bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Efficacy and Safety of 660 nm and 411 to 777 nm Light-Emitting Devices for Treating Wrinkles
Authors: Nam Chan Hee , Park Byung Cheol , Kim Myung Hwa , Choi Eun Hee , Hong Seung Phil 
Published: February 2017

BACKGROUND
Low-level light therapy (LLLT) using light-emitting diodes (LEDs) is considered to be helpful for skin regeneration and anti-inflammation.

OBJECTIVE
To evaluate the efficacy and safety of 2 types of LLLTs using 660 nm–emitting red LEDs and 411 to 777 nm–emitting white LEDs in the treatment of facial wrinkles.

MATERIALS AND METHODS
A prospective, randomized, double-blinded, comparative clinical trial involving 52 adult female subjects was performed. The faces of the subjects were irradiated daily with 5.17 J of red or white LEDs for 12 weeks.

RESULTS
In both groups treated with red and white LEDs, the wrinkle measurement from skin replica improved significantly from baseline at Week 12. The red LED group showed slightly better improvement, but there were no statistical differences. In assessments by blinded dermatologists, no significant differences were observed in both groups. In the global assessment of the subjects, the mean improvement score of the red LED group was higher than that of the white LED group.

CONCLUSION
Low-level light therapy using 660 nm LEDs or 411 to 777 nm LEDs significantly improved periocular wrinkles. Especially, 660 nm LEDs could be an effective and tolerable treatment option for wrinkles.
Surgical Treatment and Outcomes of Patients With Extramammary Paget Disease: A Cohort Study
Authors: Kim Sharon J. , Thompson Agnieszka K. , Zubair Adeel S. , Otley Clark C. , Arpey Christopher J. , Baum Christian L. , Roenigk Randall K. , Lohse Christine M. , Brewer Jerry D. 
Published: February 2017

BACKGROUND
Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma occurring mainly in the anogenital region. Traditional management with wide local excision has shown high recurrence rates, thus Mohs micrographic surgery (MMS) has emerged as a promising treatment option.

OBJECTIVE
To compare long-term outcomes after treatment with MMS or excision for primary EMPD.

METHODS AND MATERIALS
Retrospective cohort review was conducted for 207 patients with EMPD treated at Mayo Clinic in Rochester, MN, between 1961 and 2012.

RESULTS
Of the 25 patients treated with MMS, 19 primary tumors were included for outcome analysis, with an estimated 5-year recurrence-free survival rate of 91% (95% confidence interval [CI], 75–100) using Kaplan–Meier curve analysis. Of 158 patients treated with local excision, 124 were included for the analysis, with an estimated 5-year recurrence-free survival rate of 66% (95% CI, 56–78). The hazard ratio (HR) for association of treatment was 0.4 (95% CI, 0.10–1.65; p = .20). Estimated 5-year overall survival rates were 79% for MMS (95% CI, 61–100) and 68% for excision (95% CI, 59–78) (HR, 1.39 [95% CI, 0.69–2.82]; p = .36).

CONCLUSION
Although treatment of primary EMPD with MMS versus excision did not show statistical difference, MMS demonstrated favorable long-term outcomes and was associated with a higher recurrence-free survival rate.
Color Doppler Ultrasound Assessment of Activity in Keloids
Authors: Lobos Nelson , Wortsman Ximena , Valenzuela Fernando , Alonso Faustino 
Published: February 2017

BACKGROUND
The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated.

OBJECTIVE
To assess the sonographic activity of keloids in comparison with clinical scoring.

MATERIALS AND METHODS
A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon–Mann–Whitney, Student t-test, and interobserver agreement).

RESULTS
Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU.

CONCLUSION
Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.
Reconstruction of Wassel Type VI Radial Polydactyly with Triphalangeal Thumb Using an On-top Osteotomy
Authors: Shen Kaiying , Wang Zhigang , Xu Yunlan 
Published: February 2017

Background:
The purpose of this study was to present a novel surgical technique using an on-top osteotomy and to assess the clinical and radiographic outcomes for the triphalangeal Wassel type VI thumb duplication patients.

Methods:
The surgical technique involves ablation of the radial thumb at distal one-third of the metacarpal, corresponding metacarpal osteotomy of the ulnar thumb, with amalgamation of 2 metacarpals and reconstruction of the ulnar thumb by a series of soft tissue procedures. Clinical and radiologic outcomes were evaluated by using the Japanese Society for Surgery of the Hand evaluation form at a minimum of 30 months. The size of the metacarpal was measured and compared to the opposite one to assess the growth of the thumb.

Results:
Five patients, including 4 males and 1 female, were observed for an average of 37 months. All amalgamated metacarpal showed bone union in 6 weeks after surgery and revealed growth with the age. The average length of the metacarpal was 86% of the opposite one at the final follow-up. Motion at the metacarpophalangeal and interphalangeal joints showed no restriction after surgery, and they reached excellent function for gripping and pinching. According to the JHHS scoring system, the results were excellent in 3 cases, good in 2.

Conclusions:
This novel surgical technique for the reconstruction of Wassel type VI radial polydactyly with triphalangeal shows encouraging results in both clinical and radiologic evaluations; meanwhile long-term results are under evaluation.
Zygomatico-maxillary Reconstruction with Computer-aided Manufacturing of a Free DCIA Osseous Flap and Intraoral Anastomoses
Authors: Roy Andrée-Anne , Efanov Johnny I. , Mercier-Couture Geneviève , Chollet André , Borsuk Daniel E. 
Published: February 2017

Summary:
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient’s unaffected side to allow for perfect fit to the zygomatico-maxillary defect. An intraoral dissection of the facial artery and vein was performed within the right cheek mucosa and allowed for end-to-end microvascular anastomoses. 3D preoperative planning and customized free DCIA osseous flap combined with an intraoral microsurgical technique provided restoration of facial esthetics and function without visible scars. In cases where zygomatico-malar reconstruction by alloplastic material fails, a customized free DCIA osseous flap can be designed by virtual surgical planning to restore facial appearance and function.
A Comprehensive Approach to Lower Extremity Free-tissue Transfer
Authors: Pu Lee L.Q. 
Published: February 2017

Background:
The purpose of this study was to introduce a comprehensive approach to lower extremity free-tissue transfer and report the clinical outcome that has been achieved with this approach.

Methods:
The comprehensive approach developed by the author includes patient selection, flap selection, selection of the recipient vessels, flap dissection, flap preparation, microvascular anastomosis, flap inset, immediate postoperative care, intermediate postoperative care, and further follow-up care. Each part of this approach has its own special considerations. In an 8-year period, 28 consecutive lower extremity free-tissue transfers were performed in 28 patients by the author. The clinical outcomes were recorded based on the success of free-tissue transfer, any reoperations related to the revision of microvascular anastomosis, and any partial or total flap loss during an 8-year follow-up.

Results:
All 28 lower extremity free-tissue transfers were performed successfully. All patients were discharged home once they tolerated dangling. No reoperations were needed for revision of microvascular anastomosis. No total or partial flap loss was encountered. Overall success of free-tissue transfer to the lower extremity in this series was 100%.

Conclusions:
An ideal outcome of free-tissue transfer to the lower extremity can be accomplished with this comprehensive approach developed by the author. With good surgical judgment, adequate microsurgical skill, step-by-step intraoperative execution, and a protocol-driven clinical practice, the reconstructive surgeon should be able to improve his or her success for free-tissue transfer to the lower extremity.
Will Infant Hepatitis B Vaccination Protect Into Adulthood?
Authors: Pinto Michelle , Dawar Meena , Krajden Mel , Naus Monika , Scheifele David W. 
Published: February 2017

Background:
Hepatitis B virus (HBV) vaccination programs generally target infants to prevent chronic HBV infection and/or preadolescents to reduce transmission in adulthood. To assess whether infant HBV immunization can potentially accomplish both objectives, we measured residual immunity 10–16 years after vaccination in Canadian children.

Methods:
A prospective, parallel group, single center study enrolled adolescents given HBV vaccine at 2, 4 and 6 months of age. Exclusion criteria included prior HBV infection and additional vaccinations. At follow-up anti-HBs testing, participants were 10–11 or 15–16 years old; those with <12 mIU/mL anti-HBs by the assay used were challenged with HBV vaccine to assess immune memory-based responsiveness.

Results:
A total of 137 tested participants were 10–11 and 213 were 15–16 years old, respectively; none had evidence of prior HBV infection. At baseline, 78% of younger and 64% of older participants had <12 mIU/mL anti-HBs (P = 0.006) and were challenged with vaccine: 103/106 (97.2%) younger and 123/135 (91.1%) older participants developed ≥12 mIU/mL anti-HBs (P = 0.06), with geometric mean antibody concentration of 590 (95% confidence interval: 473–737) and 319 mIU/mL (95% confidence interval: 229–445; P = 0.004), respectively. Immune memory loss may have occurred in 3 younger (2.2%) and 12 older children (5.6%; P = 0.06) who were nonresponsive to first but not second vaccine challenge.

Conclusions:
After HBV vaccination at 2, 4 and 6 months of age, most adolescents had little or no residual antibody but nearly all responded to HBV challenge, confirming immune memory persistence. However, anamnestic responses were weaker in 15- to 16-year olds and lost in some. Booster responses in 10- to 11-year olds were vigorous in comparison. Extended evaluation of protection is warranted.
Osteomyelitis of the Odontoid Process in Children
Authors: Lubotzky Asael , Cytter-Kuint Ruth , Raccah Eliyahu , Megged Orli 
Published: February 2017

Objective:
To report clinical, laboratory and radiologic manifestations in 2 infants with osteomyelitis of the odontoid process (dens).

Background:
Vertebral osteomyelitis is uncommon, and osteomyelitis of the dens has rarely been reported in the pediatric population.

Methods:
The medical records of 2 infants diagnosed with dens osteomyelitis were reviewed.

Results:
Both infants had fever, which resolved spontaneously before admission. Both were nontoxic appearing with persistent neck stiffness and torticollis. White blood count and C-reactive protein were only mildly elevated in both cases. Blood cultures were sterile. Magnetic resonance imaging revealed the diagnosis. They both fully recovered.

Conclusions:
We report 2 cases of dens osteomyelitis. These cases emphasize the need to consider C1–C2 osteomyelitis in the differential diagnosis of neck stiffness and torticollis.
A Hospital-based Case-control Study of Diarrhea in Children in Shanghai
Authors: Chang Hailing , Zhang Ling , Ge Yanling , Cai Jiehao , Wang Xiangshi , Huang Zheng , Guo Jiayin , Xu Hao , Gu Zhen , Chen Hong , Xu Xuebin , Zeng Mei 
Published: February 2017

Background:
Prevention and control of childhood diarrhea is a global priority. We conducted a case-control study of childhood diarrhea in Shanghai.

Methods:
We prospectively recruited diarrheal children in an outpatient setting. Nondiarrheal controls were individually matched to cases. Rotavirus, norovirus and bacterial pathogens were examined. Clinical and epidemiologic data were obtained at enrollment and follow-up.

Results:
Potential pathogens identified in 680 diarrheal cases and 680 controls were rotavirus (19.0% vs. 1.3%), norovirus (13.4% vs. 4.7%), nontyphoidal Salmonella (9.3% vs. 1.9%), enteropathogenic Escherichia coli (8.4% vs. 6.9%) and enteroaggregative Escherichia coli (7.2% vs. 6.2%) and Campylobacter (5.1% vs. 1.2%), enterotoxigenic Escherichia coli (1.2% vs. 0.6%), enterohemorrhagic Escherichia coli (0.3% vs. 0%) and Shigella (0.15% vs. 0%), respectively. The specificity and sensitivity of fecal leukocytes >5 per high-power field for the diagnosis of bacterial diarrhea were 94.2% and 22.8%. Salmonella were susceptible to ciprofloxacin, ceftriaxone and amoxicillin-clavulanate and showed low frequency of resistance to azithromycin. Campylobacter showed low frequency of resistance to azithromycin and high frequency of resistance to ciprofloxacin. Diarrheagenic Escherichia coli was highly susceptible to ciprofloxacin and amoxicillin-clavulanate. Contact with diarrheal patients was a risk factor for rotavirus [adjusted odds ratio (aOR): 11.7], norovirus (aOR: 7.5) and Campylobacter (aOR: 27.1) infections. Mother’s education was positively associated with Salmonella infection (aOR: 2.1). Good hand hygiene was protective against rotavirus (aOR: 0.6), norovirus (aOR: 0.5) and Salmonella (aOR: 0.3) infections.

Conclusions:
Rotavirus, norovirus, nontyphoidal Salmonella and Campylobacter are significantly associated with diarrhea in Chinese children. Fecal leukocytes >5 per high-power field can predict bacterial diarrhea. Target prevention and appropriate treatment of diarrhea should consider the potential pathogen and resistance pattern.
Xpert MTB/RIF on Stool Is Useful for the Rapid Diagnosis of Tuberculosis in Young Children With Severe Pulmonary Disease
Authors: Walters Elisabetta , van der Zalm Marieke Magrieta , Palmer Megan , Bosch Corné , Demers Anne-Marie , Draper Heather , Goussard Pierre , Schaaf Hendrik Simon , Friedrich Sven Olaf , Whitelaw Andrew , Warren Robin , Gie Robert P. , Hesseling Anneke C. 
Published: February 2017

Background:
Tuberculosis (TB) continues to result in high morbidity and mortality in children from resource-limited settings. Diagnostic challenges, including resource-intense sputum collection methods and insensitive diagnostic tests, contribute to diagnostic delay and poor outcomes in children. We evaluated the diagnostic utility of stool Xpert MTB/RIF (Xpert) compared with bacteriologic confirmation (combination of Xpert and culture of respiratory samples).

Methods:
In a hospital-based study in Cape Town, South Africa, we enrolled children younger than 13 years of age with suspected pulmonary TB from April 2012 to August 2015. Standard clinical investigations included tuberculin skin test, chest radiograph and HIV testing. Respiratory samples for smear microscopy, Xpert and liquid culture included gastric aspirates, induced sputum, nasopharyngeal aspirates and expectorated sputum. One stool sample per child was collected and tested using Xpert.

Results:
Of 379 children enrolled (median age, 15.9 months, 13.7% HIV infected), 73 (19.3%) had bacteriologically confirmed TB. The sensitivity and specificity of stool Xpert versus overall bacteriologic confirmation were 31.9% [95% confidence interval (CI): 21.84%–44.50%] and 99.7% (95% CI: 98.2%–100%), respectively. A total of 23/51 (45.1%) children with bacteriologically confirmed TB with severe disease were stool Xpert positive. Cavities on chest radiograph were associated with Xpert stool positivity regardless of age and other relevant factors [odds ratios (OR) 7.05; 95% CI: 2.16–22.98; P = 0.001].

Conclusions:
Stool Xpert can rapidly confirm TB in children who present with radiologic findings suggestive of severe TB. In resource-limited settings where children frequently present with advanced disease, Xpert on stool samples could improve access to rapid diagnostic confirmation and appropriate treatment.
Late-onset Neonatal Sepsis—A 10-year Review From North Queensland, Australia
Authors: Gowda Harsha , Norton Robert , White Andrew , Kandasamy Yogavijayan 
Published: February 2017

Objective:
Late-onset sepsis (LOS) in neonates contributes significantly to both morbidity and mortality. To determine the incidence of LOS, risk factors for disease and the impact on subsequent hospital course, we evaluated a cohort of 6340 neonates admitted to the neonatal intensive care unit and of neonates (3–28 days) admitted from the community between January 2005 and January 2016.

Methods:
This was a retrospective case review of all neonates admitted with suspected LOS who had positive blood culture and/or cerebrospinal fluid cultures, for an organism determined to be a pathogen.

Results:
Of 6340 neonates who survived beyond 3 days, 2271 (35.8%) had 1 or more blood cultures collected for suspected LOS. Of these, 146 (6.4%) positive blood cultures were thought to represent true bacteremia. The vast majority of infections (73%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 39.8% of infections. Late-onset neonatal sepsis occurred predominantly in the 24–28-week age group (75.9%) and in neonates who weighed less than 1000 g (73.6%). The incubation time for positive blood cultures for Gram-negative sepsis was less (13 hours) when compared with Gram-positive sepsis (20 hours). Thrombocytopenia, elevated C-reactive protein and chorioamnionitis were consistently associated with late-onset Gram-negative sepsis (P < 0.05). Eight neonates (6%) died secondary to LOS.

Conclusions:
LOS contributes significantly to mortality and morbidity in neonates and remains a challenge to clinicians. Necessary steps to reduce late-onset neonatal sepsis should be undertaken.
Does expecting more pain make it more intense? Factors associated with the first week pain trajectories after breast cancer surgery
Authors: Sipilä Reetta M. , Haasio Lassi , Meretoja Tuomo J. , Ripatti Samuli , Estlander Ann-Mari , Kalso Eija A. 
Published: February 2017

Abstract
The aim of this study was to identify clinical risk factors for unfavorable pain trajectories after breast cancer surgery, to better understand the association between pain expectation, psychological distress, and acute postoperative pain. This prospective study included 563 women treated for breast cancer. Psychological data included questionnaires for depressive symptoms and anxiety. Experimental pain tests for heat and cold were performed before surgery. The amount of oxycodone needed for satisfactory pain relief after surgery was recorded. Pain intensity in the area of operation before surgery and during the first postoperative week and expected intensity of postoperative pain were recorded using the Numerical Rating Scale (NRS 0-10). Pain trajectories were formed to describe both initial intensity (the intercept) and the direction of the pain path (the slope). Factors associated with higher initial pain intensity (the intercept) were the amount of oxycodone needed for adequate analgesia, psychological distress, type of axillary surgery, preoperative pain in the area of the operation, and expectation of postoperative pain. The higher the pain initially was, the faster it resolved over the week. Expectation of severe postoperative pain was associated with higher scores of both experimental and clinical pain intensity and psychological factors. The results confirm that acute pain after breast cancer surgery is a multidimensional phenomenon. Psychological distress, pain expectation, and the patients' report of preoperative pain in the area to be operated should be recognized before surgery. Patients having axillary clearance need more efficient analgesic approaches.
Spinal cord interneurons expressing the gastrin-releasing peptide receptor convey itch through VGLUT2-mediated signaling
Authors: Aresh Bejan , Freitag Fabio B. , Perry Sharn , Blümel Edda , Lau Joey , Franck Marina C.M. , Lagerström Malin C. 
Published: February 2017

Abstract
Itch is a sensation that promotes the desire to scratch, which can be evoked by mechanical and chemical stimuli. In the spinal cord, neurons expressing the gastrin-releasing peptide receptor (GRPR) have been identified as specific mediators of itch. However, our understanding of the GRPR population in the spinal cord, and thus how these neurons exercise their functions, is limited. For this purpose, we constructed a Cre line designed to target the GRPR population of neurons (Grpr-Cre). Our analysis revealed that Grpr-Cre cells in the spinal cord are predominantly excitatory interneurons that are found in the dorsal lamina, especially in laminae II-IV. Application of the specific agonist gastrin-releasing peptide induced spike responses in 43.3% of the patched Grpr-Cre neurons, where the majority of the cells displayed a tonic firing property. Additionally, our analysis showed that the Grpr-Cre population expresses Vglut2 mRNA, and mice ablated of Vglut2 in Grpr-Cre cells (Vglut2-lox;Grpr-Cre mice) displayed less spontaneous itch and attenuated responses to both histaminergic and nonhistaminergic agents. We could also show that application of the itch-inducing peptide, natriuretic polypeptide B, induces calcium influx in a subpopulation of Grpr-Cre neurons. To summarize, our data indicate that the Grpr-Cre spinal cord neural population is composed of interneurons that use VGLUT2-mediated signaling for transmitting chemical and spontaneous itch stimuli to the next, currently unknown, neurons in the labeled line of itch.