bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Laser Resurfacing and Facial Plastic Surgery Using Age, Glogau, and Fitzpatrick Rating
Authors: Barrera Jose Enrique , Adame Michael Julian , Lospinoso Josh A. , Beachkofsky Thomas M. 
Published: October 2018

Background:To assess clinical outcomes based on established rating scales in patients who underwent treatment for rhytids using laser resurfacing with and without facial plastic surgery.Methods:Retrospective case review of 48 patients treated by the senior author (J.E.B) between 2009 and 2016. Three reviewers assigned ratings to a total of 48 patients using estimated age and Fitzpatrick, Modified Fitzpatrick, and Glogau scales. Reviewers were blinded to patient demographics and before and after photographs. Patients elected to receive laser-only treatment or combination laser plus facial plastic surgery. Participants included forty-eight patients were selected on the basis that they had either laser treatment alone or laser plus facial plastic surgery and pre- and postoperative photographs.Results:Patients with higher Fitzpatrick scores had a greater reduction in Glogau score (ß = 1.66; SE = 0.59;P< 0.01). With respect to modified Fitzpatrick scores after surgery, patients with higher Glogau scores of 3 or 4 before surgery (P< 0.01) had higher scores after surgery ((ß = 0.07; SE = 0.02;P< 0.01). For estimated age, the average change was -1.7 years after laser resurfacing (P= 0.038; 95% CI, 2.96–3.06 years) and -2.07 years when combined with surgery (P= 0.01; 95% CI, 2.89–3.19 years).Conclusions:Patients with Fitzpatrick scores of 3, 4, 5, younger patients, and those with less rhytids before surgery tended to have lower Glogau scores after surgery. These findings provide insight on an approach to treating ethnic skin and aging face concerns.
Balancing Distraction Forces in the Mandible: Newton’s Third Law of Distraction
Authors: Shakir Sameer , Naran Sanjay , Lowe Kristen M. , Bartlett Scott P. 
Published: October 2018

Summary:
Vertical mandibular distraction results in translation of both proximal and distal segments. The force exerted on the condylar segment not only places unwanted force on the joint but also rotates the coronoid process into the cranial base. To prevent these sequelae, we investigate the use of a "check plate" on the condylar segment in an attempt to decrease force at the Temporomandibular joint (TMJ) and prevent unwanted rotation of the coronoid. Patients with hemifacial microsomia, seen at our Children's Hospital from 2012 to 2016 having undergone unilateral vertical mandibular distraction with placement of check plate were compared with a sample of those similarly having undergone distraction without use of the plate. Preoperative and postoperative cephalometric measures and 3-dimensional computed tomography imaging were analyzed. Three subjects were identified in each group. Age and Pruzansky-Kaban classification did not differ between groups. Vertical distance from the coronoid process perpendicular to the Frankfort Horizontal did not differ between groups (P < 0.07); however, postoperative distance significantly differed with the coronoid process rotating upward into the cranial base in subjects without a check plate (P < 0.005). Preoperative angle of the coronoid process based on the Frankfort Horizontal did not differ (P < 0.06); however, postoperative angle significantly changed, confirming upward rotation into the cranial base (P < 0.01). Total regenerate did not differ (P < 0.08). Vertical mandibular distraction results in undesirable upward rotation of the proximal segment into the cranial base and superior displacement of regenerate. This can be prevented with the use of a check plate.
Prevalence of Depressive Symptoms in Patients Requesting Cosmetic Breast Surgery in Midwestern Brazil
Authors: de Paula Paulo Renato , Fortes de Arruda Fabiano Calixto , Prado Marcelo , Neves Carlos Gustavo 
Published: October 2018

Background:
The prevalence of depressive symptoms (DS) before cosmetic breast surgery was analyzed in the public (PbI) and private (PrI) institutions, comparing types of surgery and patients’ sociodemographic characteristics.

Methods:
A cross-sectional, observational, analytical study to evaluate the prevalence of DS in 185 patients of 18–71 years of age requesting 4 different cosmetic breast surgeries (with and without implants) at public and private institutions. Patients were assessed using the Beck Depression Inventory and analyzed for statistical comparison.

Results:
The most common surgical procedures were reduction mammoplasty in the PbI and augmentation mammoplasty in the PrI. The prevalence of the positive risk for depressive disorder (≥15 points in Beck Depression Inventory) in the PbI was 25.8%, whereas in the PrI: 11.4% (P = 0.012). Moderate and severe DS were, respectively, 120% and 242% higher in the PbI than in the PrI. No patients requesting mastopexy without implants had DS. The highest prevalence (51.4%) of DS occurred in patients with breast implants indications (augmentation mammoplasty and mastopexy with implants). The presence (P = 0.12) or absence (P = 0.33) of implant did not demonstrate a higher risk of DS. Among all patients, 7% answered positively to the statements on suicide ideation, with predominance within the group of implants (54.5%). There were significant differences between the PbI and PrI.

Conclusions:
The prevalence of DS was high (18.9%), with the risk being 2.3 times greater in the PbI. Patients from PbI and PrI showed significant different profiles. Patients for breast implants showed a higher score for suicide ideation.
A Single-visit Approach Using Fillers and Incobotulinumtoxin A: Full Face Enhancement in Asian Patients
Authors: Chao Yates Y. Y. 
Published: October 2018

Summary:
A 3-dimensional, multi-layered approach combining modalities targeting different manifestations is recommended for achieving optimal esthetic outcomes. To date, studies reporting same-day treatment with dermal fillers and botulinum toxin have not been published. This article documents the practical use of a single-visit, pan-facial multimodal approach in addressing the varying esthetic needs of 8 Asian adults. The case series included male or female patients of varying age and degrees of facial fat, who received combination treatment with calcium hydroxylapatite filler, polydensified hyaluronic acid filler, and incobotulinumtoxin A in a single visit in August 2016 at a treatment center in Taiwan. Treatments were individualized based on the needs of each patient, according to guideline recommendations. The agents, with distinctive rheological properties indicated for different purposes, were applied sequentially across different facial tissue planes within a single visit. Patients were monitored for development of side effects after treatment. Photographs taken before treatment and 2 weeks after treatment were evaluated by the treating physicians. For all patients, treatment produced substantial improvements in all treated facial areas. Inherent morphological deficiencies in younger patients were addressed, age-related changes in older patients were corrected, and facial sexual dimorphism was enhanced in male and female patients. No major side effects occurred after treatment. This case series showcases the real-life implementation of a flexible, single-visit, multimodal approach that can be adapted for a variety of indications.
Orbitomaxillofacial Mucormycosis Requiring Complex Multifactorial Management
Authors: Steve Anna K. , Hurdle Valerie A. , Brown Jevon Y. 
Published: October 2018

Summary:
Mucormycosis is a rare fungal infection caused by ubiquitous fungi in the order Mucorales. It is the most rapidly progressing fulminant fungal infection that mimics necrotizing soft-tissue infections. Overwhelming fungal sepsis develops quickly and mortality rates approach 70%. Culture negative necrotizing infections and cutaneous necrosis following a vascular pattern should raise suspicion for this rare entity. We describe avoiding mortality in a case of orbitomaxillofacial mucormycosis multifactorially treated with: radical serial debridement, topical amphotericin B irrigation and dressings, parenteral amphotericin B, and hyperbaric oxygen therapy. Tissue biopsy was central to confirming the diagnosis and directing multimodal management that ultimately prevented dissemination to the central nervous system and mortality.
Acquisition of analgesic properties by the cholecystokinin (CCK)/CCK2 receptor system within the amygdala in a persistent inflammatory pain condition
Authors: Roca-Lapirot Olivier , Fossat Pascal , Ma Sherie , Egron Karine , Trigilio Gabriella , López-González María-José , Covita João , Bouali-Benazzouz Rabia , Favereaux Alexandre , Gundlach Andrew L. , Landry Marc 
Published: October 2018

AbstractPain is associated with negative emotions such as anxiety, but the underlying neurocircuitry and modulators of the association of pain and anxiety remain unclear. The neuropeptide cholecystokinin (CCK) has both pronociceptive and anxiogenic properties, so we explored the role of CCK in anxiety and nociception in the central amygdala (CeA), a key area in control of emotions and descending pain pathways. Local infusion of CCK into the CeA of control rats increased anxiety, as measured in the light–dark box test, but had no effect on mechanical sensitivity. By contrast, intra-CeA CCK infusion 4 days after Complete Freund's Adjuvant (CFA) injection into the hindpaw resulted in analgesia, but also in loss of its anxiogenic capacity. Inflammatory conditions induced changes in the CeA CCK signaling system with an increase of CCK immunoreactivity and a decrease in CCK1, but not CCK2, receptor mRNA. In CFA rats, patch-clamp experiments revealed that CCK infusion increased CeA neuron excitability. It also partially blocked the discharge of wide dynamic range neurons in the dorsal spinal cord. These effects of CCK on CeA and spinal neurons in CFA rats were mimicked by the specific CCK2receptor agonist, gastrin. This analgesic effect was likely mediated by identified CeA neurons projecting to the periaqueductal gray matter that express CCK receptors. Together, our data demonstrate that intra-CeA CCK infusion activated a descending CCK2receptor-dependent pathway that inhibited spinal neuron discharge. Thus, persistent pain induces a functional switch to a newly identified analgesic capacity of CCK in the amygdala, indicating central emotion-related circuit controls pain transmission in spinal cord.
Blue laser imaging: a new image-enhanced endoscopy for the diagnosis of colorectal lesions
Authors: dos Santos Carlos E.O. , Malaman Daniele , Yoshida Naohisa , Pereira-Lima Júlio C. , Onófrio Fernanda Q. , Furlan Rafaelle G. , Tabushi Fernando I. , Malafaia Osvaldo 
Published: October 2018

Background
Image-enhanced endoscopy enables real-time differential diagnosis of colorectal lesions through the observation of microvascular architecture.

Purpose
To evaluate the efficacy of using blue laser imaging (BLI) for capillary pattern analysis in the differential diagnosis of neoplastic and non-neoplastic lesions.

Patients and methods
This prospective study included 920 consecutive superficial lesions diagnosed in 457 patients. The capillary pattern was analysed using BLI-bright magnification on the basis of the Teixeira classification. Histopathology was used as the reference standard.

Results
The adenoma detection rate was 42.3%, with a mean of 0.95 adenomas per patient. Neoplastic lesions were predominant (70.3%), of which 33 (5.1%) had advanced histology. Neoplastic progression was significantly increased in patients aged at least 50 years, in lesions at least 10 mm and in lesions located in the right colon (P<0.01). BLI-based capillary pattern analysis showed 95.5% accuracy, 95.7% sensitivity, 95.2% specificity, 97.9% positive predictive value and 90.3% negative predictive value in the diagnosis of neoplastic lesions. For 672 diminutive lesions (≤5 mm), BLI-based capillary pattern analysis showed 95.7% accuracy, 96.6% sensitivity, 93.6% specificity, 97.2% positive predictive value and 92.2% negative predictive value. Analysing only lesions up to 5 mm in the rectum and sigmoid colon, the values were 95.2, 93.9, 96.5, 95.8 and 94.8%, respectively.

Conclusion
BLI associated with magnification yielded excellent results for the real-time predictive histological diagnosis of colorectal lesions.
Comparative Clinical Outcomes of Edoxaban in Adults With Nonvalvular Atrial Fibrillation
Authors: Aronow Wilbert S. , Shamliyan Tatyana A. 
Published: October 2018

Background:
A critical appraisal of all pooled evidence regarding novel oral anticoagulants (NOACs) for stroke prevention regardless of publication status or study design has not been conducted yet. Being the latest addition to NOACs, the data on edoxaban are especially scarce.

Study Question:
What are the comparative clinical outcomes of edoxaban versus warfarin and other NOACs apixaban, dabigatran, or rivaroxaban in adults with nonvalvular atrial fibrillation?

Data Sources:
Randomized controlled trials (RCTs), observational studies, and network meta-analyses were identified in PubMed, EMBASE, the Cochrane Library, Pharmapendium, Elsevier Clinical Pharmacology, and the clinicaltrials.gov trial registry in June 2018.

Study Design:
Rapid review per a priori developed protocol, direct frequentist random-effects meta-analysis of aggregate data, grading the quality of evidence per the Grading of Recommendations Assessment, Development and Evaluation working group approach.

Results:
Direct 4 RCTs (23,021 patients) suggest that edoxaban is noninferior to warfarin in prevention of stroke and systemic embolism [pooled relative risk (RR): 0.65, 95% confidence interval (CI): 0.23–1.81, 2 RCTs] and reduces the risk of cardiovascular mortality (RR: 0.87, 95% CI: 0.78–0.97, 1 RCT), major cardiovascular morbidity (RR: 0.90, 95% CI: 0.82–0.98, 2 RCTs), and major bleeding events (RR: 0.80, 95% CI: 0.71–0.91, 1 RCT) but increases the risk of gastrointestinal bleeding (RR: 1.21, 95% CI: 1.01–1.46, 1 RCT) and anemia (RR: 1.45, 95% CI: 1.05–1.99, 3 RCTs). Edoxaban is superior to warfarin in patients with increased risk of bleeding with warfarin because of variants in CYP2C9 and VKORC1 genes. Indirect evidence does not allow valid conclusions regarding comparative superiority of NOACs. The quality of evidence was downgraded because of reporting bias, small number of events, and indirectness in comparisons.

Conclusions:
Edoxaban is a welcome addition to the NOAC's armamentarium. However, the comparative data with other novel NOACs are mostly nonexisting, and urgently needed for better individual patient assessment.
Current and future status of stem cell expansion
Authors: Becnel Melody , Shpall Elizabeth J. 
Published: October 2018

Purpose of review
Herein, we seek to describe the current and future role of ex-vivo expansion of cord blood hematopoietic stem cells.

Recent findings
As this field is only in its infancy, there have been many challenges identified. Decreased number of stem cells contained in a cord blood unit and early differentiation of stem cells once expanded have been two overarching challenges faced by the field. Many recent techniques have focused on the properties of the microenvironment and targetable cellular pathways as novel approaches to circumvent these challenges.

Summary
Novel discoveries have led to the development of approaches that will increase hematopoietic stem cell yield and will improve engraftment in patients receiving cord blood hematopoietic stem cell transplantation. As a result, patients receiving cord blood hematopoietic stem cell transplantationcontinue to have improved outcomes.
Associations Between Cannabis Use, Sexual Behavior, and Sexually Transmitted Infections/Human Immunodeficiency Virus in a Cohort of Young Men Who Have Sex With Men
Authors: Gorbach Pamina M. , Javanbakht Marjan , Shover Chelsea L. , Bolan Robert K. , Ragsdale Amy , Shoptaw Steven 
Published: October 2018

Background
Among men who have sex with men (MSM) the relationship between sexually transmitted infections (STIs) and cannabis use is not well established. We assessed cannabis use, sexual behavior, and STIs including human immunodeficiency virus (HIV) in a diverse cohort of young MSM.

Methods
In Los Angeles, the mSTUDY cohort conducted visits every 6 months with 512 MSM between 2014 and 2017 collecting demographics, sexual behaviors, and reports of frequency of substance use. Each visit conducted testing for gonorrhea, chlamydia, and syphilis via blood, urine, and pharyngeal and rectal swabs by PCR, Human immunodeficiency virus was assessed using rapid tests for HIV-negatives and viral load for HIV-positives. We analyzed the relationship between cannabis use, sexual behaviors and STIs/HIV across 1535 visits.

Results
Significantly fewer participants tested positive for STIs at visits when reporting the previous 6 months use of only cannabis (11.7%) compared with no drugs (16.3%) or other drugs (20.0%, P = 0.01). Fewer MSM reporting only cannabis use than no or other drug use had been incarcerated, had incarcerated partners, experienced interpersonal violence, and were HIV-positive. In multivariable analyses visits with positive STIs were associated with other drug use (adjusted odds ratio, 1.69; 95% confidence interval, 1.03–2.78) but not use of cannabis only or no drug use after controlling for age, HIV status, new sex partners, and number of sex partners.

Conclusions
When MSM reported using cannabis exclusively fewer STIs were detected and lower risk sexual engagements reported than when MSM reported no drug or other drug use.
Nonrheumatoid Fibrinous Pericarditis
Authors: Gupta Avneesh , Furman Jaclyn , Kesha Kilak , Diaz Francisco , Schmidt Carl J. 
Published: October 2018

Abstract
Classic “bread-and-butter” appearance of fibrinous pericarditis had been described in rheumatic disease and other immunologic diseases such as systemic lupus erythematosus, post–myocardial infarct, uremia, tuberculosis, radiation effects, bacterial, and viral etiology. In most of the described cases, pericarditis occurs as a delayed complication. We present a case of a 21-year-old white woman who was seen in the emergency department to rule out pulmonary embolism for shortness of breath, chest pain, and lightheadedness. The autopsy showed a collection of serous fluid into the pericardial sac with bread-and-butter appearance. Microscopically, the pericardium showed acute inflammation with fibrinous exudates. Sections of the heart showed areas of lymphocytic infiltration with acute fibrinous inflammation of the pericardium. Vasculitis was seen in small blood vessels in the heart and was negative in other organs. No granuloma or necrotizing lesion was seen in microscopic sections of all organs including the heart, ruling out rheumatologic disease. The present study highlights the quest and design of an algorithm for a nonrheumatic disorder as the cause of pericarditis. Molecular studies were performed on heart tissue blocks for identification of cardiotropic viruses. Human parvovirus B19 was isolated from heart tissue blocks. The present case study highlights on updates in pathophysiology and diagnostic criteria for myocarditis along with the use of new molecular techniques for detection of idiopathic cardiomyopathies in a medical examiner setup.
Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study
Authors: Arias López María del P. , Boada Nancy , Fernández Analía , Fernández Ariel L. , Ratto María E. , Siaba Serrate Alejandro , Schnitzler Eduardo 
Published: October 2018

Objective:
To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina.

Design:
Prospective, national, multicenter study.

Setting:
Forty-nine PICUs located in Argentina belonging to public and private institutions.

Patients:
All children between 1 month and 16 years old admitted to the participating PICUs between May 15, 2016, and February 15, 2017.

Interventions:
None.

Measurement and Main Results:
A total of 6,602 patients were enrolled in the study. The observed mortality was 8% (531/6,602), whereas mortality predicted by Pediatric Index of Mortality 3 was 6.16% (407 deaths). The standardized mortality rate was 1.3 (95% CI, 1.20–1.42). The area under the receiver operating characteristic curve was 0.83 (95% CI, 0.82–0.85). The Hosmer-Lemeshow test showed that the difference between the mortality observed and the mortality predicted by Pediatric Index of Mortality 3 was statistically significant (χ2, 135.63; p < 0.001).

Conclusions:
The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.
Infectious Endocarditis Prophylaxis in Children
Authors: Martin James , Lindgren Christina 
Published: October 2018

Abstract
Infectious endocarditis (IE) is a rare illness with high morbidity and mortality. Incidence of IE is on the rise in industrialized countries, particularly as those with congenital heart defects are living longer and the use of indwelling central catheters increases. With the 2007 American Heart Association guidelines, there has been a shift in recommending antibiotic prophylaxis only to high-risk patient populations. This clinical review will highlight the changing epidemiology and etiology of IE, followed by an emphasis on the appropriate indications for antibiotic prophylaxis in high-risk populations undergoing specific procedures.