bluuebunny/crossref_metadata_2025_split huggingface dataset:
Folliculocentric Herpes: A Clinicopathological Study of 28 Patients
Authors: Crowson A. Neil , Saab Jad , Magro Cynthia M. 
Published: May 2016

Background:
The cutaneous manifestations of herpes infection are primarily in the context of active infection and of the post-herpetic zosteriform eruption. The former manifests cytopathic alterations diagnostic of herpes. The latter includes lichen planus–like and granuloma annulare–like eruptions and lymphocytoma cutis.

Methods:
We encountered skin biopsies from 28 patients whose acute or chronic herpetic or post-herpetic zosteriform lesions manifested folliculocentricity. The clinical appearance of the lesions was correlated with the histopathologic and immunohistochemical features of paraffin-embedded skin biopsies to determine the specific viral etiology. A history of underlying medical disease was noted if present.

Results:
There were 16 men and 12 women with a folliculocentric eruption occurring after a known herpetic eruption or manifesting cytopathic changes and/or immunohistochemical findings compatible with herpes virus in lesional skin biopsies. Underlying immune dysregulatory states were present in most cases, namely, malignancy, anticonvulsant or antidepressant therapy, diabetes mellitus, psoriasis, Crohn disease, and other conditions. All biopsies demonstrated dense lymphohistiocytic infiltrates in or around hair follicles with variable necrosis, while active infections also showed cytopathic and/or immunohistochemical evidence of herpetic alterations, most commonly varicella zoster. Other features included interfollicular interface dermatitis, lymphocytic eccrine hidradenitis, neuritis, and folliculocentric vasculitis.

Conclusions:
Cutaneous herpetic eruptions can evoke a predominantly folliculocentric mononuclear cell reaction and vasculitis; there is an association with underlying endogenous and/or iatrogenic immune dysregulation. Most cases are secondary to reactivation of varicella zoster. The histomorphology suggests a role for cell-mediated immunity. Antigenic homology of an endogenous 72-kd heat shock protein in follicles with that of a herpetic heat shock protein, in concert with an intrafollicular proliferative response of γ-δ T lymphocytes, may explain the follicular localization and composition of the infiltrate.
Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers
Authors: Spector William D. , Limcangco Rhona , Owens Pamela L. , Steiner Claudia A. 
Published: May 2016

Background:
Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs).

Objective:
To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics.

Research Design and Subjects:
Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression.

Results:
We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900.

Conclusions:
This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.
Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes
Authors: Patel Minal R. , Piette John D. , Resnicow Kenneth , Kowalski-Dobson Theresa , Heisler Michele 
Published: May 2016

Background:
Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non–health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN.

Methods:
Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN.

Results:
Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05–1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5–1.67), and food insecurity (PR=1.30; 95% CI, 1.2–1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2–0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN.

Conclusions:
Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery
Authors: Ligh Cassandra A. , Fox Justin P. , Swanson Jordan , Yu Jason W. , Taylor Jesse A. 
Published: May 2016

Background:
This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges.

Methods:
The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care—emergency, outpatient, inpatient—within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges.

Results:
The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges.

Conclusions:
Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.
The Effect of Norepinephrine and Dopamine on Radial Forearm Flap Partial Tissue Oxygen Pressure and Microdialysate Metabolite Measurements: A Randomized Controlled Trial
Authors: Raittinen Lassi , Kääriäinen Minna T. , Lopez Jenny F. , Pukander Juhani , Laranne Jussi 
Published: May 2016

Background:
Patients undergoing ablative and reconstructive head and neck surgery with a microvascular flap have multiple factors that potentially decrease postoperative mean arterial pressure, which may endanger flap survival. The safety of vasopressor use has long been a topic of discussion. The authors analyzed the effect of vasopressors on microvascular flap perfusion after head and neck cancer reconstruction.

Methods:
A total of 27 patients were enrolled in a randomized, controlled, clinical trial. A microvascular radial forearm flap was used for reconstruction. Patients were allocated into one of three groups: dopamine, norepinephrine, and control. The intervention groups received the vasoactive drug, aiming to maintain the mean arterial pressure between 80 and 90 mmHg. Normovolemia was maintained according to central venous pressure. Flap perfusion was monitored with continuous tissue partial pressure of oxygen and microdialysate metabolite (lactate-to-pyruvate ratio) measurements.

Results:
No adverse effects were observed, and postoperative recovery was free of complications in all groups. Neither the lactate-to-pyruvate ratio nor continuous tissue partial pressure of oxygen values differed significantly between groups during the first 24 hours of the vasoactive drug infusion period or during the 72-hour follow-up.

Conclusions:
Norepinephrine and dopamine are safe and effective vasopressors for use during the postoperative period following head and neck cancer surgery with microvascular reconstruction. Dopamine should be used with caution, however, because of the risk of side effects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial
Authors: Kan Hester J. , Selles Ruud W. , van Nieuwenhoven Christianne A. , Zhou Chao , Khouri Roger K. , Hovius Steven E. R. 
Published: May 2016

Background:
As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren’s contracture, the authors introduced an extensive percutaneous aponeurotomy and lipofilling (PALF) procedure. In their previous study, the authors reported that contractures significantly improved and most patients returned to normal use of the hand within 2 to 4 weeks. To establish the safety and efficacy of PALF, the authors compared it to the standard limited fasciectomy in a single-blind, multicenter, prospective, randomized, controlled trial.

Methods:
Patients with a primary Dupuytren’s contracture were assigned randomly to the limited fasciectomy group or the PALF group. Patients were measured at baseline and at 2 weeks, 3 weeks, 6 months, and 1 year postoperatively. Primary outcome of the trial was contracture correction and convalescence time. Groups were compared using a mixed models approach.

Results:
Eighty patients were randomized to PALF or limited fasciectomy. In both groups, almost full metacarpophalangeal joint contracture correction was obtained, whereas for the proximal interphalangeal joint, some residual contracture remained. Patients in the PALF group returned significantly earlier to their normal daily activity. At 1 year after surgery, no significant differences in recurrence rate or hand function were present. However, limited fasciectomy seems to have a higher incidence of permanent complications.

Conclusions:
PALF demonstrates a significantly shorter convalescence, similar operative contracture correction, lower incidence of long-term complications, and no significant difference regarding 1-year postoperative results compared with limited fasciectomy. It is therefore a valuable, minimally invasive alternative to limited fasciectomy in the treatment of Dupuytren’s disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Dynamics of the Subdomal Graft
Authors: Lee Michelle , Guyuron Bahman 
Published: May 2016

Background:
The authors examined the dynamics of the subdomal graft and its frequency of use in primary and secondary rhinoplasty in detail.

Methods:
One hundred consecutive primary and 100 consecutive secondary rhinoplasty patients with at least 1 year of follow-up were reviewed retrospectively. The nose sheet containing a detailed intraoperative recording of all rhinoplasty maneuvers was reviewed to analyze the frequency of subdomal graft use. Intraoperative observations of the effects of the subdomal graft on the nasal tip and the surrounding structures were recorded. Data were tabulated in an Excel file and analyzed.

Results:
The subdomal graft was used in 77 percent of 100 primary rhinoplasty patients and 31 percent of 100 secondary rhinoplasty patients. After placement of the subdomal graft, the intraoperative changes included (1) improved dome symmetry in all three dimensions, (2) precise control of interdomal distance, (3) lateral and cephalic rotation of the lateral crura of the lower lateral cartilages, (4) widening of the nostrils secondary to lateral rotation of the lower lateral cartilages, (5) external valve function improvement, (6) prevention of lateral crura concavity by preventing overtightening of the transdomal suture, and (7) prevention of excessive narrowing of the domal arch.

Conclusions:
The subdomal graft improves domal symmetry, precisely controls the interdomal distance, reorients the domes/lateral crura, widens the nostrils, prevents excessive narrowing of the medial genu angle, and prevents lateral crura concavity from transdomal sutures. The graft should be strongly considered in primary and secondary rhinoplasty patients with (1) pinched tip deformity, (2) excessive narrowing of the interdomal distance, (3) asymmetric domes, (4) caudally positioned lower lateral cartilages, and (5) narrow nostrils with external valve dysfunction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Design for Natural Breast Augmentation: The ICE Principle
Authors: Mallucci Patrick , Branford Olivier Alexandre 
Published: May 2016

Background:
The authors’ published studies have helped define breast beauty in outlining key parameters that contribute to breast attractiveness. The “ICE” principle puts design into practice. It is a simplified formula for inframammary fold incision planning as part of the process for determining implant selection and placement to reproduce the 45:55 ratio previously described as fundamental to natural breast appearance. The formula is as follows: implant dimensions (I) − capacity of the breast (C) = excess tissue required (E). The aim of this study was to test the accuracy of the ICE principle for producing consistent natural beautiful results in breast augmentation.

Methods:
A prospective analysis of 50 consecutive women undergoing primary breast augmentation by means of an inframammary fold incision with anatomical or round implants was performed. The ICE principle was applied to all cases to determine implant selection, placement, and incision position. Changes in parameters between preoperative and postoperative digital clinical photographs were analyzed.

Results:
The mean upper pole–to–lower pole ratio changed from 52:48 preoperatively to 45:55 postoperatively (p < 0.0001). Mean nipple angulation was also statistically significantly elevated from 11 degrees to 19 degrees skyward (p ≤ 0.0005). Accuracy of incision placement in the fold was 99.7 percent on the right and 99.6 percent on the left, with a standard error of only 0.2 percent. There was a reduction in variability for all key parameters.

Conclusion:
The authors have shown using the simple ICE principle for surgical planning in breast augmentation that attractive natural breasts may be achieved consistently and with precision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Takayasu Arteritis in Major Rheumatology Centers in Malaysia
Authors: Khor Chiew Gek , Tan Bee Eng , Kan Sow Lai , Tsang Esther Ee Ling , Lim Ai Lee , Chong Eleen Yun Yin , Rachel Thundyil , Teh Cheng Lay , Loh Yet Lin , Ch'ng Shereen Suyin , d'Souza Beryl Agnes , Mohd Mokhtar Ainon , Ong Swee Gaik , Mohd Isa Liza 
Published: May 2016

ObjectiveThere is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups.MethodsThis is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013.ResultsMajority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33–177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period.ConclusionsThe Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.
Hepatic and Mesenteric Vasculitis as Presenting Manifestation of Mixed Cryoglobulinemia Related to Chronic Hepatitis C Virus Infection in a Female Patient
Authors: Calle Toro Juan S. , Davalos Diana M. , Charry Jose D. , Arrunategi Ana M. , Tobon Gabriel 
Published: May 2016

Abstract
Approximately 80% of patients with hepatitis C virus infection develop chronic liver disease as cirrhosis, and 40% develop autoimmune complications as mixed cryoglobulinemia (MC). Gastrointestinal involvement in MC is rare, and even more so is hepatic involvement. We report a case of an 87-year-old woman with a 10-year history of blood transfusion–acquired hepatitis C virus infection, without treatment. She consulted the emergency department for diffuse abdominal pain, associated with vomiting. After 2 weeks of hospitalization in the intensive care unit, a diagnosis of MC was made; cirrhosis and secondary mesenteric and hepatic vasculitis were confirmed by a diagnostic laparoscopy. Unfortunately the condition of the patient worsened with sepsis and resulted in death in the fourth week from admission. This case highlights the importance of having in mind gastrointestinal tract vasculitis as a medical cause of abdominal pain in patients with chronic hepatitis C virus infection and using data laboratory tests, images, and histopathologic studies to aid with the diagnosis.
Hacienda Flandes: the ups and downs of a Colombian coffee farm
Authors: Ossa Henry , Gonzalez Ana Cristina 
Published: May 2016

Subject area
Strategic Planning for family businesses.

Study level/applicability
MBA family businesses courses and/or executive education courses that focus on family businesses. The case can be used in introductory sessions related to family business strategy.

Case overview
This case tells the story of two generations of coffee plant growers at Hacienda Flandes in Colombia’s coffee region. It describes external and internal factors that affected the family business from 1970 to 2013. The case presents antecedents and consequences of environmental circumstances and family members’ decisions that drive this business from boom to decline and later on to its potential reinvention. Through an analysis of this family-owned coffee plantation across generations, students are expected to understand the importance of strategic planning in family businesses, in a changing and competitive environment. Family businesses in emerging economies are the most common type of businesses. In Latin America, most of family businesses might be younger than those in Europe and even in North America. Therefore, family businesses in these economies can be going through or will soon go through a succession. Succession success rate is low, regardless of the culture or country in which the family business develops. This case deals with the preparation (or lack of preparation) of the next generation in family businesses management and its consequences and helps students suggest alternatives and better decisions to run family businesses in an emerging economy.

Expected learning outcomes
Students will be able to know and explain the concept of a family business as a dynamic system: firm, family and individuals, each one with actions and outcomes; analyze opportunities for and threats to family businesses across generations; and formulate strategies that balance business and family demands.

Supplementary materials
The teaching note has specific reading materials to support class discussion.
I cross my heart, hope to live: LPCI Insurance Company’s dilemma in protecting mutual interests in Mexico
Authors: López-Fernández Andrée Marie , Rajagopal  
Published: May 2016

Subject area
The subject area of the case study is strategic management with emphasis in stakeholder satisfaction and added value and business performance.

Study level/applicability
The case study illustrates the challenges of business dynamics in an emerging market. It is applicable, especially, for undergraduate and graduate students in management studies.

Case overview
The case of LPCI Insurance Company in Mexico illustrates the challenges that firms face when doing business in an unstable, rapidly changing environment. Conflict-affected areas pose significant threats and opportunities for firms; it is, however, up to the firm to decide whether to avoid change and risk or to design and execute effective strategies to tackle such external issues. The case has been developed in a narrative way as to demonstrate the intricacies of internal incidents and board meeting discussions, which lead to strategic planning and decision-making.

Expected learning
outcomes It is expected that students enhance their awareness of businesses’ role in the protection of Human Rights as a key factor in their engagement in corporate social responsibility and achievement of objectives. It is expected that students also increase their awareness of the implications of operating in a conflict-affected area in emerging markets. Also, it is expected that students learn that doing business effectively requires a holistic approach to business dynamics.

Supplementary materials
Teaching notes.

Subject code
CSS 11: Strategy.