bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking the Silence: Time to Talk About Race and Racism
Authors: Acosta David , Ackerman-Barger Kupiri 
Published: September 2016

Recent events in the United States have catalyzed the need for all educators to begin paying attention to and discovering ways to dialogue about race. No longer can health professions (HP) educators ignore or avoid these difficult conversations. HP students are now demanding them. Cultural sensitivity and unconscious bias training are not enough. Good will and good intentions are not enough. Current faculty development paradigms are no longer sufficient to meet the educational challenges of delving into issues of race, power, privilege, identity, and social justice.
Engaging in such conversations, however, can be overwhelmingly stressful for untrained faculty. The authors argue that before any curriculum on race and racism can be developed for HP students, and before faculty members can begin facilitating conversations about race and racism, faculty must receive proper training through intense and introspective faculty development. Training should cover how best to engage in, sustain, and deepen interracial dialogue on difficult topics such as race and racism within academic health centers (AHCs). If such faculty development training—in how to conduct interracial dialogues on race, racism, oppression, and the invisibility of privilege—is made standard at all AHCs, HP educators might be poised to actualize the real benefits of open dialogue and change.
Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study
Authors: Aya Hollmann D. , Rhodes Andrew , Chis Ster Irina , Fletcher Nick , Grounds R. Michael , Cecconi Maurizio 
Published: September 2016

Objective:
The objectives of this study are to determine what is the minimal volume required to perform an effective fluid challenge and to investigate how different doses of IV fluids in an fluid challenge affect the changes in cardiac output and the proportion of responders and nonresponders.

Design:
Quasi-randomized controlled trial.

Setting:
Cardiothoracic ICU, tertiary university hospital.

Patients:
Eighty postcardiac surgery patients.

Intervention:
IV infusion of 1, 2, 3, or 4 mL/Kg (body weight) of crystalloid over 5 minutes.

Measurements and Main Results:
Mean systemic filling pressure measured using the transient stop-flow arm arterial-venous equilibrium pressure, arterial and central venous pressure, cardiac output (LiDCOplus; LiDCO, Cambridge, United Kingdom), and heart rate. The groups were well matched with respect to demographic and baseline physiologic variables. The proportion of responders increased from 20% in the group of 1 mL/kg to 65% in the group of 4 mL/kg (p = 0.04). The predicted minimal volume required for an fluid challenge was between 321 and 509 mL. Only 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure beyond the limits of precision and was significantly associated with a positive response (odds ratio, 7.73; 95% CI, 1.78–31.04).

Conclusion:
The doses of fluids used for an fluid challenge modify the proportions of responders in postoperative patients. A dose of 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure and reliably detects responders and nonresponders.
Cysticercosis of the Pectoralis Major: A Case Report and Review of Literature
Authors: Chauhan Sushila , Singh Gagandeep , Khan Imran 
Published: September 2016

Abstract:
Cysticercosis is a condition caused by the encysted larval form of Taenia solium (pork tapeworm). The commonest system affected is the central nervous system. Symptomatic primary muscle involvement is a rare phenomenon. We present a case of a 19-year-old male who presented with a solitary cystic swelling in the right infraclavicular area. Magnetic resonance imaging revealed a cystic mass in the right pectoralis major muscle. The cyst was excised and submitted for histopathology. The diagnosis of cysticercosis was confirmed on histopathology of the excised cyst.
Fewer Revisions in Abdominal-based Free Flaps than Latissimus Dorsi Breast Reconstruction after Radiation
Authors: Hanson Summer E. , Smith Benjamin D. , Liu Jun , Robb Geoffrey L. , Kronowitz Steven J. , Garvey Patrick B. 
Published: September 2016

Background:
The most commonly chosen flaps for delayed breast reconstruction after postmastectomy radiation therapy (PMRT) are abdominal-based free flaps (ABFFs) and pedicled latissimus dorsi (LD) musculocutaneous flaps. The short-and long-term advantages and disadvantages of delayed ABFFs versus LD flaps after PMRT remain unclear. We hypothesized that after PMRT, ABFFs would result in fewer postoperative complications and a lower incidence of revision surgery than LD flaps.

Methods:
We retrospectively reviewed a prospectively maintained database of consecutive patients who underwent unilateral, delayed breast reconstruction after PMRT using ABFFs or pedicled LD flaps with implants at the MD Anderson Cancer Center between January 1, 2001, and December 31, 2011. We compared outcomes and additional surgeries required between the 2 groups. Univariate and multivariate logistic regression modeling analyzed the relationships between patient and reconstruction characteristics and postoperative outcomes.

Results:
A total of 139 consecutive patients’ breast reconstructions were evaluated: 101 ABFFs (72.7%) versus 38 LDs (27.3%). Average follow-up was similar for ABFF and LD reconstructions. Although ABFF and LD reconstructions experienced similar rates of overall (30.7% vs 23.7%, respectively; P = 0.53), donor-site (8.91% vs 5.13%, respectively; P = 0.48), and flap (20.7% vs 17.9%, respectively; P = 0.37) complications, the LD reconstructions required more additional surgeries (92.1% vs 67.3%; P < 0.001). Furthermore, LDs required more revision surgeries more than 1 year after reconstruction (37.1% vs 14.7%; P = 0.02).

Conclusion:
Although early complication rates were similar for both types of reconstructions, ABFFs seem to have the advantage of providing a more durable result that required fewer revision surgeries in the long term.
HORIZONTAL RIDGE AS A POSTERIOR POLE FINDING IN A HIGHLY MYOPIC EYE WITH DOME-SHAPED MACULA
Authors: Liang I Chia 
Published: September 2016

Purpose:
This article describes a case with a highly myopic eye and a posterior pole with ridge-like lesions.

Methods:
Case report.

Results:
A 72-year-old man with unilateral high myopia showed poor vision and an extremely elongated axial length in his right eye, but normal vision and normal axial length in his left eye. He was examined using fundus examination and optical coherence tomography, and revealed to have dome-shaped macula with two horizontal ridges connecting the optic disc and the macula in his highly-myopic eye.

Conclusion:
The findings suggest that a dome-shaped macula may not be limited to the macula area, but may involve the whole posterior pole and is potentially involved in the elongation of highly myopic eyeballs.
WHY THE DOTS ARE BLACK ONLY IN THE LATE PHASE OF THE INDOCYANINE GREEN ANGIOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Gaudric Alain , Mrejen Sarah 
Published: September 2016

Purpose:
To determine what retinal layer is primarily involved in multiple evanescent white dot syndrome compared with acute posterior multifocal placoid pigment epitheliopathy using multimodal imaging including indocyanine green angiography.

Methods:
Color fundus photographs and fluorescein angiography, ICGA and spectral domain optical coherence tomography images of two typical acute cases, one of acute posterior multifocal placoid pigment epitheliopathy and one of multiple evanescent white dot syndrome, were assessed and compared.

Results:
In both diseases, white plaques or dots were seen at the posterior pole. The hypofluorescence of acute posterior multifocal placoid pigment epitheliopathy in the early phase of the fluorescein angiography and throughout the ICGA sequence suggested a multifocal choroidal hypoperfusion as the cause of the opacification of the outer retina corresponding to its hyper-reflectivity on spectral domain optical coherence tomography. In multiple evanescent white dot syndrome, there was no choroidal filling defect and the white spots were silent in the early phase of the ICGA, whereas they became black only in the late phase. The outer retina was also altered at the spots.

Conclusion:
In multiple evanescent white dot syndrome, the late hypofluorescence of the white spots on ICGA was likely due to the absence of ICG uptake by a damaged retinal pigment epithelium. Multiple evanescent white dot syndrome seems as a primary reversible nondestructive retinal pigment epitheliopathy, whereas acute posterior multifocal placoid pigment epitheliopathy is a true choroidopathy.
The Effect of Laser Photocoagulation on Intraocular Pressure in Premature Infants With Retinopathy of Prematurity
Authors: Erginturk Acar Damla , Acar Ugur , Tunay Zuhal Ozen , Ozdemir Ozdemir 
Published: September 2016

Purpose:
To evaluate the effects of diode laser treatment on intraocular pressure (IOP) of premature infants with retinopathy of prematurity (ROP).

Patients and Methods:
The premature infants who underwent retinal laser photocoagulation therapy for ROP, and gestational age–matched, birth weight–matched, and sex-matched premature infants with ROP which recovered spontaneously without any treatment were enrolled into the study. Anterior segment examination and longitudinal IOP and central corneal thickness measurements were performed 5 times as follows: 1 day before the laser treatment (T0), and 24 hours (T1), 1 week (T2), 1 month (T3), and 3 months (T4) after the laser treatment. Premature infants who experienced any complication related to the laser treatment were excluded from the study.

Results:
Laser treated 67 premature infants and 70 premature infants in control group met inclusion criteria. Significant linear decreases in IOP and central corneal thickness values were measured throughout the study period for both groups (both, P<0.001). These changes were similar in 2 groups. There was a statistically insignificantly (P=0.999) and transient increase in the mean IOP value in the laser-treated group 24 hours after laser treatment. None of the patients in the laser-treated group experienced a shallow anterior chamber or a remarkable IOP elevation.

Conclusions:
Diode laser treatment for ROP was safe, and did not raise the IOP of premature infants.
Refractive Outcome of Cataract Surgery in Eyes With Prior Trabeculectomy: Risk Factors for Postoperative Myopia
Authors: Yeh Oliver L. , Bojikian Karine D. , Slabaugh Mark A. , Chen Philip P. 
Published: September 2016

Purpose:
To examine refractive outcomes after phacoemulsification in eyes with prior trabeculectomy.

Design:
Retrospective observational case-control study

Methods:
Comparison of eyes of glaucoma patients undergoing cataract surgery after trabeculectomy (study group) with a matched group with medically controlled glaucoma (control group). Laser interferometry was used to obtain ocular biometry. We measured the difference between the expected and actual postoperative refraction using third-generation and fourth-generation intraocular lens (IOL) prediction formulae (Haigis, Holladay 2, Hoffer Q, and SRK-T). A residual difference of >1.0 D of hyperopia or myopia was considered a “refractive surprise.”

Results:
In total, 86 eyes (85 patients) were included, including 23 eyes (22 patients) in the study group and 63 eyes (63 patients) in the control group. The mean follow-up was 12.2±4.1 months. Eyes (n=13) with trabeculectomy and a preoperative intraocular pressure (IOP)≤9 mm Hg had significantly more large myopic surprises than the control group for all IOL formulae (P=0.015 Haigis, P=0.003 Holladay 2, P=0.004 Hoffer Q, P=0.003 SRK-T). Eyes (n=10) with trabeculectomy and preoperative IOP>9 mm Hg, however, did not have significantly more myopic errors than the control (P>0.05, all formulae). An “IOP spike” defined as a >50% rise in IOP from baseline within 1 month of cataract surgery in the subgroup with preoperative IOP≤9 mm Hg (n=8) was associated with increased risk of large myopic surprise (3/8 subset vs. 1/63 control eyes for all formulae; P=0.004 Haigis, P=0.004 Holladay 2, P=0.001 Hoffer Q, P=0.004 SRK-T) as well as for large myopic and hyperopic surprises overall (4/8 subset vs. ≤2/63 depending upon formulae; all P≤0.001).

Conclusions:
Low posttrabeculectomy IOP (≤9 mm Hg) is a risk factor for significant myopic surprise when undergoing subsequent cataract surgery despite using laser interferometry to measure ocular biometry and later generation formulae to determine IOL power. In addition, an IOP spike was associated with a 50% risk for large refractive surprise in this low IOP group.
Methylmalonic and propionic acidemias: clinical management update
Authors: Fraser Jamie L. , Venditti Charles P. 
Published: September 2016

Purpose of review
Recent clinical studies and management guidelines for the treatment of the organic acidopathies methylmalonic acidemia (MMA) and propionic acidemia address the scope of interventions to maximize health and quality of life. Unfortunately, these disorders continue to cause significant morbidity and mortality due to acute and chronic systemic and end-organ injury.

Recent findings
Dietary management with medical foods has been a mainstay of therapy for decades, yet well controlled patients can manifest growth, development, cardiac, ophthalmological, renal, and neurological complications. Patients with organic acidopathies suffer metabolic brain injury that targets specific regions of the basal ganglia in a distinctive pattern, and these injuries may occur even with optimal management during metabolic stress. Liver transplantation has improved quality of life and metabolic stability, yet transplantation in this population does not entirely prevent brain injury or the development of optic neuropathy and cardiac disease.

Summary
Management guidelines should identify necessary screening for patients with methylmalonic acidemia and propionic acidemia, and improve anticipatory management of progressive end-organ disease. Liver transplantation improves overall metabolic control, but injury to nonregenerative tissues may not be mitigated. Continued use of medical foods in these patients requires prospective studies to demonstrate evidence of benefit in a controlled manner.
Patient Safety During Chest Drain Insertion—A Survey of Current Practice
Authors: Villanueva Claudia , Doyle Mathew , Parikh Roneil , Manganas Con 
Published: September 2016

Objectives
The aim of this study was to identify the degree of awareness of the current guidelines and common practices for pleural drain insertion.

Methods
A 10-item questionnaire was sent electronically to junior physicians from 4 different hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health District. Participants were asked to give their level of experience and management practices for chest drain insertion.

Results
A total of 94 junior medical officers from 4 hospitals in the district completed the survey. More than 20% had never inserted a chest drain at the time; 72% had primarily learned from bedside teaching and peer learning, but 11% had no training at all. More than 50% of physicians felt that the biggest threat to the procedure was their own lack of confidence for drain insertion. Despite current guidelines, 25% insert chest drains routinely without the aid of ultrasound. A third of interviewees were aware of local guidelines but had not read them. Most physicians (86%) believe that formal standardized training should be available for junior physicians.

Conclusions
Our findings demonstrate the ongoing need for improved procedural training in chest drain insertion, with emphasis on mandatory thoracic ultrasound. We consider it important to continue to raise concern and awareness that chest drain insertion is not a harmless procedure, and further physician procedural competence is required.
Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians
Authors: Bacon Oliver , Gonzalez Rafael , Andrew Erin , Potter Michael B. , Iñiguez James R. , Cohen Stephanie E. , Liu Albert Y. , Fuchs Jonathan D. 
Published: September 2016

Abstract:
A large pool of clinicians are needed to meet the growing demand for HIV preexposure prophylaxis. We surveyed a mixed group of HIV specialists and nonspecialists in the San Francisco Bay Area to determine their attitudes toward and training needs regarding prescribing preexposure prophylaxis to persons at increased risk of HIV infection. Willingness to prescribe was associated with experience in caring for HIV-infected patients (adjusted odds ratio 4.76, 95% confidence interval: 1.43 to 15.76, P = 0.01). Desire for further training was associated with concerns about drug resistance (P = 0.04) and side effects (P = 0.04) and was more common among noninfectious disease specialists. Clinicians favored online and in-person training methods.
Detection of Calcium Crystals in Knee Osteoarthritis Synovial Fluid
Authors: Frallonardo Paola , Oliviero Francesca , Peruzzo Luca , Tauro Leonardo , Scanu Anna , Galozzi Paola , Ramonda Roberta , Punzi Leonardo 
Published: September 2016

Background
The identification of calcium crystals in synovial fluid (SF) of patients with osteoarthritis (OA) represents an important step in understanding the role of these crystals in synovial inflammation and disease progression.

Objectives
This study aimed to investigate the presence of calcium pyrophosphate (CPP) and basic calcium phosphate (BCP) crystals in SF collected from patients with symptomatic knee OA by scanning electron microscopy (SEM) coupled to x-ray energy dispersive spectroscopy, compensated polarized light microscopy (CPLM), and alizarin red staining.

Methods
Seventy-four patients with knee OA were included in the study. Synovial fluid samples were collected after arthrocentesis and examined under CPLM for the assessment of CPP crystals. Basic calcium phosphate crystals were evaluated by alizarin red staining. All the samples were examined by SEM. The concordance between the 2 techniques was evaluated by Cohen κ agreement coefficient.

Results
Calcium pyrophosphate and BCP crystals were found, respectively, in 23 (31.1%) and 13 (17.5%) of 74 OA SFs by SEM analysis. Calcium pyrophosphate crystals were identified in 23 (31.1%) of 74 samples by CPLM, whereas BCP crystals were suspected in 27 (36.4%) of 74 samples. According to κ coefficient, the concordance between CPLM and SEM was 0.83 for CPP, and that between alizarin red and SEM was 0.68 for BCP.

Conclusions
The results of our study showed a high level of concordance between the 2 microscope techniques as regards CPP crystal identification and a lower agreement for BCP crystals. Although this finding highlights the difficulty in identifying BCP crystals by alizarin red staining, the use of SEM remains unsuitable to apply in the clinical setting. Because of the in vitro inflammatory effect of BCP crystals, further work on their analysis in SF could provide important information about the OA process.
Systemic Lupus Erythematosus Does Not Increase Risk of Adverse Events in the First 6 Months After Total Knee Arthroplasty
Authors: Fein Arielle W. , Figgie Caroline A. , Dodds Taylor R. , Wright-Chisem Joshua , Parks Michael L. , Mandl Lisa A. , Su Edwin P. , Salmon Jane E. , Mayman David J. , Lee Yuo-Yu , Figgie Mark P. , Goodman Susan M. 
Published: September 2016

Background
Increasing numbers of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA). Whether postsurgical adverse events (AEs) are higher in patients with SLE than patients with osteoarthritis (OA) is unknown.

Objectives
This study aims to compare AEs within 6 months of TKA.

Methods
Patients in a single institution’s arthroplasty and SLE registries who underwent TKA from 2007 to 2014 were eligible. SLE cases were matched 1:2 to OA on age, sex, year of TKA, and procedure type. AEs were collected through chart review and registry responses. Baseline characteristics were compared and regression analysis performed to determine predictors of AEs.

Results
Fifty-two SLE TKA were matched to 104 OA TKA. There was no difference in follow-up between groups. SLE patients had more comorbidities (≥1 Charlson-Deyo comorbidity: SLE 38.4% vs. OA 17.3%; P-value < 0.001) and steroid use (preoperative [SLE 28.8% vs. OA 1.9%, P-value < 0.001] and perioperative “stress-dose” [30.8% vs. 2.9%, P-value = 0.01]). SLE patients did not experience more major (SLE 25.0% vs. OA 19.2%; P-value = 0.41), minor (15.4% vs. 10.6%; P-value = 0.39), or total (38.5% vs. 27.9%; P-value = 0.18) AEs. AEs were not increased among patients on stress-dose steroids. In a multiple logistic regression analysis controlling for comorbidities and diagnosis, neither SLE (OR 1.61, 95% CI 0.74–3.50) nor >1 comorbidity (OR 1.05, 95% CI 0.46–2.39) was an independent risk factor for AEs.

Conclusion
SLE is not an independent risk factor for increased AEs 6 months after TKA. Stress-dose steroid use does not heighten AE risk. These findings should inform recommendations for SLE patients considering TKA.
Titanium Surgical Tacks: Are They Safe? Do They Work?
Authors: Shatkin-Margolis Abigail , Merchant Maqdooda , Margulies Rebecca U. , Ramm Olga 
Published: September 2016

Objectives
Minimally invasive approaches to sacrocolpopexy have transformed it into a primary procedure for treatment of pelvic organ prolapse. Certain modifications are commonly used to facilitate the laparoscopic approach, but have not yet been widely studied. In this study, we investigated the efficacy and safety of titanium surgical tacks for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy.

Methods
This retrospective cohort study involved all patients within 1 health care system who underwent laparoscopic sacrocolpopexy between January 2009 and December 2012. Each medical record was reviewed and abstracted.

Results
Of the 231 patients included in our study, 190 (82%) had titanium surgical tacks, and 41 (18%) had suture for mesh attachment to the anterior longitudinal ligament. The demographics of the 2 subgroups as well as concomitantly performed procedures were comparable. There was no significant difference found between the 2 cohorts in regards to operative time, estimated blood loss, complication rates, rate of recurrent pelvic organ prolapse symptoms or the rate of reoperation for pelvic organ prolapse.

Conclusions
Surgical tacks are a safe alternative to suture for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy. Although we saw no advantage to using tacks over suture, tacking the mesh to the anterior longitudinal ligament may make the laparoscopic approach more accessible to a wider range of gynecologic surgeons. Further studies about the long-term impact of surgical tacks on bone and disk disease are needed.