bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phenazopyridine for Evaluation of Ureteral Patency
Authors: Propst Katie , Tunitsky-Bitton Elena , O'Sullivan David M. , Steinberg Adam C. , LaSala Christine 
Published: July 2016

OBJECTIVE:
To evaluate the usefulness of phenazopyridine for confirmation of ureteral patency during intraoperative cystoscopy.

METHODS:
We conducted a randomized controlled trial comparing use of phenazopyridine with no medications for evaluation of ureteral patency during intraoperative cystoscopy in women undergoing pelvic surgery. The primary study outcome was time to visualize ureteral urine efflux. To detect a 3-minute difference with α of 0.05 using a two-sided, two-sample t test and β 0.80 required 98 patients equally divided into two groups.

RESULTS:
A total of 104 women were randomized from April to December 2015. Patients in the treatment group tended to be older (P=.02); otherwise, study groups were similar. Time to visualize ureteral urine efflux did not differ between study groups with a mean time of 2 minutes 40 seconds (±2 minutes 38 seconds) in the control group and 2 minutes 53 seconds (±4 minutes 35 seconds) in the treatment group (P=.77). Regarding the surgeon survey, surgeons felt less frustrated and impatient in visualization of ureteral urine efflux in the treatment group compared with the control group (mean response 1.5±0.8 in treatment compared with 2.0±1.0 in control, P=.007), and surgeons felt that the cystoscopy took too long more often in the control than in the treatment group (1.7±0.9 in treatment compared with 2.1±1.0 in control, P=.02). Trial of void result differed significantly between groups with fewer patients in the treatment group failing a void trial (P=.04). There were no adverse events related to phenazopyridine use.

CONCLUSION:
Preoperative phenazopyridine is a useful and cost-saving medication for use in planned cystoscopy for evaluation of ureteral patency.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02424149.
Local and Systemic Inflammation in Localized, Provoked Vestibulodynia
Authors: Chalmers K. Jane , Madden Victoria J. , Hutchinson Mark R. , Moseley G. Lorimer 
Published: July 2016

OBJECTIVE:
To synthesize and critically evaluate all available evidence investigating whether localized, provoked vestibulodynia is associated with a specific inflammatory profile at both a local and a systemic level.

DATA SOURCES:
Comprehensive electronic searches were performed in MEDLINE, EMBASE, Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Collaboration databases, and ClinicalTrials.gov. The search strategy was developed using MeSH terms related to localized, provoked vestibulodynia, and inflammatory markers.

METHODS OF STUDY SELECTION:
Two independent investigators screened titles and abstracts and performed data extraction and risk of bias assessments. Studies were included if they reported at least one baseline inflammatory marker in women with localized, provoked vestibulodynia and compared them with healthy women. Reference lists from published reviews on localized, provoked vestibulodynia were screened for additional studies.

TABULATION, INTEGRATION, AND RESULTS:
There were 1,619 studies identified. Eighteen studies met the inclusion criteria, including 400 women with localized, provoked vestibulodynia and 212 healthy women in a control group. Risk of bias assessment revealed that the methodologic quality was generally low. Fifteen studies investigated local inflammation and three studies investigated systemic inflammation. On a local level, the number of mast cells expressed in vestibular tissues was greater in women with localized, provoked vestibulodynia expressed than in women in the control group. Several studies reported undefined inflammatory infiltrate in vestibular tissues to a greater level in women with localized, provoked vestibulodynia than in women in the control group. Systemically, levels of natural killer cells were lower in women with localized, provoked vestibulodynia than in women in the control group. There were no systemic differences in systemic interferon-α and interferon-ϒ levels between groups.

CONCLUSION:
There is limited and contradictory evidence regarding the characteristics of local and systemic inflammation in women with localized, provoked vestibulodynia.
Duration of Oxytocin and Rupture of the Membranes Before Diagnosing a Failed Induction of Labor
Authors: Kawakita Tetsuya , Reddy Uma M. , Iqbal Sara N. , Landy Helain J. , Huang Chun-Chih , Hoffman Matthew , Sciscione Anthony C. , Grantz Katherine L. 
Published: July 2016

OBJECTIVE:
To compare maternal and neonatal outcomes based on length of the latent phase during induction with rupture of membranes before 6 cm dilation.

METHODS:
This is a retrospective cohort study using data from the Consortium of Safe Labor study, including 9,763 nulliparous and 8,379 multiparous women with singleton, term pregnancies undergoing induction at 2 cm dilation or less with rupture of membranes before 6 cm dilation after which the latent phase ended. Outcomes were evaluated according to duration of oxytocin and rupture of membranes.

RESULTS:
At time points from 6 to 18 hours of oxytocin and rupture of membranes, the rates of nulliparous women remaining in the latent phase declined (35.9–1.4%) and the rates of vaginal delivery for those remaining in the latent phase at these time periods decreased (54.1–29.9%) Nulliparous women remaining in the latent phase for 12 hours compared with women who had exited the latent phase had significantly increased rates of chorioamnionitis (12.1% compared with 4.1%) and endometritis (3.6% compared with 1.3%) and increased rates of neonatal intensive care unit admission (8.7% compared with 6.3%). Similar patterns were present for multiparous women at 15 hours.

CONCLUSION:
Based on when neonatal morbidity increased, in an otherwise uncomplicated induction of labor with rupture of membranes, a latent phase after initiation of oxytocin of at least 12 hours for nulliparous women and 15 hours in multiparous women is a reasonable criterion for diagnosing a failed induction.
Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States
Authors: Garcia Christine , Martin Maria , Tucker Lue-Yen , Lyon Liisa , Armstrong Mary Anne , McBride-Allen Sally , Littell Ramey D. , Alabaster Amy , Raine-Bennett Tina , Powell C. Bethan 
Published: July 2016

OBJECTIVE:
To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice.

METHODS:
This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older undergoing hysterectomy from June 2011 to May 2014 in a large integrated health care delivery system. The primary outcome was the change in rate of opportunistic salpingectomy over time and after a systemwide practice recommendation was issued in May 2013. Secondary outcomes included data on blood loss, operating time, and length of stay.

RESULTS:
Of the 12,143 hysterectomies performed over the 3-year study period, 7,498 were performed without oophorectomy. There was a statistically significant rise in rate of salpingectomy over time from 14.7% for June 2011 to May 2012 to 44.6% from June 2012 to May 2013 and to 72.7% from June 2013 to May 2014 (P<.001). Sixty-one percent of laparoscopic hysterectomies were performed with salpingectomy, whereas only 25% of abdominal and 17% of vaginal hysterectomies had salpingectomies. Median estimated blood loss was lower in the salpingectomy group, 100 compared with 150 mL (P<.01). There was a significantly shorter median operating time (147 compared with 154 minutes, P=.002) for laparoscopic hysterectomy with bilateral salpingectomy compared with laparoscopic hysterectomy alone.

CONCLUSION:
Rates of salpingectomy increased significantly over time, consistent with the high reported acceptance rate reported by health care providers and highlighting the importance of physician education to improve compliance with risk-reducing clinical strategies.
Overall Survival in Spine Myeloma Metastases: Difficulties in Predicting With Prognostic Scores
Authors: Amelot Aymeric , Cristini Joseph , Salaud Céline , Moles Alexis , Hamel Olivier , Moreau Philippe , Bord Eric , Buffenoir Kevin 
Published: July 2016

Study Design.
Fifty-one patients with spinal multiple myeloma (MM) metastases were operated and followed between January 2004 and July 2014.

Objective.
The aim of this study was to consider the efficiency of surgical prognosis scores in the management of spinal metastases myelomas.

Summary of Background Data.
The spine is the most common site of bone metastases in MM. Surgery in spine metastases MM is a matter of debate and its impact on the increase of a patient's survival time is not clear. Several surgical survival scores have been developed to determine the best treatment in these patients.

Methods.
We studied 51 patients operated for spinal MM metastases between January 2004 and July 2014. We determined the Tokuhashi and Tomita survival scores and compared them with documented patient survivals. The two scores were also compared with the International Staging System (ISS).

Results.
Median survival (MS) was 108 months [standard deviation (SD) 62] for ISS I, 132.2 (SD 40) for ISS II, and 45.5 months (SD 16.3) for ISS III (P = 0.09). According to Tokuhashi survival score, 21 patients (41.2%) will survive <6 months, 6 (11.8%) 6 to 12 months, and 24 (47%) >12 months. According to Tomita et al., 50 patients (98%) will survive >49.9 months and 1 patient (2%) <15 months. Regardless of the ISS grade prognosis, Tokuhashi survival score, and to a lesser extent Tomita score, underestimated the actual survival very significantly [P < 0.0001, Log Rank (Mantel-Cox)].

Conclusion.
We suggest that spine surgical prognosis scores are not accurate and are not able to predict the survival of patients with spine myeloma metastases. Spine surgeons have to be guided not by the initial ISS stage but rather by spinal instability and neurological status.

Level of Evidence: N/A
Neurotropic Gamma-Delta T-Cell Lymphoma With CD30-Positive Lymphoid Infiltrates
Authors: Gammon Bryan , Gammon Benjamin R. , Kim Youn H. , Kim Jinah 
Published: July 2016

Abstract:
Primary cutaneous gamma-delta T-cell lymphoma (PCGD-TCL) is a clonal proliferation of gamma-delta T cells with a cytotoxic phenotype that is typically characterized by an aggressive clinical course with ulcerative plaques or subcutaneous nodules. In this report, the authors describe a patient who developed an ulcerated tumor on the left upper extremity and painful papules and nodules on the right lower extremity. Interestingly, several of the papulonodules on the right lower extremity underwent spontaneous involution. A skin biopsy of the papulonodular lesion demonstrated a superficial and deep perivascular interstitial infiltrate with a population of pleomorphic enlarged CD30-positive T cells. These enlarged lymphocytes lacked expression of TCR beta, CD4, CD8, and the pan T-cell antigen CD7, but were positive for TCR gamma, supporting the diagnosis of PCGD-TCL. The patient rapidly developed pain and severe weakness in the left upper limb and MRI revealed extensive neurolymphomatosis of the left brachial plexus. The patient was treated with chemotherapy with complete remission achieved. Unfortunately, her response was transient and the patient relapsed and ultimately died due to her disease. In this article, the authors describe an extraordinary case of a CD30-positive PCGD-TCL to expand the histopathological spectrum of CD30-positive and gamma-delta–positive lymphoproliferative disorders.
Annular Lichenoid Dermatitis (of Youth) Immunohistochemical and Serological Evidence for Another Clinical Presentation of Borrelia Infection in Patients of Western Austria
Authors: Wilk Michael , Zelger Bettina G. , Emberger Michael , Zelger Bernhard 
Published: July 2016

Abstract:
Annular lichenoid dermatitis of youth (ALDY) is a more recently described inflammatory disease of the skin of unknown etiology with clinical similarities to morphea. The authors clinically, histopathologically, and immunohistochemically investigated 14 biopsies from 12 patients in western Austria with this disease. There were 6 female and 6 male patients with solitary (n = 7) and multiple lesions (n = 5) affecting the trunk (n = 11), upper arm (n = 2), thigh (n = 1), and calf (n = 1). Clinically, early lesions were erythematous in nature leading to central paleness, scaling, wrinkling, dermal atrophy, slight pigmentation, and telangiectasia later on. Histopathologically, all specimens showed the typical features of ALDY with a superficial lichenoid process with sprinkling of lymphocytes along the basal cell layer and within the epidermis accompanied by mild fibrosis. Pigment incontinence, superficial fibrosis, and dilatation of superficial capillary vessels are prominent features in more advanced stages of disease. Immunohistologically, using a polyclonal antibody against Borrelia, 11/14 specimens revealed spirochetes, either vital (n = 4) or degenerated (n = 7), in close proximity to collagen bundles. Thirteen of 14 specimens in addition showed focal (n = 4) or clustered (n = 9) positivity for CD20 in the papillary dermis. Nine of 12 sera tested for Borrelia with an enzyme-linked immunosorbent assay were positive. Lichen sclerosus et atrophicus and morphea have previously been reported to be possibly related to Borrelia infection. We postulate that a similar relationship to Borrelia infection may be true for ALDY implying that ALDY may be an early superficial stage of morphea.
Chlorhexidine Keratitis: Safety of Chlorhexidine as a Facial Antiseptic
Authors: Steinsapir Kenneth D. , Woodward Julie A. 
Published: July 2016

BACKGROUND
Effective antiseptic to reduce surgical site infections is a cornerstone of modern surgery. Chlorhexidine gluconate–based antiseptics are among the most effective of these products. Unfortunately, chlorhexidine solutions are toxic to the cornea and middle ear, and they pose a splash risk to both the patient and health care personnel.

OBJECTIVE
To examine the clinical evidence that led to the disavowal of chlorhexidine antiseptic solution for use on the face and head.

METHODS AND MATERIALS
Reference searches were performed using PubMed, Embase, and LexisNexis databases without restriction to the date of publication, language, or study setting.

RESULTS
The literature revealed 11 sentinel cases of severe chlorhexidine-related keratitis in the late 1980s. These cases are reviewed together with data on ototoxicity and alternative products to understand why chlorhexidine solution should not be used on the face and scalp.

CONCLUSION
Chlorhexidine antiseptic solutions are highly effective. However, they pose a risk to the middle ear and have the potential to irreversibly damage the cornea with a minimal splash exposure. Povidone–iodine is a safe and effective alternative.
Effect of Ondansetron on QT Interval in Patients Cared for in the PICU
Authors: Trivedi Sangita , Schiltz Brenda , Kanipakam Rakesh , Bos Johan Martijn , Ackerman Michael J. , Ouellette Yves 
Published: July 2016

Objectives:
There is no evidence regarding the effect of ondansetron on the QT interval in pediatric patients in the ICU. This study aimed to describe the effect of ondansetron on the corrected QT interval in patients cared for in the PICU.

Design:
Retrospective cohort, consecutive enrollment study.

Setting:
Single-center, tertiary-level, medical/surgical PICU.

Patients:
All patients less than 8 years old who received ondansetron over an 11-month period were included. Exclusion criteria were atrial arrhythmia, bundle-branch block, known congenital long QT syndrome, and concomitant administration of proarrhythmic antiarrhythmic agents.

Interventions:
None.

Measurements and Main Results:
Overall, 210 doses of ondansetron were administered to 107 patients, with a mean age 10.5 ± 4.8 years; 49% were men. Corrected QT interval increased to 460–500 ms in 29% and to more than 500 ms in 11% of events of ondansetron administration. The mean baseline corrected QT interval even before ondansetron administration was higher for these groups (460–500 and > 500 ms; 457 ± 33 and 469 ± 45, respectively; p ≤ 0.05). In multivariate analysis, both groups were associated significantly with underlying electrolyte abnormalities (odds ratio, 2.2; 95% CI, 1.1–4.4 and odds ratio, 5.1; 95% CI, 1.8–15.7, respectively); the group with corrected QT interval more than 500 ms was also significantly associated with organ dysfunction (odds ratio, 3.2; 95% CI, 1.1–9.4). As the numbers of risk factors increased from only ondansetron to three additional QT aggravating factors (electrolyte abnormalities, administration of other QT-prolonging drugs, and organ dysfunction), the likelihood of being associated with corrected QT interval more than 500 ms increased.

Conclusions:
Prolonged QT interval is observed commonly in PICUs following the administration of ondansetron. Underlying risk factors, such as electrolyte abnormalities and organ dysfunction, seem to pose the highest risk of prolongation of QT interval in these patients. The awareness of prevalent risk factors for increased corrected QT interval may help identify patients at high risk for arrhythmias.
Changes in Condomless Sex and Serosorting Among Men Who Have Sex With Men After HIV Diagnosis
Authors: Khosropour Christine M. , Dombrowski Julia C. , Kerani Roxanne P. , Katz David A. , Barbee Lindley A. , Golden Matthew R. 
Published: July 2016

Background:
Among men who have sex with men (MSM) diagnosed with HIV, high-risk sexual behaviors may decline in the year after diagnosis. The sustainability of these changes is unknown.

Methods:
We created a retrospective cohort (Seroconversion Cohort) of MSM attending an STD clinic in Seattle, Washington who tested HIV positive between 2001 and 2013 and had a negative HIV test <2 years before diagnosis. We randomly selected 1000 HIV-negative controls (men who always tested HIV negative) who were frequency-matched to the Seroconversion Cohort based on HIV diagnosis year. 12-month sexual behavior data were collected at each clinic visit. We examined condomless anal intercourse (CAI) with HIV-negative, HIV-positive, and HIV unknown-status partners before diagnosis and up to 4 years thereafter.

Results:
Of the 26,144 clinic visits where MSM tested for HIV, there were 655 (2.5%) new HIV diagnoses. Of these, 186 (28%) men had previously tested HIV negative and were included in the Seroconversion Cohort. The proportion (of the 186) reporting CAI with HIV-negative partners declined from 73% at diagnosis to 12% after diagnosis (P < 0.001), whereas CAI with HIV-positive partners increased (11%–67%; P < 0.001). The proportion who serosorted (ie, CAI only with HIV-concordant partners) did not change before or after diagnosis (34%–40%; P = 0.65). These 3 behaviors remained stable for up to 4 years after diagnosis. Among HIV-negative controls, serosorting and CAI with HIV-positive and HIV-negative partners was constant.

Conclusions:
MSM substantially modify their sexual behavior after HIV diagnosis. These changes are sustained for several years and may reduce HIV transmission to HIV-uninfected men.
Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System: Adherence, Renal Safety, and Discontinuation
Authors: Marcus Julia L. , Hurley Leo B. , Hare Charles Bradley , Nguyen Dong Phuong , Phengrasamy Tony , Silverberg Michael J. , Stoltey Juliet E. , Volk Jonathan E. 
Published: July 2016

Background:
Placebo-controlled and open-label studies have demonstrated the safety and efficacy of daily oral preexposure prophylaxis (PrEP) in preventing HIV infection, but data are limited on real-world PrEP use.

Methods:
We conducted a cohort study from July 2012 through June 2015 of Kaiser Permanente Northern California members initiating PrEP. We assessed pharmacy refill adherence and discontinuation, decreases in estimated glomerular filtration rate (eGFR), and sexually transmitted infection (STI)/HIV incidence.

Results:
Overall, 972 individuals initiated PrEP, accumulating 850 person-years of PrEP use. Mean adherence was 92% overall. Black race/ethnicity [adjusted risk ratio (aRR) 3.0; 95% confidence interval: 1.7 to 5.1, P < 0.001], higher copayments (aRR 2.0; 1.2 to 3.3, P = 0.005), and smoking (aRR 1.6; 1.1 to 2.3, P = 0.025) were associated with <80% adherence. PrEP was discontinued by 219 (22.5%); female sex (aRR 2.6; 1.5 to 4.6, P < 0.001) and drug/alcohol abuse (aRR 1.8; 1.3 to 2.6, P = 0.002) were associated with discontinuation. Among 909 with follow-up creatinine testing, 141 (15.5%) had an eGFR <70 mL·min−1·1.73 m−2 and 5 (0.6%) stopped PrEP because of low eGFR. Quarterly STI positivity was high and increased over time for rectal chlamydia (P < 0.001) and urethral gonorrhea (P = 0.012). No HIV seroconversions occurred during PrEP use; however, 2 occurred in individuals who discontinued PrEP after losing insurance coverage.

Conclusions:
PrEP adherence was high in clinical practice, consistent with the lack of HIV seroconversions during PrEP use. Discontinuation because of renal toxicity was rare. STI screening every 6 months, as recommended by current guidelines, may be inadequate. Strategies are needed to increase PrEP access during gaps in insurance coverage.
Characterization of the Effects ofn-butanol on the cell envelope ofE. coli
Authors: Fletcher Eugene , Pilizota Teuta , Davies Philip R. , McVey Alexander , French Chris E. 
Published: July 2016

ABSTRACTBiofuel alcohols have severe consequences on the microbial hosts used in their biosynthesis, which limits the productivity of the bioconversion. The cell envelope is one of the most strongly affected structures, in particular, as the external concentration of biofuels rises during biosynthesis. Damage to the cell envelope can have severe consequences, such as impairment of transport into and out of the cell; however the nature of butanol-induced envelope damage has not been well characterized. In the present study, the effects ofn-butanol on the cell envelope ofEscherichia coliwere investigated. Using enzyme and fluorescence-based assays, we observed that 1% v/v n-butanol resulted in release of lipopolysaccharides from the outer membrane ofE. coliand caused ‘leakiness’ in both outer and inner membranes. Higher concentrations ofn-butanol, within the range of 2% – 10% (v/v), resulted in inner membrane protrusion through the peptidoglycan observed by characteristic blebs. The findings suggest that strategies for rational engineering of butanol-tolerant bacterial strains should take into account all components of the cell envelope.