bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Modified Lateral Intercostal Artery Perforator Flap
Authors: Meybodi Farid , Cocco Annelise M. , Messer David , Brown Alexander , Kanesalingam Kavitha , Elder Elisabeth , Hsu Jeremy , French James 
Published: February 2019

Background:
The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient.

Methods:
All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 “lazy S” lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect.

Results:
Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively.

Conclusions:
Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.
Skin Necrosis following Rhinoplasty
Authors: Mrad Mohamed A. , Almarghoub Mohammed A. 
Published: February 2019

Summary:
Rhinoplasty is one of the most common cosmetic procedures performed by plastic surgeons worldwide. It is among the top 5 common aesthetic procedures in the United States. The complications rate in rhinoplasty is 8–15%, and a majority of these complications are not life-threatening. One of the rare complications reported is skin necrosis. In our article, we report 2 cases that developed skin necrosis on the nasal dorsum following rhinoplasty.
Fat Chance: The Rejuvenation of Irradiated Skin
Authors: Borrelli Mimi R. , Patel Ronak A. , Sokol Jan , Nguyen Dung , Momeni Arash , Longaker Michael T. , Wan Derrick C. 
Published: February 2019

Summary:
Radiotherapy (RT) helps cure and palliate thousands of patients with a range of malignant diseases. A major drawback, however, is the collateral damage done to tissues surrounding the tumor in the radiation field. The skin and subcutaneous tissue are among the most severely affected regions. Immediately following RT, the skin may be inflamed, hyperemic, and can form ulcers. With time, the dermis becomes progressively indurated. These acute and chronic changes cause substantial patient morbidity, yet there are few effective treatment modalities able to reduce radiodermatitis. Fat grafting is increasingly recognized as a tool able to reverse the fibrotic skin changes and rejuvenate the irradiated skin. This review outlines the current progress toward describing and understanding the cellular and molecular effects of fat grafting in irradiated skin. Identification of the key factors involved in the pathophysiology of fibrosis following RT will inform therapeutic interventions to enhance its beneficial effects.
Lymphovascular Invasion and the Decision for Postmastectomy Radiation Therapy: A Cautionary Case Report
Authors: Jensen J. Arthur , Bakkar Rania , Burnison Michele , Giuliano Armando E. 
Published: February 2019

Summary:
Breast reconstruction is frequently adversely affected by postmastectomy radiation therapy. Some radiation therapists recommend postmastectomy radiation therapy based on the finding of lymphovascular invasion in the context of other findings. However, the diagnosis of lymphovascular invasion varies between pathologists and institutions. Sometimes special endothelial cell stains and outside opinions are necessary for the decision for postmastectomy radiation therapy. This case report illustrates the variation in the diagnosis of lymphovascular invasion. Plastic surgeons must remain current on the standard indications for postmastectomy radiation therapy and on the basic findings of lymphovascular invasion.
Socioeconomic Disparities in Brachial Plexus Surgery: A National Database Analysis
Authors: Bucknor Alexandra , Huang Anne , Wu Winona , Fleishman Aaron , Egeler Sabine , Chattha Anmol , Lin Samuel J. , Iorio Matthew L. 
Published: February 2019

Background:
Brachial plexus injuries have devastating effects on upper extremity function, with significant pain, psychosocial stress, and reduced quality of life. The aim of this study is to identify socioeconomic disparities in the receipt of brachial plexus repair in the emergent versus elective setting, and in the use of supported services on discharge.

Methods:
Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database was performed for the years 2009–2014. Adults with brachial plexus injury with or without nerve repair were identified; patient and hospital specific factors were analyzed.

Results:
Overall, 6,618 cases of emergent brachial plexus injury were retrieved. Six hundred sixty cases of brachial plexus repair were identified in the emergency and elective settings over the study period. Of the 6,618 injured, 153 (2.3%) underwent nerve surgery during the admission. Patients undergoing repair in the elective setting were more likely to be white males with private insurance. Patients treated in the emergency setting were more likely to be African American and in the lowest income quartile. Significant differences were also seen in supported discharge: more likely males (P < 0.001), >55 years of age (P < 0.001), white (P < 0.001), with government-based insurance (P < 0.001).

Conclusions:
There are significant disparities in the timing of brachial plexus surgery. These relate to timing rather than receipt of nerve repair; socioeconomically advantaged individuals with private insurance in the higher income quartiles are more likely to undergo surgery in the elective setting and have a supported discharge.
Numerical Simulation Based on Individual Voxel Phantoms for a Sophisticated Evaluation of Internal Doses Mainly From 131I in Highly Exposed Workers Involved in the TEPCO Fukushima Daiichi NPP Accident
Authors: Kunishima Naoaki , Tani Kotaro , Kurihara Osamu , Kim Eunjoo , Nakano Takashi , Kishimoto Riwa , Tsuchiya Hiroki , Omatsu Tokuhiko , Tatsuzaki Hideo , Tominaga Takako , Watanabe Sadahiro , Ishigure Nobuhito , Akashi Makoto 
Published: February 2019

Abstract
As a response to the Tokyo Electric Power Company’s Fukushima Daiichi nuclear power plant accident in 2011, seven TEPCO workers whose exposure doses were expected to be >250 mSv (a tentative dose limit stipulated by the Japanese central authority) attended Japan’s National Institute for Radiological Sciences for additional internal dose measurements. The National Institute for Radiological Sciences examination revealed that these workers’ internal doses came mainly from their intake of the radionuclide 131I during emergency operations. In this study, we performed numerical simulations based on individual volume-pixel (voxel) phantoms of six of the seven workers for a more sophisticated evaluation of their internal doses, taking into account the individual thyroid size and other specific parameters. The voxel phantoms were created from magnetic resonance imaging scan images. As a result, the individual thyroid volumes ranged from 6.5 to 28.2 cm3 and were considerably smaller than the reference value (~20 cm3) adopted in the International Commission on Radiation Protection’s dosimetric model for four of the six subjects. Compared to the original estimates of the thyroid absorbed dose, our preliminary evaluation revealed values that were increased by approximately 3-fold or decreased by 30% at maximum. A wide difference in the individual thyroid size would be one of the significant modifiers in the current dose estimation of subjects of the ongoing epidemiological study project. The present simulations also provided evidence that the direct thyroid measurements by the National Institute for Radiological Sciences to determine the workers’ 131I thyroid contents were sufficiently accurate.
ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain
Authors: Miller Chadwick D. , Stopyra Jason P. , Mahler Simon A. , Case L. Doug , Vasu Sujethra , Bell Ronny A. , Hundley W. Gregory 
Published: February 2019

Background:
Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity.

Methods:
A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients. Three hundred thirty-four participants with symptoms and findings indicating intermediate to high risk for acute coronary syndrome were enrolled in 3 clinical trials. Major exclusions were ST-segment elevation, initial troponin elevation, and hemodynamic instability. Participants were randomly assigned to receive usual inpatient care, or ACES. The ACES care pathway includes placement in observation for serial cardiac markers, with an expectation for stress imaging. The primary outcome was index visit objective cardiac testing, compared among AA and White participants.

Results:
AA participants represented 111/329 (34%) of the study population, 80/220 (36%) of the ACES group and 31/109 (28%) of the usual care group. In usual care, objective testing occurred less frequently among AA (22/31, 71%) than among White (69/78, 88%, P = 0.027) participants, primarily driven by cardiac catheterization (3% vs. 24%; P = 0.012). In ACES, testing rates did not differ by race [AA 78/80 (98%) vs. White 138/140 (99%); P = 0.623]. At 90 days, death, MI, and revascularization did not differ in either group between AA and White participants.

Conclusions:
A care pathway with the expectation for stress imaging eliminates the racial disparity among AA and White participants with chest pain in the acquisition of index-visit cardiovascular testing.
Genomic Analysis of an Obesity Paradox: A Microarray Study of the Aortas of Morbidly Obese Decedents With Mild and Severe Atherosclerosis
Authors: Brodsky Sergey V. , Ganju Ramesh , Mishra Sanjay , Ivanov Iouri , Fadda Paolo , Wang Huabao , Barth Rolf F. 
Published: February 2019

Background:
Atherosclerosis of the aorta and coronary arteries is still one of the major causes of death. We recently reported obesity paradox between body mass index and atherosclerosis of the aortas (AA) in morbidly obese decedent patients. The cause of this obesity paradox is unknown. The aim of the present study was to carry out genomic microarray analysis to determine gene expression profiles in the aortas of morbidly obese decedents with either mild or severe atherosclerosis of the aorta.

Methods:
Microarray studies using Affymetrix GeneChips Clariom D Human array chips were performed on the aortas obtained from 6 morbidly obese decedents, 3 of whom had minimal AA and 3 who had severe disease.

Results:
Group 1 (severe AA) and group 2 (mild AA) included 3 patients each. The patients were matched by age and body mass index. There were significant (P<0.005) differences in the expressions of 1067 genes between groups 1 and 2, including 602 upregulated and 465 downregulated genes.

Conclusions:
Our data show significantly different gene signatures between morbidly obese decedents who have mild or severe AA, suggesting that genetic factors may be important contributors to the obesity paradox as it relates to aortic atherosclerosis. Further studies are warranted to define differences in protein expression in the aortas of these 2 groups to further elucidate the cause of this obesity paradox.
Improving Door-to-needle Times in the Treatment of Acute Ischemic Stroke Across a Canadian Province: Methodology
Authors: Kamal Noreen , Jeerakathil Thomas , Mrklas Kelly , Smith Eric E. , Mann Balraj , Valaire Shelley , Hill Michael D. 
Published: February 2019

Background:
Alteplase is a proven medical treatment for acute ischemic stroke; however, the effectiveness of this treatment is highly time dependent. Therefore, it is imperative that hospitals treat acute ischemic stroke patients as quickly as possible. The measure, door-to-needle time, is the time from hospital arrival to when alteplase administration begins.

Objective:
The goal in the Canadian province of Alberta was to reduce the door-to-needle time to a median of 30 minutes and to increase the percent of patients treated within 60 minutes to 90%.

Overview of Methodology:
A modified version of Institute for Healthcare Improvement Breakthrough Series Collaborative was used. All stroke centers self-enrolled into the collaborative after initial contact, and sites created interdisciplinary teams to participate in the Collaborative. Leadership and faculty were highly experienced in quality improvement and acute stroke. There were 3 daylong face-to-face learning sessions that were attended by enrolled teams, which included presentation about the evidence, site presentations to promote cross-site learning, and time to plan changes with their teams. The sites were also supported by site visits, webinars, and data feedback.
Blunt Scissors Stromal Dissection Technique Compared With Big-Bubble Deep Anterior Lamellar Keratoplasty
Authors: Ucgul Ahmet Yucel , Yesilirmak Nilufer , Yuvarlak Armagan , Aydin Bahri , Ozmen Mehmet Cuneyt , Akata Fikret 
Published: February 2019

Objectives:To evaluate the clinical findings and results of new modified manual deep anterior lamellar keratoplasty (M-DALK) technique compared with a big-bubble DALK (BB-DALK) technique in eyes with corneal scars or lesions.Methods:A prospective, nonrandomized, comparative study included 65 eyes of 65 patients treated by M-DALK using the blunt scissors lamellar dissection technique or standard BB-DALK. Visual acuity, endothelial cell density, corneal cylinder (Cyl), central corneal thickness (CCT), residual stromal thickness and aberrometric values were recorded pre-treatment and 1, 3, 6, 12 and 18 months after treatment.Results:Thirty-five eyes of 35 patients underwent deep anterior lamellar keratoplasty (DALK) with successful big-bubble technique, whereas 30 eyes of 30 patients underwent DALK with manual technique (in 10 eyes as a primary technique, in 20 eyes as a secondary technique). Successful big-bubble formation was achieved in 35 of 55 (64%) eyes. Microperforations occurred in three eyes in BB-DALK group, in six eyes in M-DALK group, and DALK could be completed successfully in these eyes. Visual acuity and endothelial cell loss results were not significantly different between groups during follow-up period. Mean CCT was significantly different between groups (P=0.035). Mean corneal Cyl, residual stromal thickness, and aberrometric values were similar between groups (P>0.05) at the final visit.Conclusion:New modified M-DALK technique has similar clinical findings and results with BB-DALK when using as a primary or secondary approach.
Donor-Related Nontuberculous Mycobacterial Interface Infection After Descemet Membrane Endothelial Keratoplasty
Authors: Van Landeghem Ruben , Foets Beatrijs , Desmet Stefanie , Vanhaecke Maarten , Hua Minh-Tri 
Published: February 2019

Purpose:
To describe the first reported case of Mycobacterium chelonae–related interface keratitis after Descemet membrane endothelial keratoplasty (DMEK), successfully treated with DMEK exchange.

Methods:
A case of donor-related DMEK interface keratitis, treated with medical therapy and DMEK exchange, was studied retrospectively.

Results:
A patient with Fuchs endothelial dystrophy developed infectious interface keratitis after DMEK. In cultures of the donor cornea transport medium, M. chelonae was isolated. Subsequent clinical investigation showed early signs of infectious keratitis with multiple infiltrates at the donor–graft interface. Cultures at the cornea bank of origin also showed M. chelonae, indicating a donor-related infection. Because of unsuccessful medical therapy, the DMEK graft was exchanged 4.5 months after initial DMEK. After 2 weeks, some interface precipitates appeared. These precipitates regressed over the following months with continued medical therapy. Antibiotic therapy was successfully ended 5 months after DMEK exchange.

Conclusion:
This case highlights the importance of early diagnosis and intensive treatment of nontuberculous mycobacterial interface keratitis. If intensive medical therapy is able to contain infection but fails to eradicate interface keratitis, DMEK exchange is a possible treatment option.
Micropulse Transscleral Cyclophotocoagulation in Keratoplasty Eyes
Authors: Subramaniam Kavitha , Price Marianne O. , Feng Matthew T. , Price Francis W. 
Published: February 2019

Purpose:
To assess the outcomes of micropulse transscleral cyclophotocoagulation for intraocular pressure (IOP) control in keratoplasty eyes.

Methods:
Outcomes of micropulse laser treatments of postkeratoplasty eyes were retrospectively reviewed. IOP was assessed with applanation tonometry. Keratoplasty survival was calculated with Kaplan–Meier survival analysis.

Results:
Sixty-one eyes in 57 patients received laser treatment; 31 eyes received 1, 21 received 2, 8 received 3, and 1 received 4 treatments. The median follow-up was 21 months (range, 2–35 months). At baseline, the mean IOP was 28 ± 11 mm Hg. At 1, 3, 6, and 12 months after the last treatment, respectively, the numbers of eyes with IOP data were 58, 50, 46, and 38; the mean IOP was 17 ± 7, 17 ± 8, 18 ± 9, and 15 ± 5 mm Hg; the proportions of eyes with IOP ≤ 15 mm Hg were 40%, 51%, 48%, and 55%; and the proportions with IOP ≤ 12 mm Hg were 21%, 29%, 20% and 29%. Six eyes (10%) received subsequent glaucoma filtration surgery. The mean number of antiglaucoma medications used before the initial treatment was 2.7 (range, 0–4) versus 2.2 (range, 0–4) at last follow-up. At baseline, 7 grafts were decompensated and 5 of 54 clear grafts (9%) had endothelial cell density < 700 cells/mm2. Graft survival was 94% at 1 year and 81% at 2 years after the initial laser treatment.

Conclusions:
Micropulse transscleral cyclophotocoagulation is a noninvasive alternative to glaucoma filtration surgery for IOP reduction in keratoplasty eyes.
Rotavirus Vaccination Does Not Increase Type 1 Diabetes and May Decrease Celiac Disease in Children and Adolescents
Authors: Hemming-Harlo Maria , Lähdeaho Marja-Leena , Mäki Markku , Vesikari Timo 
Published: February 2019

Background:
Rotavirus (RV) infection has been proposed to trigger type 1 diabetes mellitus (DM1) and celiac disease (CD) by molecular mimicry in genetically susceptible children. If so, a live attenuated oral RV vaccine could also trigger these autoimmune diseases, or else, prevent the effect of wild-type RV infection.

Methods:
In Rotavirus Efficacy and Safety Trial, conducted between 2001 and 2003, the participant children received RotaTeq (Kenilworth, NJ) vaccine or placebo in 1:1 ratio. The surveillance was extended as Finnish Extension Study. A questionnaire was sent in 2015 to the parents of 19,133 Finnish Extension Study participants and 5764 (30%) returned the questionnaire. Diagnosis of DM1, biopsy-proven CD and other autoimmune disease over the 11–14 year period were inquired.

Results:
At the time of questionnaire, the prevalence of DM1 was similar in both groups, 0.97% (25 of 2580 children) in the placebo group and 1.04% (33 of 3184 children) in the vaccine group (P = 0.810). The prevalence of CD was significantly higher in placebo recipients (1.11%; confidence interval: 0.78%–1.6%) than in vaccine recipients (0.60%; confidence interval: 0.38%–0.93%) (P = 0.027).

Conclusions:
RV vaccination using RotaTeq did not alter the occurrence of DM1 but decreased the prevalence of CD in childhood and adolescence. We propose that wild-type RV may trigger CD and the triggering effect can be prevented or reduced by RV vaccination.
SUMMIT-07: a randomized trial of NKTR-181, a new molecular entity, full mu-opioid receptor agonist for chronic low-back pain
Authors: Markman John , Gudin Jeffrey , Rauck Richard , Argoff Charles , Rowbotham Michael , Agaiby Eva , Gimbel Joseph , Katz Nathaniel , Doberstein Stephen K. , Tagliaferri Mary , Lu Lin , Siddhanti Suresh , Hale Martin 
Published: February 2019

Abstract
NKTR-181, a new molecular entity, mu-opioid receptor agonist with an inherently slow rate of central nervous system (CNS) entry, was designed to provide analgesia while reducing abuse potential. This phase 3, enriched-enrollment, randomized-withdrawal trial evaluated the analgesic efficacy, safety, and tolerability of NKTR-181 in patients with chronic low-back pain (CLBP). Adults with moderate-to-severe CLBP refractory to nonopioid analgesics achieving an analgesic NKTR-181 dosage (100-400 mg twice daily) during the open-label titration period were randomized to continued NKTR-181 treatment, double-blind, or switched to placebo. The study was conducted at 55 sites in the United States. Of 1189 patients exposed to NKTR-181 during the titration period, 610 were randomized to NKTR-181 100 to 400 mg every 12 hours or placebo for 12 weeks. The primary outcome measure was change in weekly pain score (scale, 0-10) at 12 weeks from randomization baseline. Secondary outcome measures included responder rates defined by ≥30% and ≥50% improvement in pain score from screening to 12 weeks. Among 610 randomized patients, the mean pain score decreased from 6.73 to 2.32 during open-label titration. After randomization, the least-squares mean change in pain score was +0.92 for NKTR-181 vs +1.46 for placebo (P = 0.002). The ≥30%-improvement responder rate of NKTR-181 vs placebo was 71.2% vs 57.1% (P < 0.001), and the ≥50%-improvement responder rate was 51.1% vs 37.9% (P = 0.001). NKTR-181 was well tolerated with a low incidence (<3%) of CNS-related adverse events during the randomized treatment phase. In patients with moderate-to-severe CLBP, NKTR-181 demonstrated significant analgesic efficacy and a favorable safety/tolerability profile, with a low incidence of CNS adverse events.