganciclovir in Patients Unresponsive or Allergic to Conventional Antiviral Therapy
Authors: Koseoglu Neslihan Dilruba , Strauss Benjamin R. , Hamrah Pedram 
Published: March 2019

Purpose:
To describe 4 cases of presumably immunocompetent patients with herpes simplex virus (HSV) keratitis unresponsive (n = 3) or allergic (n = 1) to conventional antiviral therapy that improved with oral valganciclovir treatment.

Methods:
Retrospective case series of 4 patients with HSV keratitis treated with oral valganciclovir between March 2016 and June 2018.

Results:
We reviewed the records of 4 patients with recurrent epithelial HSV keratitis. Three patients were on antiviral prophylaxis because of a history of HSV keratitis. All patients were on oral acyclovir, valacyclovir, and/or famciclovir treatment with/without topical antiviral therapy for 4 to 6 months for prophylaxis and/or recurrent dendriform epithelial keratitis. While 3 patients had recurrent episodes during their active prophylaxis with oral antiviral therapies, one patient had a recurrence after she discontinued her oral prophylactic antiviral therapy due to recurrent self-reported allergic reactions. The patients presented with recurrent dendriform epithelial keratitis despite conventional antiviral therapy. We initiated oral valganciclovir 900 mg twice a day for 10 days as a treatment dose, followed by 900 mg daily for prophylaxis. The corneal epithelium subsequently healed within the first 2 weeks in all patients. The mean follow-up time for patients on valganciclovir prophylaxis was 8 months (range: 6–12 months), and none of the patients presented with any further recurrences.

Conclusions:
In case of treatment-related side effects or failure with conventional antiviral therapies, oral valganciclovir may present an alternative for the treatment and prophylaxis of HSV keratitis.
Simple Hysterectomy for Cervical Cancer: Risk Factors for Failed Screening and Deviation From Screening Guidelines
Authors: Castellano Tara , Ding Kai , Moore Kathleen N. , Landrum Lisa M. 
Published: March 2019

Objective
The aim of this study is to describe risk factors associated with either false-negative cervical cancer screening or deviations from screening guidelines that result in incidentally found invasive cervical cancer at the time of simple hysterectomy for benign indications.

Materials and Methods
This is a retrospective review from 1990 to 2017 of subjects with incidental cervical cancer. Baseline demographics, preoperative evaluations, surgical data, and histopathologic characteristics were recorded. Deviations from screening guidelines or false-negative screenings were identified. Associations of independent risk factors according to age, insurance status, and histology were assessed.

Results
Fifty-nine subjects with a median age of 43 years were found. Abnormal uterine bleeding was the most common indication for hysterectomy (61%, n = 36) and cervical dysplasia was present in 42% (n = 25) of these cases. Of those with inappropriate screening, 38% (n = 17) did not have documented Pap test, 22% (n = 10) had Pap that was not triaged appropriately, 18% (n = 8) received Pap and colposcopy but no indicated excisional procedure, and 22% (n = 10) had an excisional procedure that was not managed according to guidelines. False-negative screening occurred in 25% subjects (n = 15). There was no significant association between age, insurance status, or histology and risk of false-negative screening or inadequate screening.

Conclusions
The most common cause of incidental cervical cancer at the time of simple hysterectomy was failure to properly adhere to screening guidelines. Less frequently, false-negative screening was the cause. No independent risk factor in either group was identified in this single institutional study. Illustrated is the importance of continuing education of surgeons about adequate screening in the preoperative evaluation for benign hysterectomy.
Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities
Authors: Martsolf Grant R. , Baird Matthew , Cohen Catherine C. , Koirala Nirabh 
Published: March 2019

Background:
There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related to certified registered nurse anesthetist (CRNA) practice may help to alleviate rural supply concerns.

Objectives:
To estimate the association between state CRNA policy and anesthesia provider supply especially in rural communities.

Research Design:
Repeated cross-sectional design using ordinary least squares and 2-stage least squares regressions.

Subjects:
All counties in the United States from 2010 to 2015.

Measures:
Dependent variables include anesthesia provider counts per 100,000 people, calculated separately for anesthesiologists, CRNAs, and their sum. Key variables of interest include state-level CRNA policy based on scope of practice (SOP) regulations and Medicare opt-out status.

Results:
Opt-out status and less restrictive SOP regulations were consistently correlated with a greater supply of CRNAs, especially in rural counties. Furthermore, we found that anesthesiologists and CRNAs tend to be complements to each other, but less restrictive SOP and opt-out status tend to weaken the importance of this relationship.

Conclusions:
State regulations may lead to increased supply of CRNAs in rural communities. However, the design of our study makes causality difficult to assert. So, it is also possible that states set CRNA policy as a response to counts of anesthesia providers in rural areas. Furthermore, given supply of anesthesiologists and CRNAs are complementary to one another, improving access to anesthesia services may require addressing issues pertaining to the supply of all anesthesia provider types.
Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department
Authors: Shamash Zohar , Catallozzi Marina , Dayan Peter S. , Chernick Lauren S. 
Published: March 2019

Objectives
Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED.

Methods
We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis.

Results
A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a condom at last intercourse (129/243, 53%). Two thirds of participants (152/236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sexual partner, or STI history. Qualitative data from both surveys and interviews revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for preferring EPT included increased treatment accessibility and convenience.

Conclusions
The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address common concerns regarding EPT to increase EPT adherence if prescribed.
Motor corticospinal excitability: a novel facet of pain modulation?
Authors: Granovsky Yelena , Sprecher Elliot , Sinai Alon 
Published: March 2019

Abstract

Introduction:
Increase in excitability of the primary motor cortex (M1) is associated with pain inhibition by analgesics, which is, in turn, associated with the psychophysical antinociceptive pain modulation profile. However, the relationship between neurophysiological M1 excitability and psychophysical pain modulation has not yet been explored.

Objectives:
We aim to study these relationships in healthy subjects.

Methods:
Forty-one young healthy subjects (22 women) underwent a wide battery of psychophysical testing that included conditioned pain modulation (CPM) and pain temporal summation, and a transcranial magnetic stimulation neurophysiological assessment of the motor corticospinal excitability, including resting motor threshold, motor-evoked potentials (MEPs), and cortical silent period.

Results:
Increased motor corticospinal excitability in 2 parameters was associated with more efficient CPM: (1) higher MEP amplitude (r = −0.574; P
_Bonferroni = 0.02) and (2) longer MEP duration (r = −0.543; P
_Bonferroni = 0.02). The latter also correlated with the lower temporal summation magnitude (r = −0.421; P = 0.007); however, on multiplicity adjustment, significance was lost.

Conclusions:
Increased corticospinal excitability of the primary motor cortex is associated with more efficient inhibitory pain modulation as assessed by CPM, in healthy subjects. Motor-evoked potential amplitude and duration may be considered as an additional, objective and easy to measure parameter to allow for better individual assessment of pain modulation profile.