bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous or intermittent feeding: pros and cons
Authors: Bear Danielle E. , Hart Nicholas , Puthucheary Zudin 
Published: June 2018

Purpose of review
There has been a recent shift in the focus of providing nutrition support to critically ill adults towards enhancing recovery and promoting survivorship. With this has come an evaluation of our current approaches to nutrition support, which includes whether continuous feeding is optimal, particularly for reducing muscle wasting, but also for managing blood glucose levels and feeding intolerance and at the organizational level. This review will discuss the pros and cons of using intermittent and continuous feeding relating to several aspects of the management of critically ill adults.

Recent findings
Few studies have investigated the effect of intermittent feeding over continuous feeding. Overall, intermittent feeding has not been shown to increase glucose variability or gastrointestinal intolerance, two of the reasons continuous feeding is the preferred method. A current study investigating the effect of intermittent vs. continuous feeding is awaited to provide insight into the effect of muscle wasting.

Summary
Although there are limited studies investigating the safety and efficacy of an intermittent rather than continuous feeding regimen in critically ill adults, there are several theoretical advantages. Further studies should investigate these and in the meantime, feeding regimens should be devised based on individual patient factors.
Vasodilatory shock in the ICU and the role of angiotensin II
Authors: Wakefield Brett J. , Sacha Gretchen L. , Khanna Ashish K. 
Published: June 2018

Purpose of review
There are limited vasoactive options to utilize for patients presenting with vasodilatory shock. This review discusses vasoactive agents in vasodilatory, specifically, septic shock and focuses on angiotensin II as a novel, noncatecholamine agent and describes its efficacy, safety, and role in the armamentarium of vasoactive agents utilized in this patient population.

Recent findings
The Angiotensin II for the Treatment of High-Output Shock 3 study evaluated angiotensin II use in patients with high-output, vasodilatory shock and demonstrated reduced background catecholamine doses and improved ability to achieve blood pressure goals associated with the use of angiotensin II. A subsequent analysis showed that patients with a higher severity of illness and relative deficiency of intrinsic angiotensin II and who received angiotensin II had improved mortality rates. In addition, a systematic review showed infrequent adverse reactions with angiotensin II demonstrating its safety for use in patients with vasodilatory shock.

Summary
With the approval and release of angiotensin II, a new vasoactive agent is now available to utilize in these patients. Overall, the treatment for vasodilatory shock should not be a one-size fits all approach and should be individualized to each patient. A multimodal approach, integrating angiotensin II as a noncatecholamine option should be considered for patients presenting with this disease state.
Assessment of human leukocyte antigen immunogenicity: current methods, challenges and opportunities
Authors: Copley Hannah C. , Elango Madhivanan , Kosmoliaptsis Vasilis 
Published: June 2018

Purpose of review
Donor–recipient human leukocyte antigen (HLA) matching improves outcomes after solid-organ transplantation, but current assessment of HLA incompatibility is inadequate as it does not consider the relative immunogenicity of individual HLA mismatches. In this article, we review existing strategies for assessing HLA immunogenicity and discuss current challenges and future opportunities in this field.

Recent findings
Current HLA immunogenicity algorithms focus primarily on the humoral component of the alloimmune response and aim to determine a measure of ‘dissimilarity’ between donor and recipient HLA. This can be achieved by deriving information from comparison of donor and recipient HLA at the amino acid sequence, structural and/or the physicochemical level, accounting for both B-cell and T-cell pathways of alloreactivity. Substantial evidence now supports the superiority of this molecular definition of HLA incompatibility, over conventional enumeration of HLA antigenic differences, for assessing the risk of humoral alloimmunity and for predicting graft outcomes after transplantation.

Summary
Significant progress has been made in developing computational HLA immunogenicity algorithms that offer exciting opportunities for a more rational approach to determining the degree of donor–recipient HLA incompatibility and to defining HLA-related immunological risk. A number of challenges now need to be overcome to enable their implementation into clinical practice.
Sustained Sexual Behavior Change After Acute HIV Diagnosis in Malawi
Authors: Rucinski Katherine B. , Rutstein Sarah E. , Powers Kimberly A. , Pasquale Dana K. , Dennis Ann M. , Phiri Sam , Hosseinipour Mina C. , Kamanga Gift , Nsona Dominic , Massa Cecilia , Hoffman Irving F. , Miller William C. , Pettifor Audrey E. 
Published: June 2018

Background
Identification of acute HIV infection (AHI) allows for important opportunities for HIV prevention through behavior change and biomedical intervention. Here, we evaluate changes in sexual risk behaviors among persons with AHI enrolled in a combined behavioral and biomedical intervention designed to reduce onward transmission of HIV.

Methods
Participants were randomized to standard HIV counseling, a multisession behavioral intervention, or a multisession behavioral intervention plus antiretrovirals. Sexual behaviors were assessed periodically over 1 year.

Results
Four weeks after diagnosis, the predicted probability of reporting multiple sexual partners decreased from 24% to 9%, and the probability of reporting unprotected sex decreased from 71% to 27%. These declines in sexual risk behaviors were sustained over follow-up irrespective of study arm.

Conclusions
Diagnosis of AHI alone may be sufficient to achieve immediate and sustained behavior change during this highly infectious period.
Repeat Chlamydia Diagnoses Increase the Hazard of Pelvic Inflammatory Disease among US Army Women: A Retrospective Cohort Analysis
Authors: Bautista Christian T. , Hollingsworth Bruce P. , Sanchez Jose L. 
Published: June 2018

Background
In the US military, chlamydia is the mostly commonly diagnosed bacterial sexually transmitted infection and the rates of pelvic inflammatory disease (PID) have remained high since the early 2000s.

Methods
The relationship between the number of chlamydia diagnoses and hazard of PID was investigated in a retrospective cohort analysis among US Army women from 2006 to 2012. Cox regression model was used to estimate hazard ratios for associations between the number of repeat chlamydia diagnoses and PID.

Results
The study population comprised 33,176 women with chlamydia diagnosis. Of these, 25,098 (75%) were diagnosed only once (“nonrepeaters”). By comparison, 6282 (19%), 1435 (4%), and 361 (1%) women had one, two and three repeat chlamydia diagnoses, respectively. Among these 4 groups, 1111, 325, 72, and 25 PID diagnoses were noted. According to the Cox regression analysis, for every additional diagnosis of chlamydia, the hazard of PID increased by 28% (95% confidence interval, 19%–38%) compared with women with a single diagnosis or nonrepeaters. Moreover, the corresponding adjusted hazard ratio of 1.28, 1.35, and 1.97 represented a significantly greater risk for PID among the three “repeater” groups compared with nonrepeaters.

Conclusions
We found an increased hazard of PID among US Army women with repeat chlamydia diagnoses and the characterization of a dose-response relationship. These findings reinforce the notion that early diagnosis and treatment of chlamydia is necessary to avoid subsequent PID and associated morbidity.
Narrative Medicine in Amyotrophic Lateral Sclerosis and a Rehabilitation Project Based on International Classification of Functioning, Disability and Health
Authors: Ciotti Silvia , Bianconi Fortunato , Saraceni Vincenzo Maria , Vulpiani Maria Chiara , Rinonapoli Giuseppe , Caraffa Auro , Zampolini Mauro 
Published: June 2018

Objective
The aim of the study was to systematize the disability condition related to amyotrophic lateral sclerosis patients using the International Classification of Functioning, Disability and Health (ICF) and narrative medicine approach as a common tool to identify a patient's functional problems. Once identified, this can be used as the basis for an individual rehabilitation project.

Design
This is an observational study on patients residing in a central region of Italy with a diagnosis of amyotrophic lateral sclerosis. The narrative approach involved listening to the patients' stories while guiding them with a semistructured questionnaire of 19 ICF items taken from the WHO Disability Assessment Schedule. A score from 0 to 4 for capacity (C) and performance (P) was adopted to evaluate each patient's functioning in their daily living activities.

Results
The ICF questionnaire was able to discriminate among responders (P < 0.001). The disability areas were in daily activities and social life (capacity 3–4, performance 3–4), whereas the performance items using facilitators were in the areas of communication, movement, personal care, and interaction with people (capacity 3–4, performance 1–2).

Conclusions
Narrative medicine using ICF in amyotrophic lateral sclerosis highlighted the main rehabilitation goals necessary to personalize a rehabilitation program, emphasizing the gap between capacity and performance. The environmental factors facilitating the areas of communication, movement, personal care, and interaction with people and not influencing daily activities and social life were identified.
Surgical Management and Outcomes of Pierre Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion
Authors: Zhang Rosaline S. , Hoppe Ian C. , Taylor Jesse A. , Bartlett Scott P. 
Published: June 2018

Summary:
There is a paucity of literature directly comparing tongue-lip adhesion versus mandibular distraction osteogenesis in surgical treatment of patients with Pierre Robin sequence. This study comprehensively reviews the literature for evaluating airway and feeding outcomes following mandibular distraction osteogenesis and tongue-lip adhesion. A search was performed using the MEDLINE and Embase databases for publications between 1960 and June of 2017. English-language, original studies subjects were included. Extracted data included prevention of tracheostomy (primary airway outcome) and ability to feed exclusively by mouth (primary feeding outcome). A total of 67 studies were included. Ninety-five percent of subjects (657 of 693) treated with mandibular distraction osteogenesis avoided tracheostomy, compared to 89% of subjects (289 of 323) treated with tongue-lip adhesion. Eighty-seven percent of subjects (323 of 370) treated with mandibular distraction osteogenesis achieved full oral feeds at latest follow-up. Seventy percent of subjects (110 of 157) treated with tongue-lip adhesion achieved full oral feeds at latest follow-up. The incidence of second intervention for recurrent obstruction ranged from 4 to 6 percent in mandibular distraction osteogenesis studies, compared to a range of 22 to 45 percent in tongue-lip adhesion studies. Variability of patient selection, surgical techniques, outcomes measurement methods, and follow-up length across studies precluded meta-analysis of the data. Both mandibular distraction osteogenesis and tongue-lip adhesion are effective alternatives to tracheostomy for patients who fail conservative management and improve feeding. Mandibular distraction osteogenesis may be superior to tongue-lip adhesion in long-term resolution of airway obstruction and avoidance of gastrostomy, but is associated with notable complications.
Anatomical Study of the Popliteal Artery Perforator–Based Propeller Flap and Its Clinical Application
Authors: Onishi Tadanobu , Shimizu Takamasa , Omokawa Shohei , Sananpanich Kanit , Kido Akira , Mahakkanukrauh Pasuk , Tanaka Yasuhito 
Published: June 2018

Summary:
There is lack of anatomical information regarding the cutaneous perforator of the popliteal artery and its connections with the descending branch of the inferior gluteal and profunda femoris arteries. The authors aimed to evaluate the anatomical basis of the popliteal artery perforator–based propeller flap from the posterior thigh region and to demonstrate their experience using this flap. Ten fresh cadaveric lower extremities were dissected following injection of a silicone compound into the femoral artery. The authors investigated the number, location, length, and diameter of cutaneous perforators of the popliteal artery. Based on the results, the authors treated three cases with a large soft-tissue defect around the knee using a popliteal artery perforator–based propeller flap. The authors found a mean of 1.9 cutaneous perforators arising from the popliteal artery, with a mean pedicle length of 6 cm and a mean arterial internal diameter of 0.9 mm, which were located at an average of 4 cm proximal to the bicondylar line. The most distal perforator consistently arose along the small saphenous vein and connected proximally with the concomitant artery of the posterior femoral cutaneous nerve, forming a connection with perforating arteries of the profunda femoris artery. A mean of 4.5 cutaneous perforators branched from the arterial connection sites. All clinical cases healed without any complications. The popliteal artery perforator–based propeller flap is reliable for reconstruction of soft-tissue defects around the knee. The flap should include the deep fascia and concomitant artery along with the posterior femoral cutaneous nerve for maintaining the blood supply.
New Strategies for Remnant Ear Treatment in Lobule-Type Microtia Reconstruction
Authors: Xu Zhicheng , Zhang Ruhong , Zhang Qun , Xu Feng , Li Datao , Li Yiyuan 
Published: June 2018

Background:
Numerous modifications have been successfully applied in microtia reconstruction over the past several decades, and lobular transposition has become a routine technique in a two-stage operation. However, it is still a demanding challenge to manipulate the remnant ear with various quantities or positions in lobule-type microtia. The authors demonstrate the relevant details of treating remnant tissue in different conditions.

Methods:
A total of 390 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2010 and 2015. Because the quantity or position of the remnant ear varies from patient to patient, corresponding tactics need to be taken into consideration for appropriate treatment. Four possible scenarios of remnant ear shape have been described, and relevant strategies for each were introduced.

Results:
Favorable reconstructed auricles with aesthetic natural earlobes have been produced; the location of the reconstructed ear is symmetric to the contralateral ear. It provides a harmonized framework and periphery tissue for the integrity of the contour of the constructed auricle.

Conclusions:
Proper use of the remnant ear along with framework fabrication and skin flap dissection are critical factors for attaining a satisfactory contour of the auricle in microtia reconstruction. The authors’ technique made it possible to construct a cosmetically refined ear with harmonious integrity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Multicenter Study of Device-Associated Infection Rates, Bacterial Resistance, Length of Stay, and Mortality in Intensive Care Units of 2 Cities of Vietnam: International Nosocomial Infection Control Consortium Findings
Authors: Viet Hung Nguyen , Hang Phan Thi , Rosenthal Victor D. , Thi Anh Thu Le , Thi Thu Nguyet Le , Quy Chau Ngo , Anh Thu Truong , Anh Dinh Pham Phuong , Hanh Tran Thi My , Hang Tran Thi Thuy , Van Trang Dang Thi , Tien Nguyen Phuc , Hong Thoa Vo Thi , Minh Đao Quang 
Published: June 2018

Objective
The aim of the study was to report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted from May 2008 to March 2015.

Methods
A device-associated healthcare-acquired infection surveillance study in three adult intensive care units (ICUs) and 1 neonatal ICU from 4 hospitals in Vietnam using U.S. the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) definitions and criteria as well as INICC methods.

Results
We followed 1592 adult ICU patients for 12,580 bed-days and 845 neonatal ICU patients for 4907 bed-days. Central line-associated bloodstream infection (CLABSI) per 1000 central line-days rate was 9.8 in medical/surgical UCIs and 1.5 in the medical ICU. Ventilator-associated pneumonia (VAP) rate per 1000 mechanical ventilator-days was 13.4 in medical/surgical ICUs and 23.7 in the medical ICU. Catheter-associated urinary tract infection (CAUTI) rate per 1000 urinary catheter-days was 0.0 in medical/surgical ICUs and 5.3 in the medical ICU. While most device-associated healthcare-acquired infection rates were similar to INICC international rates (4.9 [CLABSI]; 16.5 [VAP]; 5.3 [CAUTI]), they were higher than CDC/NHSN rates (0.8 [CLABSI], 1.1 [VAP], and 1.3 [CAUTI]) for medical/surgical ICUs, with the exception of CAUTI rate for medical/surgical ICU and CLABSI rate for the medical ICU. Because of limited resources of our Vietnamese ICUs, cultures could not be taken as required by the CDC/NHSN criteria, and therefore, there was underreporting of CLABSI and CAUTI, influencing their rates. Most device utilization ratios and bacterial resistance percentages were higher than INICC and CDC/NHSN rates.

Conclusions
Device-associated healthcare-acquired infection rates found in the ICUs of our study were higher than CDC/NHSN US rates, but similar to INICC international rates. It is necessary to build more capacity to conduct surveillance and prevention strategies.
Hematopoietically Active Adrenal Myelolipoma Mimicking Breast Cancer Metastasis
Authors: Manov John J. , Diaz-Bode Alexander , Kuker Russ 
Published: June 2018

Abstract
A 66-year old woman had a left breast mass. Biopsy showed invasive ductal carcinoma. A PET/CT scan demonstrated hypermetabolism in the left breast and atypical heterogeneously increased uptake throughout the skeleton as well as a minimally FDG-avid right adrenal myelolipoma. PET/CT 4 months later after 6 cycles of neoadjuvant chemotherapy demonstrated increased size and FDG avidity of this adrenal mass concerning for metastasis and uniformly increased skeletal FDG avidity. Biopsy demonstrated adrenal myelolipoma. The growth and increased FDG avidity of the adrenal myelolipoma were due to the action of colony-stimulating factors on the tumor's hematopoietic component.
The Arkansas Tessier Number 3 Cleft Experience: Soft Tissue and Skeletal Findings With Primary Surgical Management: Four-Step Approach
Authors: Golinko Michael S. , Pemberton John D. , Phillips James , Johnson Adam , Hartzell Larry D. 
Published: June 2018

Abstract
Tessier No 3 facial cleft (oro-nasal-ocular clefts) is the rarest and most challenging of all the Tessier clefts. Reports on Tessier No 3 clinical findings, surgical techniques, and outcomes are varied due to the scarcity of patients and the wide range of phenotypic findings. The authors present our experience of 2 children born with Tessier No 3 clefts who were both managed at the Arkansas Children's Hospital. Our purpose is to add knowledge on this rare craniofacial cleft by providing detailed soft tissue findings, skeletal findings, operative techniques, early postoperative outcome, and suggestions of a treatment protocol.
Both were born at 38 weeks gestation and had multiple associated anomalies including: syndactyly, limb anomalies, cardiac defects, and encephalocele in Patient 1 and hydrocephalus and dysphagia in Patient 2. While both patients had a bilateral cleft lip and palate, Patient 1 had a severe left-sided cleft and Patient 2 had a right-sided incomplete cleft. A multidisciplinary team of specialists in Plastic Surgery, Otolaryngology, and Oculoplastics were assembled to devise a top–down approach for repair. In brief, our surgical sequence for both infants was a dorsal nasal Reiger flap to level the ala, cheek advancement flap along with medial canthal repositioning, and more traditional bilateral cleft lip repair using a modified Millard technique. Postoperatively, Patient 1 experienced some early scarring, medial canthal rounding, lagophthalmos, and cicatricial retraction of the lower lid and patient 2 demonstrated under-correction of the displaced ala but had satisfactory medial canthal position.
Future evaluations will include serial photography and annual 3-dimensional computed tomography scans to evaluate the soft tissue and bony growth. After these initial procedures, both infants will be followed for routine cleft clinical and surgical care.
Benign Paroxysmal Positional Vertigo After Piezosurgical Removal of Osseointegrated Implants
Authors: Messina Antonello Maria , Marini Ettore 
Published: June 2018

Abstract
With the increasing popularity of dental implants, the explantation of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. We report a case of benign paroxysmal positional vertigo (BPPV) developed immediately after piezosurgical removal of osteointegrated implants.
The BPPV may be an unpleasant complication of piezosurgical removal of osseointegrated implants and may cause considerable stress if not identified correctly and managed properly.
Therapeutic Protocol for Orthosurgical Management of Class III Malocclusion in Patients With Cleidocranial Dysostosis
Authors: Barth Fernando André , Menuci Neto Angelo , Almeida-Pedrin Renata Rodrigues , Ladewig Victor de Miranda , Conti Ana Cláudia de Castro Ferreira 
Published: June 2018

Abstract
Cleidocranial dysostosis (CCD) is a congenital skeletal disorder with significant manifestations in facial and dental development. Patients are affected with CCD present maxillary deficiency, late dental eruption, and supernumerary teeth. Early and multidisciplinary approach is necessary to treat CCD patients, especially to manage dental eruption and Class III malocclusion with maxillary deficiency. Several orthodontic and surgical interventions are performed to enable traction and extraction of teeth. Yet the maxillary deficiency may be protracted followed by orthodontic dental compensation. On the other hand, it is important to note that CCD patients’ treatment is closely related to the severity of transversal and sagittal deformities, as well as the discrepancies in the lower third of the face. In this context, patients with facial impairment highly affected by CCD may need ortho-surgical decompensation to reach more aesthetic outcomes. The present study reports a case of a 14-year-old young patient affected by CCD. Clinically, the patient presented Class III malocclusion, maxillary deficiency, short lower facial third, posterior crossbite, and anterior open bite leading to facial disharmony. The patient underwent treatment in 2 stages: the interceptive approach aimed to transversally expand the maxilla and promote its protraction; and the corrective phase combined with the orthognathic surgery treated the patients’ main complains; the anterior open bite, unerupted teeth, and chin prominence. The treatment approach applied in the clinical report allowed the correction of the malocclusion and facial profile satisfying completely the patient's expectations.