bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliable, Noncontact Imaging Tool for the Evaluation of Meibomian Gland Function: Sirius Meibography
Authors: Gulmez Sevim Duygu , Gumus Koray , Unlu Metin 
Published: August 2019

Objectives:
To investigate the correlation between the clinical grading of the severity of meibomian gland dysfunction (MGD) and meibomian gland area (MGA) loss detected using Sirius meibography in the upper and lower eyelids and to correlate these parameters with dry eye signs and symptoms.

Methods:
One hundred thirty eyes of 130 volunteer patients were enrolled. Meibomian gland dysfunction was defined as the presence of signs consistent with meibomian gland terminal duct obstruction and categorized between grades 1 and 4. Upper and lower MGA loss percentages were evaluated using Sirius meibography by two blinded examiners. Patients were categorized into two groups (positive and negative for MGD) based on their Ocular Surface Disease Index (OSDI) scores (≥15 and <14, respectively) and MGD grades (≥1 and 0, respectively).

Results:
The MGA loss percentage and ocular surface test results of the MGD group were greater than in the non-MGD group in both eyelids (P=0.001). Meibomian gland dysfunction grade and MGA loss for the lower eyelid was greater than that of the upper eyelids (P=0.002 and P<0.001, respectively). The OSDI score, tear film break-up time, and lissamine green staining were all significantly correlated with MGD grade and MGA loss in both eyelids (P<0.001). For the average measures of the MGA loss percentage in each scan, the intraclass correlation value was found as 0.994 (95% confidence interval [CI]: 0.992–0.995) for reader 1 and 0.988 (95% CI: 0.982–0.992) for reader 2.

Conclusions:
Our findings suggest that Sirius meibography, a noncontact imaging device, is a reliable tool for evaluating meibomian gland structure in patients with MGD and non-MGD of various ages and regardless of sex.
Mitomycin C-augmented Phacotrabeculectomy Versus Phacoemulsification in Primary Angle-closure Glaucoma: A Randomized Controlled Study
Authors: El Sayed Yasmine M. , Elhusseiny Abdelrahman M. , Albalkini Ahmed S. , El Sheikh Reem H. , Osman Mona A. 
Published: August 2019

Precis:
Phacotrabeculectomy yielded similar results to phacoemulsification in primary angle-closure glaucoma (PACG) in terms of intraocular pressure (IOP) lowering, glaucoma medications and success rates. Although releasable sutures may have reduced the risk of hypotony; complications and interventions were more common with phacotrabeculectomy.

Purpose:
To compare the efficacy and safety of phacotrabeculectomy using releasable sutures and adjunctive mitomycin C versus phacoemulsification alone in the management of PACG.

Patients and Methods:
In total, 63 eyes of 63 PACG patients were randomized to undergo either mitomycin C-augmented phacotrabeculectomy with tight scleral flap closure using releasable sutures aiming at no flow or phacoemulsification alone. The primary outcomes were success rates and complications. Secondary outcomes were IOP and glaucoma medications.

Results:
The IOP and glaucoma medications were significantly reduced at 1, 3, 6, and 12 months postoperatively in both groups (P<0.001). There was no statistically significant difference in IOP, IOP reduction, success rates, or survival times between both groups. Glaucoma medications were only significantly lower in the phacotrabeculectomy group at 1 and 3 months. The rates of postoperative interventions and complications were higher in the phacotrabeculectomy group. Complete success, defined as an IOP of 6 to 21 mm Hg on no medications and with no signs of glaucoma progression, was achieved in 58% in the phacotrabeculectomy group, compared with 62% in the phacoemulsification group (P=0.9). Only 2 eyes (6%) in the phacoemulsification group required a subsequent trabeculectomy.

Conclusions:
Trabeculectomy did not seem to add an advantage when combined with phacoemulsification in PACG patients and was associated with more postoperative interventions. Despite the use of releasable sutures to allow titration of the IOP postoperatively, the rate of hypotony and other complications was higher in the phacotrabeculectomy group.
Flavobacteriaceae Bacteremia in Children
Authors: Cooper Shiri , Levy Itzhak , Ben-Zvi Haim , Ashkenazi-Hoffnung Liat , Ben-Shimol Shalom , Shachor-Meyouhas Yael , Grisaru-Soen Galia , Kriger Or , Yahav Dafna , Scheuerman Oded 
Published: August 2019

Background:
The Flavobacteriaceae family includes rare pathogens in children; Chryseobacterium indologenes and Elizabethkingia meningosepticum are the most common pathogenic species, with a wide range of clinical presentations and high mortality rate. Although rare, diagnosis is important due to inherent resistance to multiple antibiotics, especially those typically prescribed for empiric treatment of aerobic Gram-negative bacterial infections.

Methods:
A multicenter retrospective study conducted in 5 Israeli hospitals, describing Flavobacteriaceae bacteremia confirmed by positive blood culture from 1998 to 2018.

Results:
Thirteen cases were included; 9 isolates were C. indologenes. Bacteremia was nosocomial or healthcare-associated in all cases. Bacteremia was associated with young age (median, 1 year, range 24 days–17 years), with only 2 (15.4%) cases in neonates, Central line-associated bloodstream infection as a source (5/13, 38%) and malignancy (7/13, 54.8%). Thirty-day all-cause mortality was 23% (3/13). Ninety-one percent of isolates were susceptible to trimethoprim-sulfamethoxazole, 82% to piperacillin-tazobactam and 92% to ciprofloxacin.

Conclusions:

C. indologenes and E. meningosepticum are rare, nosocomial- or healthcare-associated pediatric bacteremia pathogens. Bacteremia was associated with young age, but in contrast to the literature, the majority of our cases were older than the neonatal age period. In addition, they were associated with central line-associated bloodstream infection and malignancy. The most adequate antibiotics according to resistance patterns were ciprofloxacin, trimethoprim-sulfamethoxazole and piperacillin-tazobactam.
Reconstruction of Large Anterior Palatal Fistulae Using Anteriorly Based Dorsal Tongue Flaps
Authors: Yang Zhao-hui , Zhong Jiang-long , Chen Wei-liang 
Published: August 2019

Background:
An anterior palatal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The authors evaluate the feasibility and outcomes of the reconstruction of large anterior palatal fistulae using anteriorly based dorsal tongue flaps.

Methods:
Eight patients with anterior palatal fistulae after repair of a bilateral cleft lip and palate using anteriorly based dorsal tongue flaps. The defect size varied from 1.0 × 1.0 cm to 1.5 × 2.0 cm, and the tongue flap size varied from 1.5 × 3.5 cm to 2.0 × 3.5 cm.

Results:
All patients underwent successful reconstruction of palatal defects using anteriorly based tongue flaps, and no case of spontaneous detachment of the tongue flap occurred. The patients with palatal fistulae were followed up for 10 to 30 months, and no recurrence was encountered.

Conclusion:
An anteriorly based dorsal tongue flap is a safe and feasible surgical technique for the closure of anterior palatal fistulae.
Modified Genioplasty Combined With Orthognathic Surgeries for the Treatment of Chin Defect Accompanying Micrognathia and Airway Stenosis
Authors: Chen Kai , Wang Lin , Xiao Yanju , Zhang Yaoyao , Wu Guomin 
Published: August 2019

Abstract
We reported a 16-year-old patient with chin defect accompanying micrognathia and airway stenosis owing to a traffic accident. The treatment of this patient involved a modified genioplasty associated with orthognathic surgeries. Through data analysis, we found that the patient's facial morphology and airway space are greatly improved compared with preoperation: y-axis(T4-T1) = −4.5 degree; FCA (T4-T1) = −18 degree; CSAmin(T4-T1) = 227 mm2. In conclusion, the modified genioplasty associated with orthognathic surgeries is an effective way to reshape the defected chin and treat micrognathia and airway stenosis in this case.
Nasal Surgery May Improve Upper Airway Collapse in Patients With Obstructive Sleep Apnea: A Drug-Induced Sleep Endoscopy Study
Authors: Bosco Gabriela , Pérez-Martín Nuria , Morato Marta , Racionero Miguel A. , Plaza Guillermo 
Published: August 2019

Objective:The aim of this study is to evaluate the effects of nasal surgery in the upper airway (UA) collapse using drug induced sleep endoscopy (DISE) in a group of patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Prospective cohort of patients treated with nasal surgery between 2015 and 2016. All patients were diagnosed with mild to severe OSAHS. The inclusion criteria were age between 18 and 70 years, apnea–hypopnea index (AHI) higher than 15, and septal deviation. All patients had a DISE performed before surgery and 3 months after. The DISE findings were evaluated through the NOHL scale.Results:Thirty-four patients were included. Surgical success with subjective and objective improvement in nasal obstructions was achieved in all cases. The pattern of UA obstruction did change significantly following nasal surgery (P < 0.05). Before nasal surgery, 74% of the patients demonstrated multilevel obstruction. After nasal surgery, only 50% patients showed multilevel collapse (P < 0.05). Among patients with single-level collapse, the oropharynx was the most common location of obstruction. It became more frequent after nasal surgery was done (41% vs 21%,P < 0.05). Significant improvement was shown in hypopharyngeal collapse. Postoperative AHI decreased from a mean of 26.7 to 19 events/h, but this change was not significant.Conclusion:Nasal surgery may improve hypopharyngeal collapses observed during DISE in patients with OSAHS. Thus, an improvement in nasal obstruction may also modify the surgical plan based on UA functional findings in OSAHS patients.
Liver Resection Improves Survival in Colorectal Cancer Patients
Authors: Raoof Mustafa , Haye Sidra , Ituarte Philip H. G. , Fong Yuman 
Published: August 2019

Objective:
The aim of this study was to estimate population-level causal effects of liver resection on survival of patients with colorectal cancer liver metastases (CRC-LM).

Background:
A randomized trial to prove that liver resection improves survival in patients with CRC-LM is neither feasible nor ethical. Here, we test this assertion using instrumental variable (IV) analysis that allows for causal-inference by controlling for observed and unobserved confounding effects.

Methods:
We abstracted data on patients with synchronous CRC-LM using the California Cancer Registry from 2000 to 2012 and linked the records to the Office of Statewide Health Planning and Development Inpatient Database. We used 2 instruments: resection rates in a patient's neighborhood (within 50-mile radius)—NALR rate; and Medical Service Study Area resection rates—MALR rate. IV analysis was performed using the 2SLS method.

Results:
A total of 24,828 patients were diagnosed with stage-IV colorectal cancer of which 16,382 (70%) had synchronous CRC-LM. Liver resection was performed in 1635 (9.8%) patients. NALR rates ranged from 8% (lowest-quintile) to 11% (highest-quintile), whereas MALR rates ranged from 3% (lowest quintile) to 19% (highest quintile). There was a strong association between instruments and probability of liver resection (F-statistic at median cut-off: NALR 24.8; MALR 266.8; P < 0.001). IV analysis using both instruments revealed a 23.6 month gain in survival (robust SE 4.4, P < 0.001) with liver resection for patients whose treatment choices were influenced by the rates of resection in their geographic area (marginal patients), after accounting for measured and unmeasured confounders.

Conclusion:
Less than 10% of patients with CRC-LM had liver resection. Significant geographic variation in resection rates is attributable to community biases. Liver resection leads to extensive survival benefit, accounting for measured and unmeasured confounders.
Effect of Postoperative Permissive Anemia and Cardiovascular Risk Status on Outcomes After Major General and Vascular Surgery Operative Interventions
Authors: Kougias Panos , Sharath Sherene , Mi Zhibao , Biswas Kousick , Mills Joseph L. 
Published: August 2019

Objectives:
To determine the effect of postoperative permissive anemia and high cardiovascular risk on postoperative outcomes.

Methods:
The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse databases were queried for patients who underwent major vascular or general surgery operations. The status of cardiovascular risk was assessed by calculating the Revised Cardiac Risk Index. Primary endpoint was a composite of mortality, myocardial infarction, acute renal failure, coronary revascularization, or stroke within 90 days postoperatively.

Results:
We analyzed 142,510 procedures performed from 2000 to 2015. Postoperative anemia was the strongest independent predictor of the primary endpoint whose odds increased by 43% for every g/dL drop in postoperative nadir Hb [95% confidence interval (95% CI): 41–45]. Cardiac risk status as described by the RCRI also independently predicted the primary endpoint, with an additive effect particularly evident at postoperative nadir Hb values below 10 gm/dL. Postoperative anemia, after age, was the second strongest independent predictor of long-term (12 years) mortality (hazard ratio: 1.18, 95% CI: 1.17–1.19).

Conclusion:
Postoperative anemia is strongly associated with postoperative ischemic events, 90-day mortality, and long-term mortality. Restrictive transfusion should be used cautiously after major general and vascular operations, particularly in patients at a high cardiovascular risk.
Fractional Ablative Laser Therapy is an Effective Treatment for Hypertrophic Burn Scars
Authors: Miletta Nathanial , Siwy Katherine , Hivnor Chad , Clark Jason , Shofner Joshua , Zurakowski David , Anderson R. Rox , Lee Kachiu , Donelan Matthias 
Published: August 2019

Objective:
The aim of this study is to determine objective and subjective changes in mature hypertrophic burn scars treated with a fractional ablative carbon dioxide (CO2) laser.

Background:
Fractional CO2 laser treatment has been reported to improve burn scars, with increasing clinical use despite a paucity of controlled, prospective clinical studies using objective measures of improvement.

Methods:
A multicenter, site-controlled, prospective open-label study was conducted from 2013 to 2016. Objective and patient-reported outcome measures were documented at baseline, at each monthly laser treatment, and 6 months after treatment. Objective measurements employed were: mechanical skin torque to measure viscoelastic properties; ultrasonic imaging to measure scar thickness; and reflectometry to measure erythema and pigmentation. Subjective measures included health-related quality of life, patient and investigator scar assessment scales, and blinded scoring of before and after photographs. Subjects aged 11 years or older with hypertrophic burn scars were recruited. Each subject received 3 monthly treatment sessions with an ablative fractionated CO2 laser.

Results:
Twenty-nine subjects were enrolled, of whom 26 received at least 1 fractional CO2 laser treatment and 22 received 3 treatments. Mean age of those completing all 3 treatments was 28 years. Statistically significant objective improvements in elastic stretch (P < 0.01), elastic recovery (P < 0.01), extensibility (P < 0.01), and thickness (P < 0.01) were noted. Patient- and physician-reported scar appearance and pain/pruritus were significantly improved (P < 0.01). There was no regression of improvement for at least 6 months after treatment.

Conclusions:
Fractional ablative laser treatment provides significant, sustained improvement of elasticity, thickness, appearance, and symptoms of mature hypertrophic burn scars.
A systematic review and meta-analysis on the effectiveness of an invasive strategy compared to a conservative approach in elderly patients with non-ST elevation acute coronary syndrome
Authors: P. Reaño Joan Dymphna , C. Dimalala Maria Grethel , B. Shiu Louie Alfred , Miralles Karen V. , Pestaño Noemi S. , R. Punzalan Felix Eduardo , Tumanan-Mendoza Bernadette , T. Reyes Michael Joseph , Castillo Rafael R. 
Published: August 2019

ABSTRACTBackgroundElderly patients, 65 years old and older, largely represent (>50 %) of hospital- admitted patients with acute coronary syndrome (ACS). Data are conflicting comparing efficacy of early routine invasive (within 48-72 hours of initial evaluation) versus conservative management of ACS in this population.ObjectiveWe aimed to determine the effectiveness of routine early invasive strategy compared to conservative treatment in reducing major adverse cardiovascular events in elderly patients with non-ST elevation (NSTE) ACS.Data SourcesWe conducted a systematic review of randomized controlled trials through PubMed, Cochrane, and Google Scholar database.Study SelectionThe studies included were randomized controlled trials that evaluated the effectiveness of invasive strategy compared to conservative treatment among elderly patients ≥ 65 years old diagnosed with NSTEACS. Studies were included if they assessed any of the following outcomes of death, cardiovascular mortality, myocardial infarction (MI), stroke, recurrent angina, and need for revascularization. Five articles were subsequently included in the meta-analysis.Data ExtractionThree independent reviewers extracted the data of interest from the articles using a standardized data collection form that included study quality indicators. Disparity in assessment was settled by an independent adjudicator.Data SynthesisAll pooled analyses were based on fixed effects model. A total of 2,495 patients were included, 1337 in the invasive strategy group, and 1158 in the conservative treatment group.ResultsMeta-analysis showed less incidence of revascularization in the invasive (2%) over conservative treatment groups (8%), with overall risk ratio of 0.31 (95% CI 0.16-0.61, I2 =0%). There was also less incidence of stroke in the invasive (2%) versus conservative group (3%) but this was not statistically significant. A significant benefit was noted in the reduction of all-cause mortality (RR 0.63, 95% CI 0.55-0.72, I2=84%) and myocardial infarction (RR 0.62, 95% CI 0.49- 0.79, I2=63%) but with significant heterogeneity.ConclusionThere was a significantly lower rate of revascularization in the invasive strategy group compared to the conservative treatment group. In the reduction of all-cause mortality and MI, there was benefit favoring invasive strategy but with significant heterogeneity. These findings do not support the bias against early routine invasive intervention in the elderly group with NSTEACS. However, further studies focusing on the elderly with larger population sizes are still needed.
Apolipoprotein B underlies the causal relationship of circulating blood lipids with coronary heart disease
Authors: Richardson Tom G , Sanderson Eleanor , Palmer Tom M. , Ala-Korpela Mika , Ference Brian A , Smith George Davey , Holmes Michael V 
Published: August 2019

AbstractBackgroundCirculating blood lipids cause coronary heart disease (CHD). However, the precise way in which one or more lipoprotein lipid-related entities account for this relationship remains unclear. We sought to explore the causal relationships of blood lipid traits with risk of CHD using multivariable Mendelian randomization.MethodsWe conducted GWAS of circulating blood lipid traits in UK Biobank (up to n=440,546) for LDL cholesterol, triglycerides and apolipoprotein B to identify lipid-associated SNPs. Using data from CARDIoGRAMplusC4D for CHD (consisting of 60,801 cases and 123,504 controls), we performed univariable and multivariable Mendelian randomization (MR) analyses. Similar analyses were conducted for HDL cholesterol and apolipoprotein A-I.FindingsGWAS identified multiple independent SNPs associated at P<5×10−8 for LDL cholesterol (220), apolipoprotein B (n=255), triglycerides (440), HDL cholesterol (534) and apolipoprotein AI (440). Between 56-93% of SNPs identified for each lipid trait had not been previously reported in large-scale GWAS. Almost half (46%) of these SNPs were associated at P<5×10−8 with more than one lipid related trait. Assessed individually using MR, each of LDL cholesterol (OR 1.66 per 1 standard deviation higher trait; 95%CI: 1.49; 1.86; P=2.4×10−19), triglycerides (OR 1.34; 95%CI: 1.25, 1.44; P=9.1×10−16) and apolipoprotein B (OR 1.73; 95%CI: 1.56, 1.91; P=1.5×10−25) had effect estimates consistent with a higher risk of CHD. In multivariable MR, only apolipoprotein B (OR 1.92; 95%CI: 1.31, 2.81; P=7.5×10−4) retained a robust effect with the estimate for LDL cholesterol (OR 0.85; 95%CI: 0.57; 1.27; P=0.44) reversing and that of triglycerides (OR 1.12; 95%CI: 1.02, 1.23; P=0.01) becoming markedly weaker.Individual MR analyses showed a 1-SD higher HDL-C (OR 0.80; 95%CI: 0.75, 0.86; P=1.7×10−10) and apolipoprotein A-I (OR 0.83; 95%CI: 0.77, 0.89; P=1.0×10−6) to lower the risk of CHD but these effect estimates weakened to include the null on accounting for apolipoprotein B.ConclusionsApolipoprotein B is of fundamental causal relevance in the aetiology of CHD, and underlies the relationship of LDL cholesterol and triglycerides with CHD.
Identifying subtypes of a stigmatized medical condition
Authors: Gabashvili Irene S. 
Published: August 2019

AbstractBackgroundSome conditions - such as obesity, depression and functional odor disorders - come with a social stigma. Understanding the etiology of these conditions helps to avoid stereotypes and find remedies. One of the major obstacles facing researchers, especially for those studying socially distressing metabolic malodor, is the difficulty in assembling biologically homogenous study cohorts.ObjectiveThe aim of this study was to examine phenotypic variance, self-reported data and laboratory tests for the purpose of identifying clinically relevant and etiologically meaningful subtypes of idiopathic body odor and the “People are Allergic To Me” (PATM) syndrome.MethodsParticipants with undiagnosed body odor conditions enrolled to participate in this research study initiated by a healthcare charity MEBO Research and sponsored by Wishart Research group at the Metabolomics Innovation Centre, University of Alberta, Canada. Primary outcomes were differences in metabolite concentrations measured in urine, blood and breath of test and control groups. Principal component analyses and other statistical tests were carried out for these measurements.ResultsWhile neither of existing laboratory tests could reliably predict chronic malodor symptoms, several measurements distinguished phenotypes at a significance level less than 5%. Types of malodor can be differentiated by self-reported consumption of (or sensitivity to) added sugars (p<0.01), blood alcohols after glucose challenge (especially ethanol: p<0.0005), urinary excretion of phenylalanine, putrescine, and combinations of blood or urine metabolites.ConclusionsOur preliminary results suggest that malodor heterogeneity can be addressed by analyses of phenotypes based on patients’ dietary and olfactory observations. Our studies highlight the need for more trials. Future research focused on comprehensive metabolomics and microbiome sequencing will play an important role in the diagnosis and treatment of malodor.Trial RegistrationThe study discussed in the manuscript was registered as NCT02692495 at clinicaltrials.gov. The results were compared with our earlier study registered as NCT02683876.