bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Report: Primary Conjunctival Non-Hodgkin Marginal Zone Lymphoma
Authors: Bennett Loren W. 
Published: December 2018

SIGNIFICANCE
Ophthalmic manifestations of non-Hodgkin lymphoma are rare, and the diagnosis can be delayed because of nonspecific symptoms and a tendency to mimic the appearance of other ocular diseases. Suspicious presentations will require confirmation of the lymphoma through surgical biopsy.

PURPOSE
The purpose of this study was to present an isolated conjunctival non-Hodgkin marginal zone lymphoma without systemic involvement, which was successfully managed with external beam radiation.

CASE REPORT
A 49-year-old man reported a red, temporal bulbar conjunctival growth on the left eye for several weeks, which was initially treated as a nodular episcleritis. When the condition did not resolve, a subsequent biopsy diagnosed a low-grade non-Hodgkin marginal zone lymphoma; further testing found no systemic involvement. No intraocular involvement was noted, and B-scan ultrasound and magnetic resonance imaging did not demonstrate any uveal or orbital extension. A trial of doxycycline did not lead to regression, and the isolated lesion was observed. Because of possible slow growth, the lesion was eventually treated with external beam radiation, which resulted in significant tumor regression. Four years after the radiotherapy, the tumor has not recurred, and there has been no systemic involvement.

CONCLUSIONS
This case of a low-grade extranodal marginal zone lymphoma on the temporal conjunctiva represents a less common variation of the classic fornix-based presentation. It is not unusual for conjunctival lymphomas to masquerade as another clinical entity, sometimes making the initial diagnosis challenging. If a patient does not respond as expected to conventional therapy, a biopsy to rule out malignancy should be considered.
A National Snapshot of Patient-Reported Outcomes Comparing Types of Abdominal Flaps for Breast Reconstruction
Authors: Atisha Dunya M. , Tessiatore Kristen M. , Rushing Christel N. , Dayicioglu Deniz , Pusic Andrea , Hwang Shelley 
Published: December 2018

Background:
This study aimed to identify differences in patient-reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction.

Methods:
Women with a history of breast cancer surgery were recruited from the Army of Women foundation to take the BREAST-Q and a background questionnaire. Descriptive statistics and regression analyses were used to compare abdominal physical well-being, breast satisfaction, chest physical, psychosocial well-being, and sexual well-being in women undergoing free versus pedicle TRAM flaps.

Results:
Of 657 women, 273 (41 percent) underwent free flap surgery and 384 (58 percent) underwent pedicle TRAM flap surgery. Compared with unilateral pedicle TRAM flaps, those with unilateral free flaps scored an average of 9.5 points higher (95 percent CI, 5.4 to 13.6; p < 0.0001) and those with bilateral free flaps reported no difference in physical well-being of the abdomen. Compared with bilateral pedicle TRAM flaps, the following groups scored higher in physical well-being of the abdomen: unilateral free flaps, an average of 17.4 (95 percent CI, 11.5 to 23.3; p < 0.0001); bilateral free flaps, an average of 6.8 (95 percent CI, 0.3 to 13.3; p = 0.04); and unilateral pedicle TRAM flaps, an average of 7.9 (95 percent CI, 2.4 to 13.4; p = 0.005) higher. Women with bilateral pedicle flaps reported sexual well-being scores 7.4 (95 percent CI, 0.6 to 14.3; p = 0.03) and 6.8 (95 percent CI, 0.3 to 13.2; p = 0.04) points lower than those with unilateral free and unilateral pedicle flaps.

Conclusions:
Muscle-preserving techniques result in improved abdominal wall function and decreased morbidity compared with pedicle TRAM flap reconstruction. These data highlight the importance of offering patients the option of microsurgical techniques.
Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians
Authors: Jung Jae-A , Kim Ki-Bum , Park Hyun , Dhong Eun-Sang , Han Seung-Kyu , Kim Woo-Kyung 
Published: December 2018

Background:
The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increase of the tip of the nose simultaneously.

Methods:
Thirty patients were the subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils, and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches.

Results:
All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05. The nasolabial angle was 91.31 ± 4.19 degrees before surgery and 105.62 ± 5.04 degrees after surgery. The angle of the upper lip was 48.97 ± 2.41 degrees before surgery and 38.21 ± 3.34 degrees after surgery.

Conclusions:
Lip lift is an effective tool for correcting a natural tendency of the upper lip to cover the upper teeth during aging. There is a dramatic improvement in the patient’s facial aesthetic appearance during smiling and at rest. The authors strongly recommend this technique as part of the surgical procedure to achieve a youthful face.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes
Authors: Black Cara K. , Graziano Francis D. , Fan Kenneth L. , Defazio Michael V. , Nahabedian Maurice Y. 
Published: December 2018

Background:
Implants offer a method for augmenting abdominal flaps in the setting of deficient volume in breast reconstruction. They may be placed immediately at the time of reconstruction or on a delayed basis. The authors seek to compare outcomes from a single surgeon and previously published studies.

Methods:
A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominally based flap breast reconstruction and implant placement between July of 2005 and August of 2015 performed by the senior author (M.Y.N.).

Results:
A systematic review of the literature yielded four articles, for a total of 96 patients (142 breasts) included for systematic review. Eighty-seven breasts (61 percent) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts (39 percent) had a staged approach to implant placement. Complications were noted in 28 breasts (32 percent) following immediate placement and in 10 breasts (18 percent) following staged placement. A total of 53 patients (79 breasts) were retrospectively reviewed, all of whom underwent reconstruction in a staged manner. Twelve breasts (15 percent) were found to have a flap- or implant-related complication; 97.5 percent of implants/flap reconstructions were successful, with a 54 percent revision rate. When pooling systematic and retrospective data, there was a significant difference in complication rates between the staged and immediate reconstruction cohorts (p < 0.001) in favor of the staged approach.

Conclusions:
The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. The authors’ experience with implant placement highlights the safety and effectiveness of the staged approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Associations Between Cannabis Use and Cardiometabolic Risk Factors: A Longitudinal Study of Men
Authors: Meier Madeline H. , Pardini Dustin , Beardslee Jordan , Matthews Karen A. 
Published: December 2018

ABSTRACT

Objective
This study tested longitudinal associations between cannabis use and cardiometabolic risk factors that underlie the development of cardiovascular diseases.

Methods
Participants were men from the youngest cohort of the Pittsburgh Youth Study who were followed prospectively from approximately age 7 to 32 years (N = 253). Frequency of cannabis use was assessed yearly from approximately ages 12 to 20 years and again at approximately ages 26, 29, and 32 years. The following cardiometabolic risk factors were assessed during a laboratory visit at approximately age 32 years: body mass index (BMI), waist-hip ratio, high- and low-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin resistance, blood pressure, interleukin 6, and C-reactive protein.

Results
Greater cannabis exposure was associated with relatively lower BMI (β = −0.31, p < .001), smaller waist-hip ratio (β = −0.23, p = .002), better high- (β = 0.14, p = .036) and low-density lipoprotein cholesterol (β = −0.15, p = .026), lower triglycerides (β = −0.17, p = .009), lower fasting glucose (β = −0.15, p < .001) and insulin resistance (β = −0.21, p = .003), lower systolic (β = −0.22, p < .001) and diastolic blood pressure (β = −0.15, p = .028), and fewer metabolic syndrome criteria (β = −0.27, p < .001). With exception of BMI, cannabis users' mean levels on cardiometabolic risk factors were generally below clinical cutoffs for high risk. Most associations between cannabis use and cardiometabolic risk factors remained after adjusting for tobacco use, childhood socioeconomic status, and childhood health. However, after adjusting for adult BMI, these associations were no longer apparent, and mediation tests suggested that cannabis users' relatively lower BMI might explain their lower levels of risk on other cardiometabolic risk factors.

Conclusions
Cannabis use is associated with lower BMI, and lower BMI is related to lower levels of risk on other cardiometabolic risk factors.
Accelerated Segmented Diffusion-Weighted Prostate Imaging for Higher Resolution, Higher Geometric Fidelity, and Multi-b Perfusion Estimation
Authors: Aksit Ciris Pelin , Chiou Jr-yuan George , Glazer Daniel I. , Chao Tzu-Cheng , Tempany-Afdhal Clare M. , Madore Bruno , Maier Stephan E. 
Published: December 2018

Purpose
The aim of this study was to improve the geometric fidelity and spatial resolution of multi-b diffusion-weighted magnetic resonance imaging of the prostate.

Materials and Methods
An accelerated segmented diffusion imaging sequence was developed and evaluated in 25 patients undergoing multiparametric magnetic resonance imaging examinations of the prostate. A reduced field of view was acquired using an endorectal coil. The number of sampled diffusion weightings, or b-factors, was increased to allow estimation of tissue perfusion based on the intravoxel incoherent motion (IVIM) model. Apparent diffusion coefficients measured with the proposed segmented method were compared with those obtained with conventional single-shot echo-planar imaging (EPI).

Results
Compared with single-shot EPI, the segmented method resulted in faster acquisition with 2-fold improvement in spatial resolution and a greater than 3-fold improvement in geometric fidelity. Apparent diffusion coefficient values measured with the novel sequence demonstrated excellent agreement with those obtained from the conventional scan (R
2 = 0.91 for b
max = 500 s/mm2 and R
2 = 0.89 for b
max = 1400 s/mm2). The IVIM perfusion fraction was 4.0% ± 2.7% for normal peripheral zone, 6.6% ± 3.6% for normal transition zone, and 4.4% ± 2.9% for suspected tumor lesions.

Conclusions
The proposed accelerated segmented prostate diffusion imaging sequence achieved improvements in both spatial resolution and geometric fidelity, along with concurrent quantification of IVIM perfusion.
The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery
Authors: Rollins Katie E. , Javanmard-Emamghissi Hannah , Acheson Austin G. , Lobo Dileep N. 
Published: December 2018

Objectives:
To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery.

Summary Background Data:
Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI).

Methods:
A meta-analysis of randomized controlled trials and cohort studies including adult patients undergoing elective colorectal surgery, receiving OAB with or without MBP was performed. The outcome measures examined were SSI, anastomotic leak, 30-day mortality, overall morbidity, development of ileus, reoperation and Clostridium difficile infection.

Results:
A total of 40 studies with 69,517 patients (28 randomized controlled trials, n = 6437 and 12 cohort studies, n = 63,080) were included. The combination of MBP+OAB versus MBP alone was associated with a significant reduction in SSI [risk ratio (RR) 0.51, 95% confidence interval (CI) 0.46–0.56, P < 0.00001, I2 = 13%], anastomotic leak (RR 0.62, 95% CI 0.55–0.70, P < 0.00001, I2 = 0%), 30-day mortality (RR 0.58, 95% CI 0.44–0.76, P < 0.0001, I2 = 0%), overall morbidity (RR 0.67, 95% CI 0.63–0.71, P < 0.00001, I2 = 0%), and development of ileus (RR 0.72, 95% CI 0.52–0.98, P = 0.04, I2 = 36%), with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. There is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation, and OAB versus MBP.

Conclusions:
Current evidence suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery. Further high-quality evidence is required to differentiate between the benefits of combined MBP+OAB or OAB alone.
Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries
Authors: Kranz Ashley M. , Mulcahy Andrew , Ruder Teague , Lovejoy Susan , Mehrotra Ateev 
Published: December 2018

Objective:
To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.

Background:
Payment for most surgical procedures bundles postoperative visits within a global period of either 10 or 90 days after a procedure. There is concern that payments for some procedures are excessive because the number of postoperative visits provided is less than the number of postoperative visits used to help determine payment. To obtain data to inform this concern, Medicare required select surgeons to report on their postoperative visits starting July 1, 2017.

Methods:
We analyzed Medicare FFS claims data from surgeons who billed Medicare for 1 or more of the 293 common procedure codes between July 1, 2017 and December 31, 2017 in the 9 states where surgeons were required to report postoperative visits. We examined the share of procedures with any reported postoperative visits and the proportion of expected postoperative visits provided. To address concerns about underreporting, we also examined procedures performed by a subset of surgeons actively reporting postoperative visits.

Results:
We linked 663,681 procedures to 422,432 postoperative visits. The share of procedures with any postoperative visits was higher for procedures with 90-day global periods (70.1%) than for procedures with 10-day global periods (3.7%). The proportions of expected postoperative visits provided for 90-day global and 10-day global periods were 0.37 and 0.04 respectively. Among surgeons actively reporting postoperative visits, the proportions of expected postoperative visits provided were modestly higher (procedures with 90-day global periods=0.46 and 10-day global periods=0.16).

Conclusions:
The proportion of expected postoperative visits that were provided is low. These results support the need for a reassessment of payment for surgical procedures.
The Promise of PROMIS in Pelvic Organ Prolapse
Authors: Bochenska Katarzyna , Hall Evelyn , Griffith James W. , Kenton Kimberly , Alverdy Alexandria , Lewicky-Gaupp Christina , Mueller Margaret 
Published: December 2018

Objectives
The aims of the study were to determine the relationship between pelvic organ prolapse (POP) and health-related quality of life dimensions and to evaluate the utility of the PROMIS Profile in women undergoing surgical treatment for POP.

Methods
We performed a planned ancillary analysis of 103 women recruited between January 2014 and December 2015 to the Restricted Convalescence Outcomes following Urogynecologic Procedures study. All participants underwent surgery for POP and completed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Severity Scale, and the 57-item Patient Reported Outcomes Measurement Information System (PROMIS-57) questionnaire, preoperatively and at 3 months postoperatively. Data were analyzed using Pearson and Spearman correlations.

Results
Preoperative PFDI-20 and PFIQ-7 scores were significantly correlated with all PROMIS domains including physical function, anxiety, depression, fatigue, sleep disturbance, satisfaction with participation in social roles, pain interference, and higher pain intensity. Worse self-reported condition assessments on the Patient Global Impression of Severity were significantly correlated with worse physical function, more pain interference, and higher pain intensity on the PROMIS Profile at baseline. Postoperatively, PFDI-20, PFIQ-7, and all PROMIS Profile domain scores improved significantly (P ≤ 0.05). Correlations between PDFI-20, PFIQ-7, and PROMIS domains persisted at 3 months.

Conclusions
In a cohort of women undergoing surgery for POP, pelvic floor symptom severity is associated with health-related quality of life domains measured by the PROMIS-57.
Immunomics of Renal Allograft Acute T Cell-Mediated Rejection Biopsies of Tacrolimus- and Belatacept-Treated Patients
Authors: van der Zwan Marieke , Baan Carla C. , Colvin Robert B. , Smith Rex N. , White Rebecca A. , Ndishabandi Dorothy , Nigg Alex L. , van den Bosch Thierry P.P. , de Graav Gretchen N. , Clahsen-van Groningen Marian C. , Hesselink Dennis A. 
Published: December 2018

Background
Belatacept-based therapy in kidney transplant recipient has been shown to increase long-term renal allograft and patient survival compared with calcineurin inhibitor–based therapy, however, with an increased risk of acute T cell-mediated rejection (aTCMR). An improved understanding of costimulation blockade-resistant rejections could lead to a more personalized approach to belatacept therapy. Here, immunomic profiles of aTCMR biopsies of patients treated with either tacrolimus or belatacept were compared.

Methods
Formalin-fixed paraffin-embedded renal transplant biopsies were used for immunohistochemistry and gene expression analysis using the innovative NanoString technique. To validate NanoString, transcriptomic profiles of patients with and without biopsy-proven aTCMR were compared. Biopsies from 31 patients were studied: 14 tacrolimus-treated patients with aTCMR, 11 belatacept-treated patients with aTCMR, and 6 controls without rejection.

Results
A distinct pattern was seen in biopsies with aTCMR compared to negative controls: 78 genes had a higher expression in the aTCMR group (false discovery rate P value <.05 to 1.42e–05). The most significant were T cell-associated genes (CD3, CD8, and CD4; P < 1.98e-04), γ-interferon-inducible genes (CCL5, CXCL9, CXCL11, CXCL10, TBX21; P < 1.33e-04) plus effector genes (GNLY, GZMB, ITGAX; P < 2.82e-03). Immunophenotypical analysis of the classic immune markers of the innate and adaptive immune system was comparable between patients treated with either tacrolimus or belatacept. In addition, the transcriptome of both groups was not significantly different.

Conclusions
In this small pilot study, no difference was found in immunomics of aTCMR biopsies of tacrolimus- and belatacept-treated patients. This suggests that clinically diagnosed aTCMR reflects a final common pathway of allorecognition which is unaffected by the type of immunosuppressive therapy.
Analysis of >30,000 abstracts suggests higher false discovery rates for oncology journals, especially those with low impact factors
Authors: Hall LM , Hendricks AE 
Published: December 2018

AbstractBackgroundRecently, there has been increasing concern about the replicability, or lack thereof, of published research. An especially high rate of false discoveries has been reported in some areas motivating the creation of resource-intensive collaborations to estimate the replication rate of published research by repeating a large number of studies. The substantial amount of resources required by these replication projects limits the number of studies that can be repeated and consequently the generalizability of the findings.Methods and findingsIn 2013, Jager and Leek developed a method to estimate the empirical false discovery rate from journal abstracts and applied their method to five high profile journals. Here, we use the relative efficiency of Jager and Leek’s method to gather p-values from over 30,000 abstracts and to subsequently estimate the false discovery rate for 94 journals over a five-year time span. We model the empirical false discovery rate by journal subject area (cancer or general medicine), impact factor, and Open Access status. We find that the empirical false discovery rate is higher for cancer vs. general medicine journals (p = 5.14E-6). Within cancer journals, we find that this relationship is further modified by journal impact factor where a lower journal impact factor is associated with a higher empirical false discovery rates (p = 0.012, 95% CI: -0.010, -0.001). We find no significant differences, on average, in the false discovery rate for Open Access vs closed access journals (p = 0.256, 95% CI: -0.014, 0.051).ConclusionsWe find evidence of a higher false discovery rate in cancer journals compared to general medicine journals, especially those with a lower journal impact factor. For cancer journals, a lower journal impact factor of one point is associated with a 0.006 increase in the empirical false discovery rate, on average. For a false discovery rate of 0.05, this would result in over a 10% increase to 0.056. Conversely, we find no significant evidence of a higher false discovery rate, on average, for Open Access vs. closed access journals from InCites. Our results provide identify areas of research that may need of additional scrutiny and support to facilitate replicable science. Given our publicly available R code and data, others can complete a broad assessment of the empirical false discovery rate across other subject areas and characteristics of published research.