bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractional Erbium-Doped Yttrium Aluminum Garnet Laser Versus Microneedling in Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study
Authors: Osman Mai Abdel Raouf , Shokeir Hisham Ali , Fawzy Marwa M. 
Published: December 2016

BACKGROUND
Ablative fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser and microneedling have been popularized in recent years and their effectiveness and side effects individually reported. No previous study, however, has directly compared the efficacy and safety between the 2 different treatments.

OBJECTIVE
To compare the efficacy and safety of the ablative fractional Er:YAG laser and microneedling for the treatment of atrophic acne scars.

MATERIALS AND METHODS
Thirty patients with atrophic acne scars were randomly treated in a split-face manner with a fractional Er:YAG laser on one side and microneedling on the other side. All patients received 5 treatments with a 1-month interval. Objective and subjective assessments were obtained at baseline and at 3 months after the final treatment.

RESULTS
At the 3-month follow-up, both treatment modalities induced noticeable clinical and histological improvement, with significantly better results in fractional Er:YAG laser versus microneedling (70% vs 30%), respectively (p < .001). Fractional Er:YAG laser sides had significantly lower pain scores. Total downtime was significantly shorter in microneedling sides.

CONCLUSION
Both treatment modalities are effective and safe in the treatment of atrophic acne scars, with significantly higher scar response to the fractional Er:YAG laser treatment.
A Prospective Study of Axillary Hair Reduction in Patients Treated With Microwave Technology
Authors: Brauer Jeremy A. , Neckman Julia P. , Zelickson Brian , Vasily David B. , Geronemus Roy G. 
Published: December 2016

BACKGROUND
Removing unwanted body hair is a growing trend in society today, and there are many laser-based devices for hair reduction. There are some limitations to those methods, including the lack of efficacy for lighter color hair.

OBJECTIVE
The objective was to quantify hair reduction in the axillae after treatment with a noninvasive microwave energy device.

MATERIALS AND METHODS
A prospective, multicenter study was performed at 3 private dermatology clinics. Fifty-six adult subjects seeking axillary hair reduction were enrolled and treated with the device in 1 or 2 treatment sessions 3 months apart at various energy levels, and followed for 12 months. The primary analysis was monitoring reduction of hair counts from baseline to follow-up visits. A subject assessment of overall satisfaction, odor ratings, and sweat reduction ratings was provided at follow-up visits.

RESULTS
Fifty-six subjects received treatment, with an average total underarm hair reduction of approximately 70% for both light and dark hair. Percentage of patients with hair reduction of 30% or more was significantly higher than 50% at all follow-up visits. Half of treated subjects reported expected mild transient post-treatment effects such as localized edema, discomfort, and bruising. Other reported events were mild.

CONCLUSION
This clinical study provides evidence for safe and permanent axillary hair reduction, showing stable average reduction that lasted through the year of follow-up. Most notably, the study has shown the treatment's efficacy for reduction of light-colored axillary hair.
Vulvar Varicosities: A Review
Authors: Kim Anna S. , Greyling Laura A. , Davis Loretta S. 
Published: December 2016

BACKGROUND
Vulvar varicosities (VV) are dilated and tortuous veins occurring within the external female genitalia. Patients may seek treatment of these varices for both medical and cosmetic purposes. In some patients, VV may be associated with a chronic pelvic pain syndrome called pelvic congestion syndrome (PCS).

OBJECTIVE
To review the English language literature on VV in both pregnant and nonpregnant women.

MATERIALS AND METHODS
A literature search pertaining to vulvar varicosities and PCS was performed using PubMed and Google Scholar databases.

RESULTS
There is an overall paucity of literature discussing VV, particularly in nonpregnant women without PCS. Management options for VV include compression, sclerotherapy, embolization, and surgical ligation. Treatment can be dependent on the coexistence of pelvic or leg varicosities and may require referral to a vein specialist for advanced imaging techniques and procedures. Direct sclerotherapy to VV may not provide adequate treatment if pelvic or leg varices are also present.

CONCLUSION
In women with persistent VV, imaging studies should be obtained before treatment to evaluate the surrounding venous anatomy of the pelvis and leg, as the results often affect the treatment approach. Patients presenting with VV and chronic pelvic pain should be evaluated for PCS.
Single-Nucleotide Polymorphism of CYP3A5 Impacts the Exposure to Tacrolimus in Pediatric Renal Transplant Recipients: A Pharmacogenetic Substudy of the TWIST Trial
Authors: Billing Heiko , Höcker Britta , Fichtner Alexander , van Damme-Lombaerts Rita , Friman Styrbjorn , Jaray Jenö , Vondrak Karel , Sarvary Eniko , Dello Strologo Luca , Oellerich Michael , von Ahsen Nicolas , Tönshoff Burkhard 
Published: December 2016

Background:
The pharmacokinetics of tacrolimus (TAC) and mycophenolic acid (MPA) are highly variable. An impact of single-nucleotide polymorphisms (SNPs) of the genes coding for enzymes and transporters involved in the pharmacokinetics of TAC and/or MPA is intuitively conceivable. Accordingly, we sought to analyze the influence of different SNPs on TAC and MPA exposure in pediatric renal transplant recipients.

Methods:
A subpopulation of 37 patients (median age: 12.8 years, range 2.2–18.3 years) participating in the TWIST study was included in the analysis of SNPs of CYP3A5, ABCB1 (MDR1), ABCG2, SLCO1B3 (coding for OATP2), ABCC2 (coding for cMOAT), and UGT1/2. TAC trough concentrations and abbreviated area under the concentration–time curves (AUC) of MPA were measured on days 7, 28, 91, and 183 after transplant. Both of these were adjusted to the respective dose the patient received.

Results:
The allele frequencies of analyzed SNP's were comparable to those reported previously for white populations. Dose-adjusted trough concentrations of TAC were approximately 60% lower in patients with the CYP3A5*1/*3 allele as compared with the CYP3A5*3/*3 allele (P = 0.004). Steroid-free patients in CYP3A5*3/*3 and CYP3A5*1/*3 carrier subgroups had comparable dose-adjusted TAC concentrations to the subgroup on steroids (P = 0.13). Patients younger than 10 years had a significantly lower median dose-adjusted TAC C0 concentration than patients older than 10 years; this age effect was comparable in heterozygous and homozygous CYP3A5 carriers as well as in patients on and off steroid medication. As for MPA, the genetic variability of transporters or enzymes had no impact on dose-adjusted MPA-AUC due to the low allele frequencies. Patients off steroids had a higher dose-adjusted MPA-AUC (0.18 mg·h/L per mg/m2, 0.012–0.27) compared with patients on steroids (0.12 mg·h·L−1·mg−1, 0.09–0.19; P = 0.04).

Conclusions:
Genetic variability of CYP3A5 has an impact on TAC metabolism in pediatric renal transplant recipients, contributing partly to the variability of TAC exposure. Therefore, adjusting initial TAC dosing to the genotype of CYP3A5 might be of clinical benefit.
Cardiac Rehabilitation Leads to Improvements in Activity Limitations
Authors: Puthoff Michael L. , Youngs Brenda 
Published: December 2016

Purpose:
The purposes of this study were to identify the number of participants who enter cardiac rehabilitation with an activity limitation and assess whether a cardiac rehabilitation program leads to improvements in activity, demonstrated through changes in gait speed and the 5-times-sit-to-stand test (FTSST).

Methods:
This study utilized a 1-group pretest-posttest design. Gait speed and FTSST were measured at the start and end of cardiac rehabilitation. Paired sample t tests were performed to assess changes pre- and postrehabilitation. Subgroup analysis was done on patients who presented with an activity limitation on admission (gait speed <1.0 m/s or FTSST time >12 seconds) to determine whether this subgroup experienced greater changes.

Results:
On admission, 60.2% of participants presented with an activity limitation using FTSST as the criterion. At the completion of cardiac rehabilitation, participants demonstrated improvements in gait speed and FTSST, but improvements were less than the minimal detectable change (MDC) for the outcome measures. Those who presented with an activity limitation on admission had greater improvements and surpassed the MDC. Even after cardiac rehabilitation, more than 30% of participants still had an activity limitation.

Conclusions:
Patients entering cardiac rehabilitation present with activity limitations and most, but not all, will make gains through a standard course of cardiac rehabilitation. Clinicians and researchers should consider how cardiac rehabilitation programs can be modified to assess the presence of activity limitation and maximize improvements in function to enhance participation in society.
Outcomes of Pulmonary Rehabilitation After Treatment for Non-Small Cell Lung Cancer Stages I to IIIa
Authors: Janssen Steffi M. J. , Abbink Jannie J. , Lindeboom Robert , Vliet Vlieland Thea P. M. 
Published: December 2016

PURPOSE:
Although rehabilitation after treatment for non-small cell lung cancer (NSCLC) was found to have a beneficial effect on exercise capacity in a number of studies, insight into its effect on quality of life (QoL) and fatigue is limited. The aim of this study was to examine the outcome of pulmonary rehabilitation (PR) regarding fatigue, QoL, and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa.

METHODS:
Study data were prospectively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa. PR consisted of 12 weeks of supervised exercises 3 times a week, supplemented with scheduled visits with members of a multidisciplinary team. Data were gathered at initial assessment and discharge. Outcomes included fatigue (the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Questionnaire); QoL (total CRQ score), Functional Assessment of Cancer Therapy-Lung, and the Short Form 36; and exercise capacity (cardiopulmonary exercise testing).

RESULTS:
Fifty patients started the program out of the 70 patients referred to PR and 43 (86%) completed the program. Significant (P ≤ .01) and clinically relevant improvements were observed for all outcome measures.

CONCLUSIONS:
Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue, QoL, and exercise capacity. PR should be considered for patients after treatment for NSCLC stages I to IIIa.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AFTER PHOTOCOAGULATION OF TYPE 2 NEOVASCULARIZATION
Authors: Arya Malvika , Cole Emily D. , Novais Eduardo A. , Louzada Ricardo N. , Waheed Nadia K. , Duker Jay S. 
Published: December 2016

Purpose:
To illustrate errors in the automated segmentation image analysis of optical coherence tomography angiography after laser photocoagulation therapy for Type 2 neovascularization.

Methods:
This case report describes a patient with extrafoveal Type 2 neovascularization treated with argon laser photocoagulation evaluated before and after treatment by optical coherence tomography angiography.

Results:
Disrupted retinal layers after laser photocoagulation therapy lead to segmentation errors.

Conclusion:
Images of optical coherence tomography angiography are prone to degradation by artifacts in cases in which there is disruption of the retinal layers. Clinicians must be aware of these errors because they can be misinterpreted as active Type 2 neovascularization. Improvement in optical coherence tomography angiography image analysis to minimize automated segmentation errors needs to be further explored.
The Influence of the Route of Antibiotic Administration, Methicillin Susceptibility, Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection
Authors: McNeil J. Chase , Kaplan Sheldon L. , Vallejo Jesus G. 
Published: December 2016

Background:
Bacteremia is often one factor used in deciding the need for prolonged intravenous antimicrobial therapy in osteoarticular infections (OAIs). We examined treatment practices and outcomes of Staphylococcus aureus bacteremic osteoarticular infections (BOAIs) evaluated at Texas Children’s Hospital.

Methods:
Cases of acute hematogenous OAI in children with positive blood cultures for S. aureus at Texas Children’s Hospital between 2011 and 2014 were reviewed. Orthopedic complications included chronic osteomyelitis, growth arrest, pathologic fracture, avascular necrosis and chronic dislocation. Acute kidney injury was defined as a doubling of the baseline creatinine.

Results:
One hundred and ninety-two cases of S. aureus OAI were identified with 102 cases of BOAI included [35 methicillin-resistant S. aureus (MRSA)]. Twenty-five patients were discharged home on oral antibiotics. Patients discharged on oral antibiotics had a shorter duration of fever, had a more rapid decline in C-reactive protein and were less likely to have MRSA. The frequency of orthopedic complications did not increase in patients who received early transition to oral antibiotics. For patients with MRSA bacteremia, the rates of complications between those who received ≥7 days versus <7 days of vancomycin did not differ. Vancomycin serum troughs >15 µg/mL were not associated with a decreased duration of fever, bacteremia or hospitalization, need for repeat operation or orthopedic complications but were associated with acute kidney injury.

Conclusions:

S. aureus BOAIs are associated with substantial morbidity. Early transition to oral therapy may be a safe option for select patients with S. aureus BOAI, including those due to MRSA. Prolonged courses of vancomycin and vancomycin troughs >15 μg/mL were not associated with improved outcomes for MRSA OAI.
Antiretroviral Treatment Initiated in the First Month of Life
Authors: Frigati Lisa , Wynberg Elke , Maritz Jean , Holgate Sandi , Cotton Mark F. , Rabie Helena 
Published: December 2016

Background:
Earlier diagnosis of HIV-infected infants facilitates earlier access to therapy and improved clinical outcomes. The aim of this study was to describe the management of infants who started antiretroviral therapy (ART) in the first month of life.

Methods:
A retrospective review was performed on HIV-infected neonates who started ART within the first month of life between January 2013 and March 2015.

Results:
A total of 997 neonates had 1 HIV polymerase chain reaction test. Of the 997 neonates, 26 (2.6%) tested positive for HIV and 22 initiated therapy in the first month of life. The median age of first HIV polymerase chain reaction test was 7 days. Neonates were started on ART within a median of 7 days of their first HIV test, which equated to a median age of 13.5 [interquartile range (IQR) 7–20] days of life. Median gestational age was 35 weeks (IQR 33–38 weeks), and birth weight was 2170 g (IQR 1773–2480). Nineteen (86.4%) had low birth weight (<2.5 kg) and 16 (72.7%) were premature. Median baseline HIV viral loads were log 4.444 copies/mL (IQR 3.457–5.125), median CD4 counts were 1338 (IQR 803–1928) and CD4% percentages were 36.1% (22.2–45.4). All children initiated zidovudine and lamivudine, 10 with lopinavir/ritonavir and 12 with nevirapine. All children in care are now receiving lopinavir/ritonavir. Of the 22 neonates initiated on treatment, 11 are in care (mean age, 2.1 years), and 2 of these infants had a viral load of <50 copies/ mL when last measured.

Conclusions:
Early ART initiation in neonates is feasible. Challenges include safe, palatable regimens and continued close follow-up of mothers and infants.
Low Bone Mineral Density in Vertically HIV-infected Children and Adolescents
Authors: Jiménez Beatriz , Sainz Talía , Díaz Laura , Mellado María José , Navarro María Luisa , Rojo Pablo , González-Tomé María Isabel , Prieto Luis , Martínez Jorge , de José María Isabel , Ramos José Tomás , Muñoz-Fernandez María Ángeles 
Published: December 2016

Background:
Our aim was to determine the prevalence and risk factors associated with low bone mineral density (BMD) in vertically HIV-infected patients and to investigate whether low BMD is related to immune activation and senescence induced by HIV infection.

Methods:
A cross-sectional study was performed in 98 vertically HIV-infected patients. BMD was measured by dual-energy radiograph absorptiometry at lumbar spine. Height adjustment of BMD Z score was performed using height-for-age Z score. T-cell immune activation and senescence were analyzed in a subgroup of 54 patients by flow cytometry.

Results:
Median age was 15.9 years, 71.4% were Caucasian, 99% received antiretroviral therapy and 80.6% had undetectable viral load. Low BMD (BMD Z score ≤ −2) was present in 15.3% of cases, but after height adjustment in 4.1% of cases. Height-adjusted BMD Z score was positively correlated with body mass index Z score, CD4/CD8 ratio and nadir CD4, and inversely with duration of severe immunosuppression and parathyroid hormone values. In the multivariate model including age, gender, ethnicity, encephalopathy, Tanner stage, nadir CD4, duration of viral suppression, CD4 count, CD4/CD8 ratio, body mass index, cumulative duration of antiretroviral therapy, tenofovir and protease inhibitors exposure, nadir CD4 was independently associated to height-adjusted BMD Z score. No association was found between height-adjusted BMD Z score and T-cell activation or senescence.

Conclusions:
The prevalence of low BMD in vertically HIV-infected patients was low after height adjustment. Nadir CD4, but not T-cell activation or senescence, was an independent predictor for low BMD. Larger and prospective studies are needed to achieve better knowledge of the pathogenesis of low BMD in vertical HIV infection.
Attitudes of Swiss Health Care Providers Toward Childhood Immunizations
Authors: Schuler Marianne , Schaedelin Sabine , Aebi Christoph , Berger Christoph , Crisinel Pierre-Alex , Diana Alessandro , Niederer-Loher Anita , Siegrist Claire-Anne , Vaudaux Bernard , Heininger Ulrich 
Published: December 2016

Background:
INFOVAC is a network providing information about immunization issues to health professionals. The aim of this study was to assess the attitude of INFOVAC subscribers toward the current Swiss immunization schedule, potential modifications, and current and hypothetical immunization practices regarding their own children.

Methods:
In March 2015, a Web-based survey was sent to 4260 physicians and pharmacists subscribed to INFOVAC. Participation was anonymous and voluntary. The following information was obtained: (1) current immunization status of own children; (2) which immunizations would currently be accepted for a hypothetical own child and (3) attitudes toward potential modifications of the Swiss immunization schedule. Descriptive methods and multivariate models to correct for covariables were used for data analysis.

Results:
Nine hundred and fifty-five valid questionnaires were received: 886/3704 (23.9%) from physicians and 69/556 (12.4%) from pharmacists. Current (>95%) and hypothetical (>99%) immunization rates were high for diphtheria, tetanus, pertussis, poliomyelitis and measles-mumps-rubella. Most pediatricians (61%) would support more vaccines for their children than currently recommended by the Swiss immunization advisory committee, whereas about 50% of other physicians and pharmacists would decline at least one of the recommended immunizations, most frequently varicella, pneumococcal or meningococcal C conjugate vaccines. Strong general support was expressed for the expansion of human papillomavirus immunization to males, acceleration of the measles-mumps-rubella schedule and a 2 + 1 instead of 3 + 1 diphtheria-tetanus-pertussis, acellular-inactivated poliomyelitis vaccine (DTPa-IPV)/Haemophilus influenzae type b ± hepatitis B virus (HBV) schedule.

Conclusions:
Survey participants generally demonstrated a positive attitude toward immunization, with pediatricians being the most progressive subgroup with the largest percentage of participants (63.1%) neither declining nor postponing any recommended immunization.
Outcomes With Fidaxomicin Therapy in Clostridium difficile Infection
Authors: Spiceland Clayton M. , Khanna Sahil , Pardi Darrell S. 
Published: December 2016

Background and Goals:
Fidaxomicin is a new antibiotic used to treat Clostridium difficile infection (CDI). Given limited clinical experience with fidaxomicin, we assessed outcomes in a diverse cohort of patients with CDI treated with fidaxomicin.

Study:
All CDI cases treated with fidaxomicin at 3 referral centers over a 4-year period were included. Response was defined as resolution of diarrhea and recurrence was defined by recurrence of CDI within 8 weeks of the end of treatment.

Results:
Overall, 81 patients (median age 55.9 y; 53% female; 26% with inflammatory bowel disease) were included. Response occurred in 90%. Responders had fewer prior CDI episodes [median 1 (range, 0 to 8)] than nonresponders [median 2.5 (range, 1 to 8)], P=0.01. Response after a first CDI episode was 100%, 96% after 1 prior episode, and 82% after 2 or more, P=0.02. Recurrence occurred in 19%. Patients without recurrence had fewer prior episodes of CDI [median 1 (range, 0 to 6)] than patients who recurred [median 2 (range, 1 to 8)], P=0.005. Recurrence after a first episode was 0%, 23% after 1 prior episode, and 29% after 2 or more, P=0.005. All patients with inflammatory bowel disease responded either with improvement of symptoms or a negative C. difficile test; 19% recurred.

Conclusions:
All patients with a first CDI episode treated with fidaxomicin responded with no recurrences. Patients with prior CDI episodes were less likely to respond (especially with more than 1 prior episode) and more likely to recur, suggesting a greater clinical benefit of fidaxomicin earlier in the course of CDI.