bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated Hemoglobin Level Is Associated With Advanced Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease
Authors: Giorgio Valentina , Mosca Antonella , Alterio Arianna , Alisi Anna , Grieco Antonio , Nobili Valerio , Miele Luca 
Published: April 2017

ABSTRACTObjectives:Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy‐proven NAFLD.Methods:A total of 117 children (85 boys, mean age 12 years) with ultrasound evidence of NAFLD undergoing liver biopsy for diagnosis of nonalcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care center. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than nonalcoholic were excluded, before liver biopsy was performed.Results:A total of 41 NAFLD (boys 29, mean age 11.2 years) and 76 NASH (boys 56, mean age 12.8 years) children were studied. Alanine transaminase levels were significantly higher in NASH group compared with NAFLD group (P = 0.05), and homeostatic model assessment of insulin resistance and triglycerides levels (P = 0.03 and 0.02, respectively). Regarding hematological components: red cell count, Hb, hematocrit, and RDW values were all significantly higher in NASH group compared with NAFLD group (P < 0.05 for each parameter).Conclusions:Children with NASH were more likely to have high levels of RDW compared to those with steatosis only. Moreover, NASH was associated with higher red cell count, Hb, and hematocrit. If confirmed in future follow‐up studies, hematological parameters may be introduced in algorithms for NASH risk prediction.
Challenges to Breastfeeding Initiation and Duration for Teen Mothers
Authors: Cota-Robles Sonia , Pedersen Laura , LeCroy Craig Winston 
Published: April 2017

Abstract

Purpose:
The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program.

Study Design and Methods:
We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped.

Results:
Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood.

Clinical Implications:
We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.
Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q
Authors: Mundy Lily R. , Homa Karen , Klassen Anne F. , Pusic Andrea L. , Kerrigan Carolyn L. 
Published: April 2017

Background:
The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation.

Methods:
Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings.

Results:
The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m2, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m2 or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction.

Conclusion:
These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.
What Is the Standard Volume to Increase a Cup Size for Breast Augmentation Surgery? A Novel Three-Dimensional Computed Tomographic Approach
Authors: King Nina-Marie , Lovric Vedran , Parr William C. H. , Walsh W. R. , Moradi Pouria 
Published: April 2017

Background:
Breast augmentation surgery poses many challenges, and meeting the patient’s expectations is one of the most important. Previous reports equate 100 cc to a one-cup-size increase; however, no studies have confirmed this between commercially available bras. The aim of this study was to identify the volume increase between cup sizes across different brands and the relationship with implant selection.

Methods:
Five bra cup sizes from three different companies were analyzed for their volume capacity. Three methods were used to calculate the volume of the bras: (1) linear measurements; (2) volume measurement by means of water displacement; and (3) volume calculation after three-dimensional reconstruction of serial radiographic data (computed tomography). The clinical arm consisted of 79 patients who underwent breast augmentation surgery from February 1, 2014, to June 30, 2016. Answers from a short questionnaire in combination with the implant volume were analyzed.

Results:
Across all three brands, the interval volume increase varied between sizes, but not all were above 100 cc. There was some variation in the volume capacity of the same cup size among the different brands. The average incremental increase in bra cup size across all three brands in the laboratory arm was 135 cc. The mean volume increase per cup size was 138.23 cc in the clinical arm.

Conclusions:
This article confirms that there is no standardization within the bra manufacturing industry. On the basis of this study, patients should be advised that 130 to 150 cc equates to a one-cup-size increase. Bras with narrower band widths need 130 cc and wider band widths require 150 cc to increase one cup size.
Correcting Concavity of Rabbit Auricular Cartilage: Comparison of Single Scoring Incisions with Butyl Cyanoacrylate–Aided Techniques
Authors: Yontar Yalcin , Özyazgan İrfan 
Published: April 2017

Background:
The authors present the results of an experimental study in which four different techniques were used for the correction of concave rabbit auricular cartilage.

Methods:
Sixteen New Zealand adult male rabbits were used in the study. Butyl cyanoacrylate–aided cartilage graft fixation and butyl cyanoacrylate–aided bone graft fixation and scoring technique, alone or combined with butyl cyanoacrylate application, were performed to correct the concavity of rabbit auricular cartilage.

Results:
Angle measurements showed that all four techniques were efficient for correction of the cartilage concavities. However, the mean postsacrifice angles of the graft fixation groups were significantly higher than those of the other study groups, reflecting the fact that graft fixation with butyl cyanoacrylate application was more efficient for preserving the final cartilage shape. Furthermore, in the ninth month, graft fixation groups had the lowest chondrocyte densities, the highest degree of inflammation, the highest degree of foreign body reaction, and the highest butyl cyanoacrylate density.

Conclusions:
Fibrosis or chondrocyte proliferation on scoring incision lines is not an associated feature of this technique. When the incision depths were standardized, the scoring technique provided efficacy similar to that of the scoring incisions combined with butyl cyanoacrylate application for correction of the cartilage concavity. The scoring incision plus butyl cyanoacrylate group showed less toxicity than the graft fixation groups because of rapid removal of toxic breakdown products. Graft fixation techniques were superior to other corrective procedures with regard to preservation of the final cartilage shape. Although they resulted in greater toxicity, the cartilage correction was not affected unfavorably.
Effect of Human Fat Graft on Breast Cancer Metastasis in a Murine Model
Authors: Moltó-García Roberto , González-Alonso Virina , Villaverde-Doménech María Eloísa , Novella-Maestre Edurne 
Published: April 2017

Background:
Isolated adipose stem cells have been reported to encourage migration and early metastasis of breast cancer. Mimicking a surgical situation, the authors developed a human breast cancer model to evaluate in vivo whether human adipose tissue promotes tumor growth and invasion.

Methods:
Human adipose tissue was obtained from four patients. The MDA-MB-468 cell line was cultured with a lentiviral vector encoding a puromycin resistance gene and mCherry fluorescent protein. Virus-infected cells were selected. Animals were injected in the left renal capsule and divided into three experimental groups: group A, MDA-MB-468 cells (n = 4); group B, MDA-MB-468 cells/human adipose tissue (n = 4); and group C, Dulbecco’s Modified Eagle Medium/F-12 medium (negative control, n = 4). Metastatic development was monitored using an in vivo imaging system. Small breast epithelial mucin (SBEM), human hypoxanthine-guanine phosphoribosyltransferase (HPRTh), and murine hypoxanthine-guanine phosphoribosyltransferase (HPRTm) expression were analyzed by real-time polymerase chain reaction to detect multifocal metastases in right/left renal capsule, liver, spleen, and pancreas.

Results:
Metastasis was observed between postinjection days 37 and 44. No significant differences were found in survival rates between groups (group A, 157 ± 42.60 days; group B, 169 ± 40.17 days). All samples expressed HPRTm. HPRTh and SBEM were expressed in left renal capsules from all group A and B mice, whereas in spleen, liver, pancreas, and right renal capsule the HPRTm and SBEM expression was not constant in all samples of group A and B mice. Differences were found between groups in HPRTh and SBEM expression but were not statistically significant.

Conclusion:
Human adipose tissue used to restore breast defects after oncologic resection did not increase metastasis development risk when there were residual breast cancer cells in proximity.
Longitudinal Photogrammetric Analysis of the Columellar-Labial Angle following Primary Repair of Bilateral Cleft Lip and Nasal Deformity
Authors: Rottgers S. Alex , Lim So Young , Hall Amber M. , Zurakowski David , Mulliken John B. 
Published: April 2017

Background:
The changing nasolabial dimensions after repair of bilateral cleft lip and nasal deformity can be documented by anthropometry; however, the columellar-labial angle is rarely measured.

Methods:
This is a study of white patients who had synchronous repair of bilateral cleft lip performed by one surgeon (J.B.M.). The columellar-labial angle was measured on lateral photographs with the subject in neutral head position. Average values for columellar-labial angle at two or more time points were analyzed with a general estimating equation and cubic modeling. Values for complete and incomplete bilateral cleft lips were compared to each other and to Farkas’ norms. Direct anthropometric measurements of intraoperative columellar length were compared to the postoperative columellar-labial angle using Pearson correlation analysis.

Results:
Eighty-five patients were studied (64 complete and 21 incomplete clefts). The average photographic follow-up interval was 10 years (range, 1.8 to 19.5 years). The columellar-labial angle in bilateral complete clefts was significantly greater than in incomplete forms (p = 0.002). Although the angles decreased with time, they remained significantly greater than Farkas’ normative values in both cleft groups (all p < 0.05). There was no correlation between the magnitude of columellar lengthening achieved during primary nasal correction and the postoperative columellar-labial angle.

Conclusions:
An obtuse columellar-labial angle can occur following synchronous nasolabial repair of a bilateral cleft lip, particularly in patients with a complete deformity. Although the angle narrows in time, it remains 1 to 2 SD greater than normal values. Secondary nasal correction may be needed if there is excessive tip rotation after completion of growth and orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Auricular Reconstruction in Hemifacial Microsomia with an Expanded Two-Flap Method
Authors: Qian Jin , Li Zhibin , Liu Tun , Zhou Xu , Zhang Qingguo 
Published: April 2017

Background:
Reconstruction of external ear is important for the child/adult with craniofacial deformities to achieve balance and harmony of the face and head. The aim of this study was to investigate the clinical application of an expanded two-flap method for auricular reconstruction in hemifacial microsomia.

Methods:
Between January of 2014 and November of 2015, 111 hemifacial microsomia patients with microtia underwent auricular reconstruction with an expanded two-flap method. The clinical data of these patients were reviewed retrospectively. Thirty-two patients (28.8 percent) underwent auricular reconstruction in combination with simultaneous mandibular lengthening. Microtia was treated by an expanded two-flap method, which includes three stages. In the first stage, the retroauricular skin was expanded using a kidney-shaped tissue expander. In the second stage, the costal cartilage was harvested and the framework was fabricated. The anterior surface of the framework was enveloped by the expanded skin flap. The posterior surface and the helical rim of the framework is covered by a retroauricular fascial flap and a full-thickness skin graft. In the third stage, the tragus was reconstructed, the lobule was formed, and the concha was excavated. The surgical planning and skills of auricular reconstruction—especially for hemifacial microsomia—were described and analyzed. The median duration of follow-up was 8.3 months.

Results:
There were nine cases (8.1 percent) of complications in our study. During follow-up, 103 patients (92.8 percent) had satisfactory outcomes, seven (6.3 percent) had partially satisfactory outcomes, and one patient (0.9 percent) had an unsatisfactory outcome.

Conclusion:
Auricular reconstruction using an expanded two-flap method in hemifacial microsomia is safe and effective, with satisfying middle-term results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Formidable Foe Is Sabotaging Your Results: What You Should Know about Biofilms and Wound Healing
Authors: Barker Jenny C. , Khansa Ibrahim , Gordillo Gayle M. 
Published: April 2017

Learning Objectives:
After reading this article, the participant should be able to: 1. Describe biofilm pathogenesis as it relates to problem wounds. 2. Understand the preclinical and clinical evidence implicating biofilm in problem wounds. 3. Explain the diagnostic and treatment challenges that biofilms create for problem wounds. 4. Demonstrate a basic understanding of emerging strategies aimed at counteracting these processes.

Summary:
Biofilm represents a protected mode of growth for bacteria, allowing them to evade standard diagnostic techniques and avoid eradication by standard therapies. Although only recently discovered, biofilm has existed for millennia and complicates nearly every aspect of medicine. Biofilm impacts wound healing by allowing bacteria to evade immune responses, prolonging inflammation and disabling skin barrier function. It is important to understand why problem wounds persist despite state-of-the-art treatment, why they are difficult to accurately diagnose, and why they recur. The aim of this article is to focus on current gaps in knowledge related to problem wounds, specifically, biofilm infection.
The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV
Authors: Powell Anna M. , DeVita Julia M. , Ogburu-Ogbonnaya Amartha , Peterson Andrea , Lazenby Gweneth B. 
Published: April 2017

Background:
Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014.

Methods:
This was a retrospective cohort study of HIV-exposed mother–infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ2 test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest.

Results:
Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001).

Conclusions:
HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.
Left Atrium Measurements via Computed Tomography Pulmonary Angiogram as a Predictor of Diastolic Dysfunction
Authors: Lick Adam N. , Danrad Raman , Smith David L. , Lammi Matthew R. 
Published: April 2017

Purpose
Left atrium (LA) enlargement on echocardiography may be an indicator of diastolic dysfunction (DD). It is not well known if computed tomography pulmonary angiography (CTPA) can detect DD.

Methods
A total of 127 patients who underwent both CTPA and echo within 48 hours were analyzed retrospectively. Left atrium diameters from CTPA were correlated with echo and evaluated against degrees of DD. Computed tomography pulmonary angiography pulmonary artery (PA)/aorta ratio was analyzed as a tool to detect pulmonary hypertension.

Results
There were 42% of patients who had DD. There was a strong correlation between LA size on CTPA and echo (r = 0.78). An LA greater than 4.0 cm gave a sensitivity of 68.1% and specificity of 73.9% for DD detection. A PA/aorta cutoff greater than 0.84 yielded a sensitivity of 84% and specificity of 33% for pulmonary hypertension.

Conclusions
Computed tomography pulmonary angiography measurements of LA and PA/aorta ratio correlate strongly with equivalent findings on echo. We suggest that LA and PA/aorta measurements be included on chest CTPA reports.
Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential
Authors: Wei Wenbo , Jia Guang , von Tengg-Kobligk Hendrik , Heverhagen Johannes T. , Abdel-Rahman Mohamed , Wei Lai , Christoforidis John B. , Davidorf Frederick , Knopp Michael V. 
Published: April 2017

Purpose
This study explores the capability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate tumor characteristics of metastatic and nonmetastatic choroidal melanoma as a potential tool for patient management.

Materials and Methods
A total of 13 patients (69 ± 9 years) with choroidal melanoma were imaged using DCE-MRI on a 3-T MRI system with a 16-channel head coil. The Tofts 2-compartment model was chosen for quantification, and parameters K
trans (the transfer constant from the blood plasma to the extracellular space) and K
ep (the transfer constant from the extracellular space to the blood plasma) were calculated and compared. Metastasis was excluded by subsequent clinical work-up or confirmed by histology after targeted biopsy.

Results
Six patients were diagnosed with metastatic melanoma and 7 without. All orbital tumors were at least larger than 2 mm. A significant difference was identified in K
trans between patients with (0.73 ± 0.18/min) and without (1.00 ± 0.21/min) metastatic melanoma (P = 0.03), whereas the difference was not significantly shown in K
ep (2.58 ± 1.54/min of metastatic patients vs 2.98 ± 1.83/min of nonmetastatic patients, P = 0.67).

Conclusions
Dynamic contrast-enhanced magnetic resonance imaging has the potential to differentiate orbital melanomas with metastatic and nonmetastatic spread. Thus, DCE-MRI has the potential to be an in vivo imaging technique to predict early which patients are prone to metastatic disease.
Usefulness of a Low Tube Voltage: Knowledge-Based Iterative Model Reconstruction Algorithm for Computed Tomography Venography
Authors: Iyama Yuji , Nakaura Takeshi , Iyama Ayumi , Kidoh Masafumi , Oda Seitaro , Tokuyasu Shinichi , Yamashita Yasuyuki 
Published: April 2017

Objectives
The objective of this study was to evaluate the use of 80-kVp scans with knowledge-based iterative model reconstruction (IMR) for computed tomography venography (CTV).

Methods
This prospective study received institutional review board approval; a previous informed consent was obtained from all participants. We enrolled 30 patients with suspected deep venous thrombosis or pulmonary embolism who were to undergo 80-kVp CTV studies. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and IMR. The venous attenuation, image noise, and contrast-to-noise ratio at the iliac, femoral, and popliteal veins were compared on FBP, HIR, and IMR images. We performed qualitative image analysis (image noise, image contrast, image sharpness, streak artifacts, and overall image quality) of the 3 reconstruction methods and measured their reconstruction times.

Results
There was no significant difference in venous attenuation among the 3 reconstruction methods (P > 0.05). On IMR images, the image noise was lowest at all 3 venous locations, and the contrast-to-noise ratio was highest. Qualitative evaluation scores were also highest for IMR images. The reconstruction time for FBP, HIR, and IMR imaging was 25.4 ± 1.9 seconds, 43.3 ± 3.3 seconds, and 78.7 ± 6.0 seconds, respectively.

Conclusions
At clinically acceptable reconstruction times, 80-kVp CTV using the IMR technique yielded better qualitative and quantitative image quality than HIR and FBP.