bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Predictors of Reduced Marginal Reflex Distance After Upper Blepharoplasty
Authors: Putthirangsiwong Bunyada , Katsev Blake , Steinsapir Kenneth D. , Goldberg Robert A. , Rootman Daniel B. 
Published: March 2019

The authors’ study demonstrates a 15% incidence of postoperative MRD1 reduction after upper eyelid blepharoplasty. Orbicularis oculi muscle removal was significantly associated with this occurrence.

Purpose:
Ptosis may occur in certain cases after upper blepharoplasty. The authors aim to characterize the incidence of postoperative marginal reflex distance (MRD1) reduction after upper blepharoplasty and surgical variables that may predict this occurrence.

Methods:
In this cross-sectional study, patients > 18 years old undergoing upper blepharoplasty were screened. Patients were excluded if they had any history of ptosis and brow surgery. Data regarding the excision of skin, muscle, fat, and brow fat as well as crease formation were documented. The distance in millimeter from the center of the pupil to the upper eyelid margin in the midpupillary line (MRD1) was measured digitally. The primary outcome measure was a postoperative reduction in MRD1 of >1 mm. Secondary outcome was overall mean change in MRD1 and the incidence of ptosis as defined by a final MRD1 ≤ 2.5 mm.

Results:
The final sample consisted of 100 patients (200 eyelids) and the mean age was 55.8 years. There were 65 patients with orbicularis muscle removal, 52 patients with postseptal fat removed, and 9 patients with crease formation. Overall 15 patients developed MRD1 decrease of greater than 1 mm (5 bilaterally and 10 unilaterally) with 7 eyes demonstrating a final MRD1 of ≤ 2.5 mm. In multivariate modeling, muscle removal was found to be the only variable with significant impact on the development of MRD1 reduction > 1 mm after upper blepharoplasty (p < 0.05, odds ratio = 8.2). The other variables did not significantly contribute. The overall mean (SD) MRD1 was 3.43 mm (1.1) preoperatively and 3.62 mm (1.1) postoperatively (p < 0.01).

Conclusions:
Fifteen percent of patients demonstrated a reduction in MRD1 > 1 mm after upper eyelid blepharoplasty, and those with orbicularis resection were more likely to experience this change.
Collaborative care intervention for patients with chronic heart failure
Authors: Cui Xiaoting , Dong Wenyi , Zheng Hongxiao , Li Haiyan 
Published: March 2019

Abstract

Introduction:
Patients with chronic heart failure (HF) show many symptoms that worsen the quality of life (QoL). Collaborative care intervention (CCI) aims to improve the QoL and symptoms by integrating psychosocial and palliative strategies in chronic care.

Methods:
The PubMed, EMBASE, and Cochrane library databases were searched from inception to September 2018. The included studies were used to determine pooled standard mean differences (SMDs) and associated 95% confidence intervals (CIs). The data were assessed by fixed- and random effects models, respectively.

Results:
Twenty-one studies including 2999 patients with chronic heart failure were included. The results showed significantly improved QoL in the CCI group compared with the routine care group (SMD = 0.60, 95%CI 0.27–0.94, P
heterogeneity < .001, I
2 = 94.1%). The patients who received face-to-face interventions experienced a significant improvement (SMD = 0.54, 95%CI 0.24–0.85, P
heterogeneity < .001, I
2 = 88.7%) in terms of QoL compared with those administered only telephone interventions. Furthermore, significantly improved anxiety level (SMD = 0.33, 95%CI 0.12–0.55, P
heterogeneity = .612, I
2 = 0%) and 6-min walk test (SMD = 0.46, 95%CI 0.29–0.64, P
heterogeneity = .458, I
2 = 0%) were found in the CCI group compared with the routine care group.

Conclusion:
These findings confirmed that collaborative care intervention effectively improves the quality of life as well as psychological (anxiety) and physical (6-min walk test) functions in patients with chronic heart failure compared with routine care. Furthermore, face-to-face interventions show a greater improvement of QoL compared with telephone-only interventions.
Successful management of lower limb nonunion using locking plates and bone graft with retention of intramedullary nail
Authors: Zhang Hong-Jun , Wang Shuai , Dong Yong-Hui , Zheng Wen-Di , Sun Zhe , Zheng Jia 
Published: March 2019

Abstract
This study aims to investigate the clinical effect of the combined an additional locking plate with bone graft based on retaining the original intramedullary nail for the treatment of lower limb nonunion.
From June 2008 to December 2012, 39 patients were admitted and treated, who developed non-infectious bone nonunion after intramedullary nail fixation for long bone fracture in the lower limb. Additional locking plate and autogenous iliac bone grafting were performed for these patients, in which the original intramedullary nail was retained. Follow-ups were performed once at postoperative months 1, 2, 3, 6, and 12, and every year onwards. During these follow-ups, imaging and clinical function examinations were performed, in order to observe callus growth and the fractured limb functions.
All patients have been followed-up, in which the duration of these follow-ups ranged between 8 and 24 months. All patients gained bony union within 6 to 11 months, and the healing rate was 100%. Radiographic healing time ranged between 8 and 15 months. Full weight-bearing time ranged between 2 and 10 months. According to Harris hip scores and Hospital for Special Surgery (HSS) Knee joint scores, 17 cases were excellent, 2 cases were good, and 1 case was acceptable; with an excellent and good rate of 95.00%. According to HHS score for the knee, 15 cases were excellent, 3 cases were good, and 1 case was acceptable; with an excellent and good rate of 94.74%.
The combined treatment of the additional blocking plate with bone grafting based on retaining the original intramedullary nail for bone nonunion could effectively eliminate lateral and rotatory instability of the fractured ends. This surgical method had a short operation time, high healing rate and other advantages.
Acute myeloid leukemia in an 86-year-old man with AML1/ETO treated with Homoharringtonine and Arsenic Trioxide
Authors: He Zhipeng , Chen Meiling , Huang Yiping , Chen Lili , Wang Bixin , Wang Huixian , Yang Mengting , Xiao Xueting , Lu Yanhong , Chen Jiaying , Wu Yong 
Published: March 2019

Abstract

Rationale:
Acute myeloid leukemia (AML) is a malignantly clonal and highly heterogeneous disease. Although the treatment of AML has brought promising outcomes for younger patients, prognosis of the elderly remains dismal. Innovative regimens are increasingly necessary to be investigated.

Patient concerns:
We present an 86-year-old AML patient with fever, cough, and sputum production.

Diagnoses:
A diagnosis of AML with maturation (AML-M2) and AML1/ETO was made.

Interventions:
The patient was treated with a regimen of Homoharringtonine coupled with arsenic trioxide.

Outcomes:
The AML-M2 patient with AML1/ETO achieved incomplete remission, but showed few toxic side effects and improved survival. Besides, we analyzed the dynamic counts of complete blood cells during the treatment. The count of white blood cell had a positive correlation with the percentage of blast cells (r = 0.65), both of which had a negative correlation with the percentage of segmented neutrophils (r = –0.63, –0.89).

Lessons:
Homoharringtonine and arsenic trioxide may induce both the apoptosis and differentiation of leukemic cells in AML-M2 with AML1/ETO.
Paediatric Colonoscopy Direct Observation of Procedural Skills
Authors: Siau Keith , Levi Rachel , Iacucci Marietta , Howarth Lucy , Feeney Mark , Anderson John T , Tzivinikos Christos , Thomson Mike , Narula Priya 
Published: March 2019

ABSTRACTIntroduction:The paediatric series of direct observation of procedural skills (DOPS) were introduced into the UK national endoscopy training curriculum in 2016, but lack validity evidence. We aimed to present validity evidence for paediatric colonoscopy DOPS and study competency development in a national trainee cohort.Methods:This prospective UK‐wide study analysed formative paediatric colonoscopy DOPS which were submitted to the e‐Portfolio between 2016 and 2018. Item, domain, and average DOPS scores were correlated with the overall DOPS rating to evidence internal structure validity. Overall DOPS ratings were compared over lifetime procedure count to demonstrate learning curves (discriminant validity). Consequential validity was founded on receiver operating characteristic curve analyses.Results:A total of 203 DOPS assessments were completed for 29 trainees from 11 UK training centres. Internal structure validity was provided through item‐total correlation analyses. DOPS scores positively correlated with trainee seniority (P < 0.001) and lifetime procedure count (P < 0.001). Competency acquisition followed the order of: “preprocedure,” “postprocedure,” “endoscopic nontechnical skills,” “management,” “procedure” domains, followed by overall DOPS competency, which was achieved in 81% of the cohort after 125 to 149 procedures. Mean DOPS scores could be used to predict overall procedure competence (area under receiver operating characteristic curve 0.969, P < 0.001), with a mean score of 3.9 demonstrating optimal sensitivity (93.5%) and specificity (87.6%).Conclusions:This study provides validity evidence supporting the use of paediatric colonoscopy DOPS as an in‐training competence assessment tool. DOPS may also be used to measure competency development and benchmark performance during training, which may be of value to trainees, trainers, and training programmes.
Multilocus sequence typing and antibiotic resistant patterns of the meticillin-resistant Staphylococcus aureus isolates from different clinical specimens
Authors: Valadan Tahbaz Sahel , Azimi Leila , Nowroozi Jamileh , Armin Shahnaz , Fallah Fateme 
Published: March 2019

Backgrounds:
Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging threat worldwide. Community-associated-MRSA strains differ from hospital-acquired MRSA strains in their genetic backgrounds, pathogenicity, and antibiotic susceptibilities. Although few studies have reported the epidemiology of the different community-associated-MRSA and hospital-acquired-MRSA clones present, there are insufficient data available on MRSA characteristics in Iran. The present cross-sectional study was conducted to explore the prevalence of MRSA, the antimicrobial susceptibility of the strains, and the molecular epidemiology of such MRSA isolates from a hospital in Tabriz, Iran.

Methods:

S. aureus isolates were collected from patients with clinical signs and symptoms of infection admitted to Imam Reza Hospital, from September 2016 to March 2017 in Tabriz, Iran. Standard conventional biochemical tests for identification of the isolates were performed on colonies from primary cultures. The antibiotic susceptibility testing was performed using the standardized Kirby–Bauer disc-diffusion method on Mueller–Hinton agar. All methicillin-resistant isolates were archived for subsequent molecular tests, including PCR for mecA gene and multilocus sequence typing.

Results:
Among 39 S. aureus isolates enrolled, 33.3% (13/39) were identified as MRSA strains. Antibiotic susceptibilities to erythromycin, ciprofloxacin, and clindamycin, were measured as, 48.7, 46.2, and 35.9%, respectively. All of the 39 isolates were susceptible to vancomycin and linezolid. Sequence type (ST)-238 was the predominant clone (15.3%), and ST585, ST1, ST88, ST45, ST158, ST1097, ST2373, and ST2873 were other detected sequence type. In addition, two undetermined sequence type (a sequence type was not matched to any sequence type identified) were detected in this study.

Conclusion:
ST238 strains, which were previously not found as MRSA, could now widely distribute in Iranian population. In addition, the resistance rate of MRSA strains against multiple classes of antibiotics should be considered when selecting empirical antibiotics for MRSA infections in Iran.
Expanded Algorithm and Updated Experience with Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction Mammaplasty in the Large or Ptotic Breast
Authors: Economides James M. , Graziano Francis , Tousimis Eleni , Willey Shawna , Pittman Troy A. 
Published: March 2019

Background:
Staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty was first described in 2011 by Spear et al. to expand the indications for nipple-sparing mastectomy to women with large or ptotic breasts. Since that time, the authors have revised their treatment algorithm and technique to enhance oncologic safety and improve wound healing complications.

Methods:
An institutional review board–approved retrospective review was undertaken of all patients undergoing staged nipple-sparing mastectomy following mastopexy or reduction mammaplasty at a single institution from July of 2011 through July of 2016. Management followed an updated treatment protocol to improve surgical and oncologic outcomes.

Results:
Twenty-six patients (50 breasts) were identified who underwent staged nipple-sparing mastectomy. Five breasts (10 percent) required reoperation for a complication such as infection or tissue necrosis. Two devices (4 percent), both in the therapeutic cohort, required explantation because of infection. Skin flap necrosis and nipple-areola complex necrosis were each seen in two breasts (4 percent). Infection was seen in four breasts (8 percent), and wound healing complications were seen in only two breasts (4 percent).

Conclusions:
The authors offer their updated treatment algorithm for a staged approach to nipple-sparing mastectomy for patients with macromastia or grade II or III ptosis. Their results build on previously published reports demonstrating the safety and efficacy of this approach for nipple preservation and oncologic management in this patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics
Authors: Bloch Karen C. , Bailin Samuel S. 
Published: March 2019

Purpose of review
Fungal infections of the central nervous system (CNS) are relatively uncommon but associated with significant morbidity and mortality. We reviewed recent literature highlighting new approaches to management of these complex patients.

Recent findings
Fungal infections are increasingly recognized as important causes of CNS disease in both immunocompromised and immunocompetent hosts. Globally, cryptococcal meningitis remains a leading cause of death in HIV-infected persons in resource-limited settings. Emerging fungal pathogens with increased virulence and resistance to numerous classes of antifungal agents have been identified and represent a management challenge. Newer diagnostic techniques focused on antigen detection or molecular amplification of fungal pathogens offer promise in the expediated diagnosis and treatment of CNS fungal infections.

Summary
Meningitis and brain abscess because of invasive fungal pathogens are frequently fatal infections. Newer laboratory tests allowing antigen detection or molecular amplification from cerebrospinal fluid are more sensitive than culture and allow earlier initiation of effective therapy.
Cleft Rhinoplasty Study and Evolution
Authors: Agochukwu-Nwubah Nneamaka , Boustany Ashley , Vasconez Henry C. 
Published: March 2019

Background:
Most patients with a cleft lip will have a cleft lip nasal deformity. The nasal deformities are complex and are difficult to surgically correct as a result of the anatomical issues and deficiencies. In this study, the authors analyzed and reviewed nasal pathology and surgical maneuvers in patients with cleft lip nasal deformity treated by the senior author over the past 15 years.

Methods:
A retrospective review was performed on patients who underwent a rhinoplasty for a cleft nasal deformity from the years of 2002 to 2017. Patients were stratified by unilateral and bilateral cleft lip. For each variable, comparisons were made between unilateral and bilateral cases.

Results:
39 patients had a unilateral cleft lip nasal deformity, while 17 had a bilateral cleft lip nasal deformity. Patients with a unilateral cleft nasal deformity had a significantly higher incidence of vestibular stenosis and septal deviation. Regarding surgical maneuvers, unilateral cleft lip patients had a relatively higher utilization of septoplasty, spreader grafts, and alar grafts compared to bilateral cleft lip patients. Bilateral cleft lip patients had a relatively higher utilization of dorsal hump reduction, columella strut grafts, and nasal tip grafts. These differences were not statistically significant. Unilateral cleft lip patients had a statistically significant higher use of alveolar support at the time of rhinoplasty.

Conclusions:
The rhinoplasty operation in patients with cleft lip nasal deformity is uniquely challenging and rewarding. This operation has undergone an evolution in our own practice and has led to improved outcomes for these patients.
High-Velocity Ballistic Injuries Inflicted to the Maxillofacial Region
Authors: Jose Anson , Arya Saurabh , Nagori Shakil 
Published: March 2019

Background & Aim:
Gun-shot trauma inflicted to the maxillofacial region results in multiple injuries which significantly impacts management and reconstructive options. The authors investigated the efficacy/outcomes of primary management of maxillofacial trauma inflicted in ballistic injuries.

Methods:
This is a retrospective descriptive study carried out solely at 15 Corps Dental Unit, a tertiary care military hospital at Srinagar between the year 2016 & 2017. At the time of enrolment age, gender, extent of injury and definitive diagnosis were recorded. Other information such as type of surgery, hospital stay was taken from in-patient hospital record documents. An informed consent was taken from all patients.

Results:
A total of 16 patients (all males) with a mean age of 29.6 ± 4.2 years were part of our study. The average time interval between trauma and surgery was 7 to 10 days. There was striking high prevalance of mandibular injuries in 62.5% patients, 18.7% patients having combined maxilla-mandibular defects and 12.5% patients with injuries around the mid-face. Complications such as immediate airway compromise were seen in 50% of the patients who suffered direct airway trauma necessitating tracheostomy. The 43.7% patients suffered nerve injuries at the time of presentation while 56.2% patients suffered scar contracture noted at follow-up of 1 year. One patient suffered a stellate wound with ragged and torn edges and also trauma to the parotid gland. Other salivary gland injuries were also noted in 18.7% patients. Reconstruction using local flaps was done in 3 patients of our series. The mean duration of hospital stay was 43.3 ± 33.5 days. An average follow up ranged from 12 ± 6 months.

Conclusions:
Early and appropriate intervention to preserve and stabilise the facial skeleton and reconstruction of the facial soft tissue envelope in high-velocity ballistic injuries is highly effective and yields superior functional and esthetic outcomes.
A multidimensional functional fitness score is a stronger predictor of type 2 diabetes than obesity parameters in cross sectional data
Authors: Patil Pramod , Lalwani Poortata S , Vidwans Harshada B , Kulkarni Shubhankar A , Bais Deepika , Diwekar-Joshi Manawa M , Rasal Mayur , Bhasme Nikhila , Naik Mrinmayee , Batwal Shweta , Watve Milind G 
Published: March 2019

AbstractObjectiveWe examine here whether multidimensional functional fitness is a better predictor of type 2 diabetes as compared to morphometric indices of obesity such as body mass index (BMI) and waist to hip ratio (WHR).Research design and methodWe analysed retrospective data of 663 volunteer participants (285 males and 378 females between age 28 and 84), from an exercise clinic in which every participant routinely undergoes a health related physical fitness (HRPF) assessment consisting of 15 different tasks examining 8 different aspects of functional fitness.ResultsThe odds of being diabetic in the highest quartile of BMI were not significantly higher than that in the lowest quartile in either of the sexes. The odds of being a diabetic in the highest WHR quartile were significantly greater than the lowest quartile in females (OR = 4.54 (1.95, 10.61) as well as in males (OR = 3.81 (1.75, 8.3). In both sexes the odds of being a diabetic were significantly greater in the lowest quartile of HRPF score than the highest (males OR = 10.52 (4.21, 26.13); females OR = 10.50 (3.53, 31.35)). HRPF was not correlated with BMI in both sexes but was negatively correlated with WHR. After removing confounding, the predictive power of HRPF was significantly greater than that of WHR.ConclusionMultidimensional functional fitness score was a better predictor of type 2 diabetes than obesity parameters in the Indian population.
Landscape epidemiology of ash dieback
Authors: Grosdidier M. , Scordia T. , loos R. , Marçais B. 
Published: March 2019

AbstractAsh dieback caused byHymenoscyphus fraxineus, an invasive alien pathogen, has been severely damaging European ash populations. Nevertheless, a large range of disease severities was observed at the landscape scale in the field. Several studies suggested that environment, such as climate, site conditions or local tree cover strongly affects ash dieback. We characterized the landscape epidemiology of the disease at two stages of the invasion process with spatio-temporal models using Bayesian models fitted by Integrated Nested Laplace Approximation (INLA). We first analyzed the effect of landscape features on the disease arrival and establishment stage at the scale of a village in NE France in 2012, 2 years after first report of the disease in the area and then, on the disease development stage in 2016-18. Landscape features had little impact on the disease at the establishment stage but strongly determined it further development. The local fragmentation of the tree cover was the most important factor with trees isolated or in hedges in agricultural settings far less affected then trees in forest environment. We showed that they were subjected to different microclimate with higher crown temperatures unfavorable to the pathogen development. Furthermore, host density was important for disease development with ash at low density far less affected by ash dieback. Presence of ashes in the vicinity affected local disease severity up to several hundred meters. These results may help to develop management strategy for the disease.
The ability of single genes vs full genomes to resolve time and space in outbreak analysis
Authors: Dudas Gytis , Bedford Trevor 
Published: March 2019

AbstractInexpensive pathogen genome sequencing has had a transformative effect on the field of phylodynamics, where ever increasing volumes of data have promised real-time insight into outbreaks of infectious disease. As well as the sheer volume of pathogen isolates being sequenced, the sequencing of whole pathogen genomes, rather than select loci, has allowed phylogenetic analyses to be carried out at finer time scales, often approaching serial intervals for infections caused by rapidly evolving RNA viruses. Despite its utility, whole genome sequencing of pathogens has not been adopted universally and targeted sequencing of loci is common in some pathogen-specific fields. In this study we aim to highlight the utility of sequencing whole genomes of pathogens by re-analysing a well-characterised collection of Ebola virus sequences in the form of complete viral genomes (~19kb long) or the rapidly evolving glycoprotein (GP, ~2kb long) gene. We quantify changes in phylogenetic, temporal, and spatial inference resolution as a result of this reduction in data and compare these to theoretical expectations. We propose a simple intuitive metric for quantifying temporal resolution,i.e.the time scale over which sequence data might be informative of various processes as a quick back-of-the-envelope calculation of statistical power available to molecular clock analyses.