bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the Ultra–High-Frequency Electrical Field Radiofrequency Device on Mouse Skin: A Histologic and Molecular Study
Authors: Kim Miri , Kim Kyung-Eun , Jeong Seo-won , Hwang Se Won , Jo Hyunmu , Lee Jahyung , Cho Daeho , Park Hyun Jeong 
Published: August 2016

Background:
Radiofrequency technology is one of the most recently developed methods for noninvasive skin tightening and facial contouring, and works by generating thermal energy in the deep dermis. Although clinical improvements have been reported using radiofrequency devices, there are few histologic and molecular studies about the mechanisms of dermal collagen remodeling. The authors investigated the histologic effects of an ultra–high-frequency electrical field (40.68 MHz) radiofrequency device (Polargen) on collagen remodeling in hairless mouse skin and evaluated its relative molecular mechanism.

Methods:
The radiofrequency was applied to the dorsal skin of hairless mice three times per week for 2 weeks. At 21 days after initial treatment, treated skin and nontreated control skin samples were excised for semiquantitative analysis of histologic features, including collagen. The authors also checked the mRNA expression levels of collagen type 1, transforming growth factor (TGF)-β, matrix metalloproteinase-1, vascular endothelial growth factor, tumor necrosis factor-α, and interleukin-1.

Results:
Histologic examination revealed epidermal hyperplasia, increased collagen staining, and fat atrophy in treated skin area compared with the nontreated skin area. In addition, mRNA expression of collagen type І, TGF-β, and vascular endothelial growth factor in radiofrequency-treated areas was significantly increased compared with that in untreated control areas (p < 0.05, p < 0.05, and p < 0.01, respectively).

Conclusions:
These results suggest that the device may facilitate replacement of subcutaneous fat tissue with new collagen in association with the increased mRNA levels in TGF-β and vascular endothelial growth factor. Therefore, this device may effectively reduce adipose tissue and achieve facial contouring in addition to skin tightening.
One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation
Authors: Lee Yao-Chou , Chen Wei-Chen , Chen Szu-Han , Hung Kuo-Shu , Hsiao Jenn-Ren , Lee Jing-Wei , Shieh Shyh-Jou 
Published: August 2016

Background:
Whether one-vein or two-vein drainage yields better outcomes in anterolateral thigh flap reconstruction after oral cancer ablation is still being debated. Thus, the authors investigated this question.

Methods:
In this retrospective cohort study, the authors reviewed the charts of 321 patients with oral cancer who, between August of 2010 and July of 2014, had undergone ablative surgery and then immediate reconstruction with the anterolateral thigh flap. Patients who underwent simultaneous reconstruction with additional free flaps were excluded. The patients were subgrouped into newly diagnosed (n = 221) and previously treated (n = 100) groups and then subgrouped into one-vein and two-vein groups.

Results:
Overall, operative time was significantly longer (366.8 ± 112.7 minutes versus 336.3 ± 99.7 minutes; p = 0.009) and hospitalization was significantly shorter (22.0 ± 13.3 days versus 24.5 ± 13.8 days; p = 0.027) in the two-vein group. In the newly diagnosed two-vein group, operative time was also significantly longer (355.5 ± 91.7 minutes versus 319.9 ± 95.9 minutes; p = 0.008), anterolateral thigh flap take-backs for vascular compromise (3.2 percent versus 10.9 percent; p = 0.041) and venous congestion (1.1 percent versus 7.8 percent; p = 0.027) were fewer, and flap survival was greater (100 percent versus 95.3 percent; p = 0.041). Differences between the one-vein and two-vein previously treated subgroups were not significant.

Conclusion:
In newly diagnosed patients undergoing anterolateral thigh flap reconstruction after oral cancer ablation, better outcomes are achieved with two venous anastomoses rather than one.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?
Authors: Marchac Alexandre , Kuschner Tomasine , Paris John , Picard Arnaud , Vazquez Marie Paule , Lantieri Laurent 
Published: August 2016

Background:
In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults.

Methods:
The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation.

Results:
Children’s youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant.

Conclusion:
After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.
A Longitudinal Relationship Between Depressive Symptoms and Development of Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults Study
Authors: Womack Veronica Y. , De Chavez Peter John , Albrecht Sandra S. , Durant Nefertiti , Loucks Eric B. , Puterman Eli , Redmond Nicole , Siddique Juned , Williams David R. , Carnethon Mercedes R. 
Published: August 2016

ABSTRACT

Objective
Despite variability in the burden of elevated depressive symptoms by sex and race and differences in the incidence of metabolic syndrome, few prior studies describe the longitudinal association of depressive symptoms with metabolic syndrome in a diverse cohort. We tested whether baseline and time-varying depressive symptoms were associated with metabolic syndrome incidence in black and white men and women from the Coronary Artery Risk Development in Young Adults study.

Methods
Participants reported depressive symptoms using the Center for Epidemiologic Studies Depression Scale at four examinations between 1995 and 2010. At those same examinations, metabolic syndrome was determined. Cox proportional hazards models were used to examine the associations of depressive symptoms on the development of metabolic syndrome in 3208 participants without metabolic syndrome at baseline.

Results
For 15 years, the incidence rate of metabolic syndrome (per 10,000 person-years) varied by race and sex, with the highest rate in black women (279.2), followed by white men (241.9), black men (204.4), and white women (125.3). Depressive symptoms (per standard deviation higher) were associated with incident metabolic syndrome in white men (hazard ratio = 1.25, 95% confidence interval = 1.08–1.45) and white women (hazard ratio = 1.17, 95% confidence interval = 1.00–1.37) after adjustment for demographic characteristics and health behaviors. There was no significant association between depression and metabolic syndrome among black men or black women.

Conclusions
Higher depressive symptoms contribute modestly to the onset of metabolic syndrome among white adults.
Evaluation of Sexual Risk Behavior Among Study Participants in the TDF2 PrEP Study Among Heterosexual Adults in Botswana
Authors: Gust Deborah A. , Soud Fatma , Hardnett Felicia P. , Malotte Charles K. , Rose Charles , Kebaabetswe Poloko , Makgekgenene Lebogang , Henderson Faith , Paxton Lynn , Segolodi Tebogo , Kilmarx Peter H. 
Published: August 2016

Objective:
Among participants of a clinical trial to test the efficacy of tenofovir/emtricitabine in protecting heterosexual men and women living in Botswana from HIV infection, the aim was to determine (1) if sexual risk behavior, specifically condomless sex acts and number of sex partners, changed over time, (2) factors associated with condomless sex acts and number of sex partners, and (3) the effect of participant treatment arm perception on risk behavior to address the possibility of risk compensation.

Methods:
A longitudinal modeling of rates of risk behaviors was used to determine if the rate of condomless sex acts (#acts/person) and rate of sex partners (#partners/person) changed over time and which factors were associated with behavior change.

Results:
One thousand two hundred participants were analyzed over 1 year. There was a 25% decrease in the rate of sex partners among participants sexually active in the last 30 days. The rate of reported condomless sex acts was greater for males [rate ratio (RR) = 1.34; confidence interval (CI): 1.07 to 1.67] and participants whose sexual debut in years was ≤15 years of age (RR = 1.65; CI: 1.14 to 2.38) and 16–17 (RR = 1.68; CI: 1.22 to 2.31) compared with those ≥20 years. Rate of reported sex partners was greater for males (RR = 3.67; CI: 2.86 to 4.71) and participants whose age at sexual debut in years was ≤15 (RR = 2.92; CI: 2.01 to 4.22) and 16–17 (RR = 2.34; CI: 1.69 to 3.24) compared with those ≥20. There was no effect of participant treatment arm perception on risk behavior.

Conclusions:
Our study of preexposure prophylaxis to prevent HIV infection found no evidence of risk compensation which may have been due to participants' motivations to reduce their risk behaviors and risk-reduction counseling.
Marker of Endothelial Dysfunction Asymmetric Dimethylarginine Is Elevated in HIV Infection but Not Associated With Subclinical Atherosclerosis
Authors: Haissman Judith M. , Haugaard Anna K. , Knudsen Andreas , Kristoffersen Ulrik S. , Seljeflot Ingebjørg , Pedersen Karin K. , Lebech Anne-Mette , Hasbak Philip , Kjær Andreas , Ostrowski Sisse R. , Gerstoft Jan , Trøseid Marius , Nielsen Susanne D. 
Published: August 2016

Background:
Cardiovascular disease contributes to excess morbidity and mortality in HIV infection, and endothelial dysfunction may contribute to this pattern. We aimed to determine the endothelial function in treated and untreated HIV-infected individuals and investigate potential associations with viral replication, immune activation, coagulation, platelet function, and subclinical atherosclerosis.

Methods:
Asymmetric dimethylarginine (ADMA, marker of endothelial dysfunction) and soluble CD14 (sCD14, marker of monocyte activation) were measured in plasma from two previously established cross-sectional cohorts: cohort A including 50 untreated and 50 antiretroviral therapy (ART)–treated HIV-infected individuals with previously assessed coagulation and platelet function and cohort B including 105 HIV-infected individuals on ART and 105 uninfected controls with previously assessed coronary artery calcium score, myocardial perfusion defects, and carotid intima–media thickness.

Results:
Concentrations of ADMA were higher in HIV-infected individuals compared with uninfected controls, and higher ADMA was found in ART-treated compared with untreated HIV-infected individuals. ADMA was associated with viral load, sCD14, D-dimer, and low CD4+ T-cell count in untreated HIV infection. Only viral load remained significant in multivariate analyses. In ART-treated HIV-infected individuals, ADMA was not associated with coronary artery calcium score, myocardial perfusion defects, or intima–media thickness.

Conclusions:
Evidence of endothelial dysfunction was found in HIV infection and in untreated compared with treated HIV infection. In untreated HIV infection, the main driver of endothelial dysfunction was viral replication. Importantly, in treated HIV infection, ADMA was not associated with subclinical atherosclerosis. Thus, our data question the potential of ADMA as a useful biomarker of early atherosclerosis in treated HIV infection.
Precursor Forms of Vitamin D Reduce HIV-1 Infection In Vitro
Authors: Aguilar-Jimenez Wbeimar , Villegas-Ospina Simon , Gonzalez Sandra , Zapata Wildeman , Saulle Irma , Garziano Micaela , Biasin Mara , Clerici Mario , Rugeles Maria T. 
Published: August 2016

Background:
Although the anti-HIV-1 effects of vitamin D (VitD) have been reported, mechanisms behind such protection remain largely unexplored.

Methods:
The effects of two precursor forms (cholecalciferol/calciol at 0.01, 1 and 100 nM and calcidiol at 100 and 250 nM) on HIV-1 infection, immune activation, and gene expression were analyzed in vitro in cells of Colombian and Italian healthy donors. We quantified levels of released p24 by enzyme-linked immunosorbent assay, of intracellular p24 and cell-surface expression of CD38 and HLA-DR by flow cytometry, and mRNA expression of antiviral and immunoregulatory genes by real-time reverse transcription-polymerase chain reaction.

Results:
Cholecalciferol decreased the frequency of HIV-1-infected p24+CD4+ T cells and levels of p24 in supernatants in a dose-dependent manner. Moreover, the CD4+CD38+HLA-DR+ and CD4+CD38−HLA-DR+ subpopulations were more susceptible to infection but displayed the greatest cholecalciferol-induced decreases in infection rate by an X4-tropic strain. Likewise, cholecalciferol at its highest concentration decreased the frequency of CD38−HLA-DR+ but not of CD38+HLA-DR+ T-cell subsets. Analyzing the effects of calcidiol, the main VitD source for immune cells and an R5-tropic strain as the most frequently transmitted virus, a reduction in HIV-1 productive infection was also observed. In addition, an increase in mRNA expression of APOBEC3G and PI3 and a reduction of TRIM22 and CCR5 expression, this latter positively correlated with p24 levels, was noted.

Conclusions:
VitD reduces HIV-1 infection in T cells possibly by inducing antiviral gene expression, reducing the viral co-receptor CCR5 and, at least at the highest cholecalciferol concentration, by promoting an HIV-1-restrictive CD38+HLA-DR− immunophenotype.
Chronic HIV-1 Infection Impairs Superantigen-Induced Activation of Peripheral CD4+CXCR5+PD-1+ Cells, With Relative Preservation of Recall Antigen–Specific Responses
Authors: Nicholas Katherine J. , Flaherty David K. , Smith Rita M. , Sather D. Noah , Kalams Spyros A. 
Published: August 2016

Abstract:
Peripheral CD4+CXCR5+PD-1+ T cells are a putative circulating counterpart to germinal center T follicular helper (TFH) cells. They show both phenotypic and functional similarities to TFH cells, which provide necessary help for the differentiation of B cells to antibody-secreting plasmablasts. In this study, we evaluated the frequency, phenotypes, and responses of peripheral TFH-like (pTFH) cells to superantigen and recall antigen stimulation in 10 healthy and 34 chronically infected treatment-naive HIV-1+ individuals. There was no difference in the frequency of pTFH cells between HIV+ and HIV− individuals. Surface expression of ICOS, but not CD40L, was higher on pTFH cells at baseline in HIV+ individuals. Compared with HIV− individuals, pTFH cells from HIV+ individuals had decreased maximal expression of ICOS and CD40L in response to in vitro superantigen stimulation. This decreased response did not correlate with viral control, CD4+ T-cell count, duration of infection, or the degree of neutralizing antibody breadth. Despite a decreased maximal response, pTFH responses to HIV Gag and tetanus toxoid recall antigens were preserved.
Giardia: a pathogen or commensal for children in high-prevalence settings?
Authors: Bartelt Luther A. , Platts-Mills James A. 
Published: August 2016

Purpose of review

Giardia is a common intestinal parasite worldwide, and infection can be associated with clear and sometimes persistent symptomatology. However, in children in high-prevalence settings, it is not associated with or is perhaps even protective against acute diarrhea, and the association with long-term outcomes has been difficult to discern.

Recent findings
Recent studies have made progress in helping us disentangle this apparent paradox. First, prospective, well-characterized cohort studies have added to the data on the association between Giardia and diarrhea in these settings and have further characterized associations between Giardia infection and nutrition, gut function, and growth. Second, animal models have further characterized the host response to Giardia and helped elucidate mechanisms by which Giardia could impair child development. Finally, new work has shed light on the heterogeneity of human Giardia strains, which may both explain discrepant findings in the literature and help guide higher-resolution analyses of this pathogen in the future.

Summary
The true clinical impact of endemic pediatric giardiasis remains unclear, but recent prospective studies have confirmed a high prevalence of persistent, subclinical Giardia infections and associated growth shortfalls. Integrating how nutritional, microbial, metabolic, and pathogen–strain variables influence these outcomes could sharpen delineations between pathogenic and potentially beneficial attributes of this enigmatic parasite.
What can we learn about breathlessness from population-based and administrative health data?
Authors: Ekström Magnus 
Published: August 2016

Purpose of review
To review the findings and methodological strengths and limitations of studies of breathlessness using population-based or routinely collected data, including the novel methodology of the registry-based randomized controlled trial (R-RCT).

Recent findings
Breathlessness severe enough to restrict activity is common and increases in the last months of life both among elderly in the community and among patients in specialized palliative care. During the last week of life, risk factors for more severe breathlessness have been identified. Patients with advanced chronic obstructive or interstitial lung disease experience more breathlessness than patients dying from lung cancer. Breathlessness often remains unrelieved or only partially relieved at the end of life.

Summary
Data from population-based or health-administrative databases can inform on the epidemiology, associated factors and the potential impact of breathlessness. Potential strengths of these data are high precision and generalizability because of large, nonselective study populations with high completeness of follow-up of outcomes such as survival. Potential limitations include residual confounding and insufficient data quality which is unaffected by increasing the sample size. The R-RCT methodology combines strengths of randomization with those of large representative databases to evaluate effectiveness in clinical care.
Contributions of military surgeons to the management of vascular trauma
Authors: Feliciano David V. 
Published: August 2016

ABSTRACT
Many military trauma surgeons have helped to advance the management of vascular injuries during wartime. The five surgeons highlighted—Sir George Henry Makins, Michael E. DeBakey, Harris B. Shumacker, Jr., Carl W. Hughes, and Norman M. Rich—made significant and lasting contributions.
Advances in modeling and treating spinal muscular atrophy
Authors: Van Alstyne Meaghan , Pellizzoni Livio 
Published: August 2016

Purpose of review
Spinal muscular atrophy (SMA) is an inherited childhood neurodegenerative disorder caused by ubiquitous deficiency of the survival motor neuron (SMN) protein – the hallmarks of which are the selective loss of motor neurons and skeletal muscle atrophy. Here, we highlight recent progress in the understanding of SMA pathology and in the development of therapeutic approaches for its treatment.

Recent findings
Phenotypic characterization of mouse models of the disease, combined with analysis of SMN restoration or depletion in a spatially and temporally controlled manner, has yielded key insights into the normal requirement of SMN and SMA pathophysiology. Increasing evidence indicates a higher demand for SMN during neuromuscular development and extends the pathogenic effects of SMN deficiency beyond motor neurons to include additional cells both within and outside the nervous system. These findings have been paralleled by preclinical development of powerful approaches for increasing SMN expression through gene therapy or splicing modulation that are now in human trials.

Summary
Along with the availability of SMN-upregulating drugs, identification of the specific cell types in which SMN deficiency induces the disease and delineation of the window of opportunity for effective treatment are key advances in the ongoing path to SMA therapy.
Maximizing the Yield of Rapid Eye Movement Sleep in the Epilepsy Monitoring Unit
Authors: Ng Marcus C. 
Published: August 2016

Purpose:
Rapid eye movement (REM) sleep can help localize the epileptogenic zone in multifocal epilepsy when interictal discharges appear diffuse. However, REM sleep is reputedly rare and easily overlooked in the Epilepsy Monitoring Unit (EMU). The aims of this study are to determine the characteristics of REM sleep in a typical EMU and whether using automated artifact recognition can meaningfully enhance REM sleep detection.

Methods:
Artifact-based REM sleep detection was applied to 581 nights of EMU recording from 100 patients over 12 months. REM sleep had been manually detected at the time of recording. The index of suspicion for manual detection was raised after 6 months. Artifact-based detection was compared with manual detection, and the impact on localization was assessed.

Results:
REM sleep occurred in 77% of EMU nights. Thirty-six patients achieved REM sleep nightly and 62 patients on at least one night. Mean admission was 5.83 days. Mean REM sleep duration was 5.92 minutes over 1.88 mean nightly bouts. Raising the level of suspicion increased manual detection rates from 22.6% to 40.5%. The artifact-based detection rate was 96% and provided additional localizing information in 10% of epilepsy patients.

Conclusions:
REM sleep is common in the EMU, but bouts are few and brief. Capturing these bouts to maximize the yield of REM sleep in the EMU is made possible by automated artifact recognition whose results could enhance localization of the epileptogenic zone.