bluuebunny/crossref_metadata_2025_split huggingface dataset:
Academic Productivity of Accreditation Council for Graduate Medical Education–Accredited Critical Care Fellowship Program Directors*
Authors: Fahy Brenda G. , Vasilopoulos Terrie , White Peggy , Culley Deborah J. 
Published: August 2016

Objectives:
Academic productivity is an expectation for program directors of Accreditation Council for Graduate Medical Education–accredited subspecialty programs in critical care medicine. Within the adult critical care Accreditation Council for Graduate Medical Education–accredited programs, we hypothesized that program director length of time from subspecialty critical care certification would correlate positively with academic productivity, and primary field would impact academic productivity.

Design:
This study received Institutional Review Board exemption from the University of Florida. Data were obtained from public websites on program directors from all institutions that had surgery, anesthesiology, and pulmonary Accreditation Council for Graduate Medical Education–accredited subspecialty critical care training programs during calendar year 2012. Information gathered included year of board certification and appointment to program director, academic rank, National Institutes of Health funding history, and PubMed citations.

Results:
Specialty area was significantly associated with total (all types of publications) (p = 0.0002), recent (p < 0.0001), last author (p = 0.008), and original research publications (p < 0.0001), even after accounting for academic rank, years certified, and as a program director. These differences were most prominent in full professors, with surgery full professors having more total, recent, last author, and original research publications than full professors in the other critical care specialties.

Conclusions:
This study demonstrates that one’s specialty area in critical care is an independent predictor of academic productivity, with surgery having the highest productivity. For some metrics, such as total and last author publications, surgery had more publications than both anesthesiology and pulmonary, whereas there was no difference between the latter groups. This suggests that observed differences in academic productivity vary by specialty.
Molsidomine Attenuates Ventricular Electrical Remodeling and Arrhythmogenesis in Rats With Chronic β-Adrenergic Receptor Activation Through the NO/cGMP/PKG Pathway
Authors: Shan Yingguang , Wang Dandan , Li Ran , Huang Congxin 
Published: August 2016

Abstract:
This study investigated the effects and associated underlying mechanisms of molsidomine, a nitric oxide (NO) donor, on cardiac electrical remodeling and ventricular tachycardias (VTs) induced by chronic isoprenaline (ISO) stimulation in rats. The rats were randomly divided into groups that were treated with saline (control group), ISO (ISO group), ISO + molsidomine (ISO + M group), and ISO + molsidomine + the soluble guanylate cyclase inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, ISO + M + O group) for 14 days. An electrophysiological study was performed to assess cardiac repolarization, action potential duration restitution, and the induction of action potential duration alternans and VTs in vitro. The properties of the Ca2+ transients, Ca2+ handling–related proteins, and NO/guanosine 3′5′-cyclic monophosphate (cGMP)/protein kinase G (PKG) pathway were examined. Compared with the control group, chronic ISO stimulation prolonged the cardiac repolarization, decreased the Ca2+ transient alternans and action potential duration alternans thresholds, and increased the maximum slope (Smax) of the action potential duration restitution curve and incidence of VTs in vitro. All these effects were attenuated by molsidomine treatment (P < 0.05). Moreover, molsidomine activated cGMP/PKG signaling and stabilized the expression of calcium handling–related proteins compared with the ISO group. However, the protective effects of molsidomine were partially inhibited by ODQ. Our results suggest that molsidomine stabilizes calcium handling and attenuates cardiac electrical remodeling and arrhythmogenesis in rats with chronic β-adrenergic receptor activation. These effects are at least partially mediated by the activation of NO/cGMP/PKG pathway.
Calcium plus vitamin D supplementation and height loss: findings from the Women's Health Initiative Calcium and Vitamin D clinical trial
Authors: Crandall Carolyn J. , Aragaki Aaron K. , LeBoff Meryl S. , Li Wenjun , Wactawski-Wende Jean , Cauley Jane A. , Margolis Karen L. , Manson JoAnn E. 
Published: August 2016

Abstract

Objective:
The aim of this study was to determine the associations between calcium + vitamin D supplementation (vs placebo) and height loss in 36,282 participants of the Women's Health Initiative Calcium and Vitamin D trial.

Methods:
Post hoc analysis of data from a double-blind randomized controlled trial of 1,000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily (CaD) or placebo in postmenopausal women at 40 US clinical centers. Height was measured annually (mean follow-up 5.9 y) with a stadiometer.

Results:
Average height loss was 1.28 mm/y among participants assigned to CaD versus 1.26 mm/y for women assigned to placebo (P = 0.35). Effect modification of the CaD intervention was not observed by age, race/ethnicity, or baseline intake of calcium or vitamin D. Randomization to the CaD group did not reduce the risk of clinical height loss (loss of ≥1.5 inches [3.8 cm]: hazard ratio (95% CI) = 1.00 (0.81, 1.23). A strong association (P < 0.001) was observed between age group and height loss. When we censored follow-up data in participants who became nonadherent to study pills, the results were similar to those of our primary analysis.

Conclusions:
Compared with placebo, the CaD supplement used in this trial did not prevent height loss in healthy postmenopausal women.
Use of systemic hormone therapy in BRCA mutation carriers
Authors: Domchek Susan , Kaunitz Andrew M. 
Published: August 2016

Abstract
As more women are being counseled and tested, clinicians increasingly encounter women with identified BRCA1 and BRCA2 gene mutations. Existing, albeit limited, data indicate that risks of breast cancer are not increased with use of systemic hormone therapy by menopausal BRCA mutation carriers with intact breasts. Young mutation carriers with or without intact breasts should not defer or avoid risk-reducing (and lifesaving) bilateral salpingo-oophorectomy because of concerns that subsequent use of systemic hormone therapy will elevate breast cancer risk.
Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction
Authors: Mountziaris Paschalia M. , Soteropulos Carol E. , Rezak Kristen M. , Patel Ashit 
Published: August 2016

Summary:
The anterolateral thigh (ALT) free flap has proven to be a reliable option for the coverage of soft tissue defects in adults and more recently in the pediatric population. When considering the use of the ALT flap in the pediatric patient, there are few studies that detail techniques specific to pediatric free flap management. We present a unique case of a 14- × 8-cm ALT flap used for traumatic wound coverage in a distal tibial injury in a 6-year-old girl. This case highlights innovative techniques in pediatric perioperative free flap monitoring and the use of continuous external tissue expansion to achieve delayed primary closure of the donor site.
The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery
Authors: Spear Scott L. , Coles Courtney N. , Leung Braden K. , Gitlin Matthew , Parekh Mousam , Macarios David 
Published: August 2016

Background:
For years, the safety and effectiveness of autologous fat grafting (AFG) for breast reconstruction have been in question, with particular concern over fat necrosis, calcifications, cyst formation, and interfering with the detection of breast cancer. However, increasing evidence suggests that the complication rates and clinical results are generally acceptable to both clinicians and patients. The emerging challenge is the numerous AFG techniques and systems, where there are limited knowledge and data. The objective of this study was to conduct a literature review that focuses on the safety, effectiveness, and efficiency of various AFG techniques as applied to the breast.

Methods:
A PubMed search using terms related to AFG was performed over a 5-year period (April 1, 2010–April 30, 2015). Original articles focused on AFG to the breast, with outcomes on safety, effectiveness, and efficiency, were included.

Results:
Five hundred ninety-eight articles were identified with 36 articles included (n = 4306 patients). Satisfaction rates were high although the prevalence of complications was low—similar to previous findings. Seven studies reported average operating room time with an overall mean of 125 minutes (range: 40–210). The mean volume of fat harvested was 558 mL (range: 120–1299), and fat injected was 145 mL (range: 20–607). A positive association between injection volume and operating time was observed.

Conclusions:
This review validates previous findings on the safety and effectiveness of AFG to the breast and highlights its efficiency. The efficiency data available, although limited, suggest that there is an opportunity to achieve time and cost savings while not sacrificing safety and effectiveness.
Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease
Authors: Pflum Adam , Gomadam Pallavi , Mehta Hardik , Sacrinty Matthew , Paladenech Connie C. , Robinson Killian 
Published: August 2016

PURPOSE:
The correlation between chronic kidney disease (CKD) and increased cardiovascular disease-related mortality is well established. Cardiac rehabilitation (CR) improves exercise capacity, quality of life, and risk factors in patients with coronary artery disease (CAD). Data on the benefits of CR in patients with CKD are sparse. The purpose of this study was to compare outcomes after CR in patients with CAD but normal renal function, versus those with CAD and CKD.

METHODS:
We studied 804 patients with CAD entering an exercise-based CR program. Demographics, risk factors, exercise capacity in metabolic equivalent levels (METs), and estimated glomerular filtration rate (GFR) were recorded before and after the 3-month CR program. Use of polyunsaturated fatty acid (PUFA) was determined by medical records review. Stage III-V CKD (GFR <60 mL/min/1.73 m2) was present in 170 patients at baseline.

RESULTS:
After CR, METs improved in all patients, although increases in patients with a GFR 30 to 59 mL/min/1.73 m2 (Δ1.6) and a GFR <30 (Δ1.2) were smaller than those in patients with a GFR ≥60 (Δ2.6, P < .05 vs GFR 30-59 and GFR <30). In patients with a GFR ≥60 mL/min/1.73 m2, PUFA use was associated with a 20% greater increase in MET levels compared with nonusers (Δ3.0 vs Δ2.5, P = .02); and in patients with a GFR 30 to 59, PUFA use was associated with 30% increase in MET level compared with nonusers (Δ2.0 vs Δ1.4, P = .03). These observations persisted after multivariable adjustment for baseline MET level, demographics, and risk factors.

CONCLUSIONS:
Potential mitigation by PUFA of the smaller improvement in exercise capacity with decreasing GFR requires confirmation in prospective randomized trials.
INTRAVITREAL RANIBIZUMAB AS AN ADJUNCTIVE TREATMENT FOR COATS DISEASE (6-YEAR FOLLOW-UP)
Authors: Giannakopoulos Marios , Drimtzias Evangelos , Panteli Vasiliki , Vasilakis Panagiotis , Gartaganis Sotirios P. 
Published: August 2016

Purpose:
To evaluate the effectiveness of intravitreal ranibizumab in combination with laser photocoagulation in the management of Coats disease.

Method:
Six intravitreal injections of 0.5 mg (0.05 mL) ranibizumab were performed, each 4 weeks apart. Correspondence to therapy was evaluated using visual acuity measurements and optical coherence tomography images. Six months after the initiation of treatment, laser photocoagulation was applied on the telangiectasias and on the surrounding ischemic areas, followed by a single intravitreal ranibizumab injection. Three months later, laser photocoagulation was repeated in purpose to prevent recurrence.

Results:
In the sixth month, no improvement in visual acuity was recorded, as thick circinate hard exudates still remained in the submacular space. Nevertheless, retinal detachment had completely subsided, and fluorescein angiography showed a significant decrease of leakage from the telangiectatic vessels. At the 12-month follow-up visit, an impressive improvement was recorded, with total absorption of the submacular exudate and visual acuity being 20/30. At the 20-month follow-up visit, his visual acuity was 20/20 and the retina was flat with no signs of macular edema or exudates. At the 6-year follow-up visit, the patient was absolutely stable.

Discussion:
Elevated vascular endothelial growth factor levels have been demonstrated in Coats disease. Anti–vascular endothelial growth factor agents assist to the decrease of vascular permeability of the capillary endothelial cells, thus increasing the efficiency of laser application.
SUCCESSFUL TREATMENT OF REFRACTORY PROLIFERATIVE RETINOPATHY OF INCONTINENTIA PIGMENTI BY INTRAVITREAL RANIBIZUMAB AS ADJUNCT THERAPY IN A 4-YEAR-OLD CHILD
Authors: Ho Mary , Yip Wilson W. K. , Chan Vesta C. K. , Young Alvin L. 
Published: August 2016

Purpose:
To describe a case of incontinentia pigmenti with proliferative retinopathy successfully treated by combination of repeated retinal laser photocoagulation and intravitreal ranibizumab injection.

Methods:
Single interventional case report of a 4-year-old girl, known case of incontientia pigmenti, first screened at the age of two, presented with proliferative retinopathy. Sole treatment by panretinal laser photocoagulation failed to control the progression of retinal neovascularization. Intravitreal ranibizumab injections were used as an adjunct therapy.

Results:
The proliferative retinopathy was brought under control and halted till this date with repeated intravitreal ranibizumab and panretinal photocoagulation. No systemic side effect was noted.

Conclusion:
Intravitreal ranibizumab can be considered as an adjunct therapy in proliferative retinopathy secondary to incontinentia pigmenti when monotherapy with panretinal photocoagulation fails. Intravitreal ranibizumab may quickly inhibit the intraocular vascular endothelial growth factor and may prevent devastating complications like tractional retinal detachment. Extra caution has to be taken in adopting different dosages and injection regimes especially in pediatric cases.
Additive Effect of Risk Factors for Trabeculectomy Failure in Glaucoma Patients: A Risk-group From a Cohort Study
Authors: Issa de Fendi Ligia , Cena de Oliveira Tiago , Bigheti Pereira Carolina , Pereira Bigheti Carina , Viani Gustavo A. 
Published: August 2016

Purpose of the Study:
The purpose of the study was to assess the role of significant risk factors and develop a risk-group category related to the trabeculectomy (Trab) failure.

Materials and Methods:
A retrospective cohort study was developed between January 2009 and June 2014. In total, 120 eyes included in this study had a glaucoma diagnosis and undergone to Trab with mitomycin. The main outcome measures were surgical success and failure rate. Multivariate (Cox proportional hazards regression model) analyses were used to examine the predictive value of significant factors. A risk-group category was build based on the number of significant risk factors for patients. The risk group category was tested using the Kaplan-Meier method and log-rank test.

Results:
With a median follow-up of 33 months (3 to 72 mo), the complete surgical success in 1, 2, 3, and 4 years was 82%, 63.5%, 52%, and 27.6%, respectively. The probability of freedom from a complete surgical failure was 88%, 84.5%, 78%, and 70% in 1, 2, 3, and 4 years, respectively. Glaucoma type (P=0.008), previous ophthalmic surgery (P=0.04), glaucoma medication use ≥3 years (P=0.010) and 4 glaucoma medication use pre-Trab (P=0.038) were identified as risk factors for surgical failure. The probability of freedom of surgical failure in 3 years was 93%, 83%, and 37.6% (P=0.003), for low (no factors), intermediate (1 to 2 factors), and high-risk group (3 to 4 factors).

Conclusions:
Trab with mitomycin produces satisfactory intraocular pressure control over time. However, several risk factors influence the efficacy of the surgical procedure. Our data show that there seems to exist an additive effect among risk factors with similar pathophysiology.
Achromobacter Bacteremia in Patients With Cancer
Authors: Stutzman Tyler , Sánchez-Vargas Flor Maria , Nanjappa Sowmya , Velez Ana Paula , Greene John N. 
Published: August 2016

Background

Achromobacter species are Gram-negative waterborne bacteria that occasionally cause bacteremia primarily in immunocompromised hosts. Cancer patients have increased risk due to their use of intravascular catheters and immunosuppression from neoplasm, chemotherapy, and prolonged steroids. In this study, we investigated the clinical characteristics of cancer patients with Achromobacter bacteremia and identified risk factors, outcomes, and susceptibility patterns in this selective population.

Methods
We retrospectively reviewed all cases of Achromobacter bacteremia occurring from March 2010 to March 2015 at Moffitt Cancer Center. Data collected included age, sex, comorbidities, underlying malignancy, neutropenia status, prior bacteremia, treatment course, and patterns of susceptibilities of the isolates. We also reviewed outcomes such as discharge disposition and death.

Results
Eleven patients were identified with positive blood cultures for Achromobacter species. Central venous catheters were infected in 9 patients (82%), and 2 patients had recurrent bacteremia, which resolved after removal of the catheter. Eight (73%) patients had a history of prior bacteremia. Patients were treated with meropenem (n = 4), piperacillin/tazobactam (n = 3), cefepime, ceftazidime, and trimethoprim-sulfamethoxazole (TMP-SMX). The isolates were susceptible to meropenem (8 of 8 isolates), piperacillin/tazobactam (10 of 10), ceftazidime (7 of 7), and TMP-SMX (8 of 8). Most of isolates were resistant to aminoglycosides and fluoroquinolones.

Conclusions
The major predisposing factors for Achromobacter bacteremia were infected intravascular catheters and prior history of bacteremia. Infections can be treated with piperacillin/tazobactam, a carbapenem, or TMP-SMX. Compared with other studies, we observed similar risk factors and morbidity but with a higher rate of intravascular catheter infections.
Antidepressant Medication Treatment and Risk of Death
Authors: Zivin Kara , Kim H. Myra , Yosef Matheos , Maust Donovan T. , Valenstein Marcia , Smith Eric G. , Davydow Dimitry S. 
Published: August 2016

Objective
Although previous studies have assessed whether depression is a mortality risk factor, few have examined whether antidepressant medications (ADMs) influence mortality risk.

Methods
We estimated hazards of 1-year all-cause mortality associated with ADMs, with use occurring within 90 days of depression diagnosis among 720 821 patients who received treatment in a Veterans Health Administration facility during fiscal year 2006. We addressed treatment selection biases using conventional Cox regression, propensity-stratified Cox regression (propensity score), and 2 forms of marginal structural models. Models accounted for multiple potential clinical and demographic confounders, and sensitivity analyses compared findings by antidepressant class.

Results
Antidepressant medication use compared with no use was associated with significantly lower hazards of 1-year mortality risk in Cox (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90–0.97) and propensity score estimates (HR, 0.94; 95% CI, 0.91–0.98), whereas marginal structural model–based estimates showed no difference in mortality risk when the exposure was specified as “as-treated” in every 90-day intervals of the 1-year follow-up (HR, 0.91; 95% CI, 0.66–1.26) but showed increased risk when specified as “intent-to-treat” (HR, 1.07; 95% CI, 1.02–1.13).

Conclusions
Among patients treated with ADMs belonging to a single class in the first 90 days, there were no significant differences in 1-year all-cause mortality risks. When accounting for clinical and demographic characteristics and treatment selection bias, ADM use was associated with no excess harm.
Comparison of Subjective Experiences and Effectiveness of First-Generation Long-Acting Injectable Antipsychotics and Risperidone Long-Acting Injectables in Patients With Schizophrenia
Authors: Chen Wen-Yin , Lin Shih-Ku 
Published: August 2016

Abstract
We conducted a cross-sectional study to compare the subjective experiences and clinical effects of first-generation long-acting injectable (FGA-LAI) antipsychotics with those of risperidone long-acting injectables (RIS-LAIs) in 434 schizophrenia patients. Compared with the RIS-LAI group, the patients treated with FGA-LAIs had a significantly longer duration of illness and LAI treatment and were older. Our results suggest that patients treated with FGA-LAI have more satisfactory subjective experiences compared with patients treated with RIS-LAI and that both FGA-LAI and RIS-LAI treatments can prevent relapses and hospitalization. Additional longitudinal studies determining the long-term benefits of RIS-LAI are warranted.
Sore on the Neck
Authors: Jacob Sharon E. , Love Justin 
Published: August 2016

ABSTRACT
Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, there is transfer of medical information electronically (including history and visual data) on a patient in one location to a provider who is in another location. The construct of this column is such that cases are presented in a standardized teledermatology reader format. This is a case of a sore on the neck.
Topical Metronidazole in the Management of Rosacea
Authors: Hill Hannah E. , Pham Quy , Jacob Sharon E. 
Published: August 2016

ABSTRACT
By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this section is to focus on some of the more common substances, specifically how they work, how they are utilized, and routine alternatives (if available). This article gives an overview of rosacea and discusses the role of topical metronidazole in the management of rosacea as well as details the mechanism of action, adverse effects, and alternative treatments.