bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary Hypertension in Pregnancy
Authors: Meng Marie-Louise , Landau Ruth , Viktorsdottir Olof , Banayan Jennifer , Grant Tamila , Bateman Brian , Smiley Richard , Reitman Elena 
Published: February 2017

OBJECTIVE:
To identify whether pregnancy outcomes vary by etiology and severity of pulmonary hypertension and whether contemporary therapies influence outcomes.

METHODS:
A retrospective review of medical records at four academic institutions was conducted to identify pregnant women with pulmonary hypertension (2001–2015). International Classification of Diseases, 9th Revision codes for pulmonary hypertension and pregnancy were used to identify potential participants. Medical records were abstracted for demographics, management, and outcomes. Women were classified according to the 2013 World Health Organization (WHO) pulmonary hypertension classification groups 1–5. Mild pulmonary hypertension was defined as a mean pulmonary artery pressure 25–49 mm Hg and severe pulmonary hypertension as mean pulmonary artery pressure 50 mm Hg or greater or systolic pulmonary artery pressure 70 mm Hg or greater. Descriptive statistics were used to compare outcomes.

RESULTS:
Forty-nine women were identified. Mortality rate was 16% (n=8/49); all deaths occurred postpartum, and seven of eight deaths occurred in women with WHO group 1 pulmonary hypertension (mortality rate 23%, n=7/30). Of the women who had documented live births with known mode of delivery (n=41), mortality was 4 of 22 among women with severe pulmonary hypertension and 1 of 19 among women with mild pulmonary hypertension. Mortality among women who delivered by cesarean was 4 of 22 and was 1 of 19 among women who delivered vaginally. Neuraxial anesthesia was performed in 20 of 22 cesarean and 17 of 19 vaginal deliveries with no anesthesia-related adverse events. Women with severe pulmonary hypertension needed more advanced therapies such as inotropes, pulmonary vasodilators, and extracorporeal membrane oxygenation than did women with mild pulmonary hypertension, 19 of 26 compared with 7 of 22. Preterm delivery was more common in women with severe compared with mild pulmonary hypertension, 19 of 23 compared with 8 of 17. There was one 25-week intrauterine fetal demise, but no neonatal deaths.

CONCLUSION:
In this large series of pulmonary hypertension in pregnancy, mortality remained high despite advanced therapies. Maternal mortality was specific to WHO group 1 pulmonary hypertension and possibly associated with severe pulmonary hypertension. In selected patients with a favorable prognosis for vaginal birth, a trial of labor can be considered.
Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis
Authors: Boggess Kim A. , Tita Alan , Jauk Victoria , Saade George , Longo Sherri , Clark Erin A. S. , Esplin Sean , Cleary Kristin , Wapner Ronald , Letson Kelli , Owens Michelle , Blackwell Sean , Beamon Carmen , Szychowski Jeffrey M. , Andrews William ,   for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium
Published: February 2017

OBJECTIVE:
To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis.

METHODS:
We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection.

RESULTS:
Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race–ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3–0.6).

CONCLUSION:
Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, https://clinicaltrials.gov, NCT012235546.
Automated Bone Screw Tightening to Adaptive Levels of Stripping Torque
Authors: Reynolds Karen J. , Mohtar Aaron A. , Cleek Tammy M. , Ryan Melissa K. , Hearn Trevor C. 
Published: February 2017

Objective:
To use relationships between tightening parameters, related to bone quality, to develop an automated system that determines and controls the level of screw tightening.

Methods:
An algorithm relating current at head contact (IHC) to current at construct failure (Imax) was developed. The algorithm was used to trigger cessation of screw insertion at a predefined tightening level, in real time, between head contact and maximum current. The ability of the device to stop at the predefined level was assessed.

Results:
The mean (±SD) current at which screw insertion ceased was calculated to be [51.47 ± 9.75% × (Imax − IHC)] + IHC, with no premature bone failures.

Conclusions:
A smart screwdriver was developed that uses the current from the motor driving the screw to predict the current at which the screw will strip the bone threads. The device was implemented and was able to achieve motor shut-off and cease tightening at a predefined threshold, with no premature bone failures.
Safety and Accuracy of Freehand Versus Navigated Iliac Screws
Authors: Hlubek Randall J. , Almefty Kaith K. , Xu David S. , Turner Jay D. , Kakarla Udaya Kumar 
Published: February 2017

Study Design.
Retrospective review.

Objective.
To compare the safety and accuracy of the freehand technique versus stereotactic navigation for placement of iliac screws.

Summary of Background Data.
Iliac screw fixation is often used to augment lumbosacral reconstruction in advanced spine disease to increase the likelihood of successful arthrodesis. Iliac screws can be placed with image guidance, using either intraoperative fluoroscopy or computed tomography (CT) to guide navigation. However, these imaging modalities add radiation exposure and can disrupt workflow. The freehand technique is an alternative strategy that decreases radiation exposure and workflow disruption but may compromise safety and accuracy.

Methods.
A retrospective review was performed for a consecutive series of adult patients with degenerative spine conditions who underwent posterior reconstruction with iliac screw placement between 2011 and 2016. Clinical and radiographic data were collected and analyzed. The accuracy of iliac screw placement was determined with either intraoperative/postoperative CT imaging or anteroposterior/lateral radiography when CT was not performed.

Results.
Bilateral iliac screws were placed in all 111 patients, for a total of 222 iliac screws. Eighty screws were placed with the freehand technique and 142 with the intraoperative navigation technique. CT imaging was used to assess placement accuracy of 124 screws (46 freehand [37%], 78 navigated [63%]). Accuracy was similar for the freehand group (89%, 41/46) and the navigated group (96%, 75/78) (P = 0.12). For patients without intraoperative/postoperative CT imaging, radiography was used to assess placement accuracy of 98 screws (34 freehand, 64 navigated) and the placement accuracy rate for the freehand group (100%, 34/34) was comparable to that for the navigated group (98%, 63/64) (P = 0.46). No complications attributable to iliac screw placement occurred in either group.

Conclusion.
Overall, there was no difference in the safety and accuracy between the freehand and navigated techniques.

Level of Evidence: 4
A Modified Dual-plane Technique Using the Serratus Anterior Fascia in Primary Breast Augmentation
Authors: Hwang Dong Yeon , Park Sang Hoon , Kim Sang Wha 
Published: February 2017

Background:
Breast augmentations are commonly performed aesthetic surgical procedures. As the breast is a changeable structure, the ideal location of an implant would be a plane that can adjust to the dynamic changes of the breast. We present a modified dual-plane technique for breast augmentation using the fascia for thin patients.

Methods:
Between June 2014 and June 2015, 27 patients with small breasts underwent breast augmentation using the modified dual-plane technique. The average age was 29.4 years (range, 20–41 y). The mean body mass index was 18.9 kg/m2 (range, 17.6–20.4 kg/m2).

Results:
The mean size of the implant was 288.9 ml (range, 255–360 ml) on the right side and 281.6 ml (range, 255–360 ml) on the left side. All the patients returned to daily-life activities within 1 week. There have been no complications during minimum follow-up periods of 18 months. The mean follow-up was 25.6 months (range, 18–36 mo).

Conclusions:
Visible, palpable implants and rippling after breast augmentation with implants are relatively common problems. Our modified dual-plane technique with the serratus anterior fascia can reduce visible rippling and yields a natural-looking breast, especially in thin patients.
The Telemark Breast Score: a Valid Method for Evaluation of Outcome after Breast Surgery
Authors: Begic Anadi , Stark Birgit 
Published: February 2017

Background:
“Telemark Breast Score” (TBS) has been developed at Telemark Hospital in Norway for evaluation of results after breast surgery based on standardized patients’ photographs taken as a part of daily routine. Its reliability has recently been tested and approved. The external validity of the TBS was assessed by matching its data against the internationally recognized Breast-Q (BQ) questionnaire as a further step to study the validity of this new tool.

Methods:
The ideal distribution of breast volume is 45% of the total volume above and 55% below the nipple, and a 40° slope line at the upper pole. TBS makes the evaluation of these parameters of breast aesthetics more explicit. The method has been tested on photographs from 31 patients operated on for breast cancer with the Deep Inferior Perforator Flap. The evaluation was done by an independent experienced plastic surgeon earlier participating in the test–retests. The external validity of TBS was investigated against domains 1 and 3 of the BQ reconstruction module. The concordance between ratings was analyzed.

Results:
Concordance between TBS items and BQ domain 1 items regarding patient satisfaction, and between TBS items and BQ domain 3 items regarding how the patient experienced the outcome of breast reconstruction was relatively high except for 6 comparisons where we could not statistically ensure that more pairs were concordant than discordant. A total of 178 comparisons appeared to be concordant. This means that for all other comparisons, there was a preponderance of pairs of concordant observations, which indicates that measurements from the 2 instruments follow each other.

Conclusion:
The present data indicate that the TBS can be recommended as a valid tool to professionals for assessment of the outcome after breast reconstruction.
Functional and Aesthetic Thorax Reconstruction after Desmoid Tumor Resection
Authors: Olvera-Caballero Carlos , Acosta-Ponce de Leon Eric , Sanchez-Sosa Sergio 
Published: February 2017

Summary:This study describes a case report of a 31-year-old patient who presented with a left thoracic tumor on costal cartilages 5 and 6 that was diagnosed as a desmoid tumor 3 years after receiving retropectoral breast implants for cosmetic reasons. The integral reconstruction of the thoracic wall, functional and aesthetic, was planned for a single surgical period. The defect secondary to the tumor resection, which left the pericardium and lung exposed, was closed using the pectoral muscle as a “pre-expanded” flap by the breast implant, and the breast aesthetic was treated bilaterally with new implants in the retromammary position. After 12 months, the patient remained free from tumor recurrence and had a satisfactory aesthetic result.
Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use
Authors: Odell Annie P. , Reynolds Grace L. , Fisher Dennis G. , Huckabay Loucine M. , Pedersen William C. , Xandre Pamela , Miočević Milica 
Published: February 2017

Abstract
This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.
Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center
Authors: Schechter Sarah B. , Romo Dina L. , Cohall Alwyn T. , Neu Natalie M. 
Published: February 2017

Background and Objectives
Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center.

Methods
Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ2 analyses were used to assess association between STI testing, chief complaint, and sexual history.

Results
Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01).

Discussion
Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs.
Haemophilus influenzae Isolated From Men With Acute Urethritis: Its Pathogenic Roles, Responses to Antimicrobial Chemotherapies, and Antimicrobial Susceptibilities
Authors: Ito Shin , Hatazaki Kyoko , Shimuta Ken , Kondo Hiromi , Mizutani Kosuke , Yasuda Mitsuru , Nakane Keita , Tsuchiya Tomohiro , Yokoi Shigeaki , Nakano Masahiro , Ohinishi Makoto , Deguchi Takashi 
Published: February 2017

Background
There have been few comprehensive studies on Haemophilus influenza–positive urethritis.

Methods
In this retrospective study, we enrolled 68 men with H. influenzae–positive urethritis, including coinfections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or genital mycoplasmas: 2, 3, 20, and 43 treated with ceftriaxone, levofloxacin, sitafloxacin, and extended-release azithromycin (azithromycin-SR), respectively. We assessed microbiological outcomes in 54 men and clinical outcomes in 46 with H. influenzae–positive monomicrobial nongonococcal urethritis. We determined minimum inhibitory concentrations (MICs) of 6 antimicrobial agents for 59 pretreatment isolates.

Results

H. influenzae was eradicated from the men treated with ceftriaxone, levofloxacin, or sitafloxacin. The eradication rate with azithromycin-SR was 85.3%. The disappearance or alleviation of urethritis symptoms and the decreases in leukocyte counts in first-voided urine were significantly associated with the eradication of H. influenzae after treatment. For the isolates, ceftriaxone, levofloxacin, sitafloxacin, azithromycin, tetracycline, and doxycycline MICs were ≤0.008–0.25, 0.008–0.5, 0.001–0.008, 0.12–1, 0.25–16, and 0.25–2 μg/mL, respectively. The azithromycin MICs for 3 of 4 strains persisting after azithromycin-SR administration were 1 μg/mL. H. influenzae with an azithromycin MIC of 1 μg/mL increased chronologically.

Conclusions

H. influenzae showed good responses to the chemotherapies for urethritis. The significant associations of the clinical outcomes of the chemotherapies with their microbiological outcomes suggested that H. influenzae could play pathogenic roles in urethritis. All isolates, except for one with decreased susceptibility to tetracyclines, were susceptible to the examined agents. However, the increase in H. influenzae with an azithromycin MIC of 1 μg/mL might threaten efficacies of azithromycin regimens on H. influenzae–positive urethritis.
Faster and Riskier? Online Context of Sex Seeking Among Men Who Have Sex With Men in China
Authors: Cao Bolin , Liu Chuncheng , Stein Gabriella , Tang Weiming , Best John , Zhang Ye , Yang Bin , Huang Shujie , Wei Chongyi , Tucker Joseph D. 
Published: February 2017

Background
Many men who have sex with men (MSM) seek sex partners online, creating barriers and opportunities for human immunodeficiency virus prevention. The purpose of this study was to examine the characteristics of MSM and the risks associated with seeking sex through websites, gay apps, and both platforms in China.

Methods
Data were collected through a cross-sectional online survey from September through October 2014 from 3 large gay Web portals. Sociodemographic information, sexual behaviors, and online sex seeking behaviors were measured. Multinomial logistic regression was performed to compare sexual risk behaviors among website users, gay app users, and men who used both platforms.

Results
Of the 1201 participants, 377 (31.4%) were website-only users, 487 (40.5%) were gay app-only users, and 337 (28.0%) were men who used both platforms. These 3 MSM subgroups have distinct sociodemographic characteristics. Overall, 57.6% of participants reported having engaged in condomless anal sex with their last male partner in the past 6 months, but there was no significant difference in condomless sex between the 3 groups. Men who used both platforms viewed more sexually transmitted disease-related messages than website-only users (adjusted odds ratio, 2.19; 95% confidence interval, 1.57–3.05).

Conclusions
Condom usage behaviors were unaffected by the medium through which sexual partners were found. However, the high frequency of condomless sex suggests that websites and gay apps are both risk environments. This study suggests using multiple platforms for human immunodeficiency virus/sexually transmitted disease social media interventions may be useful.
Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases
Authors: Leeyaphan Charussri , Ong Jason J. , Chow Eric P.F. , Dimovski Karolina , Kong Fabian Y.S. , Hocking Jane S. , Howden Ben , Bissessor Melanie , Fairley Christopher K. , Bradshaw Catriona , Read Timothy , Chen Marcus 
Published: February 2017

Abstract
Background: Treatment for rectal lymphogranuloma venereum where doxycycline 100 mg twice daily for 21 days was used—either alone or together with azithromycin 1 g single dose—resulted in microbiological cure of 97%. These data support doxycycline 100 mg twice daily for 21 days as the preferred treatment for rectal lymphogranuloma venereum.
Benefits and Potential Harms of Human Immunodeficiency Virus Self-Testing Among Men Who Have Sex With Men in China: An Implementation Perspective
Authors: Qin Yilu , Tang Weiming , Nowacki Amy , Mollan Katie , Reifeis Sarah A. , Hudgens Michael G. , Wong Ngai-Sze , Li Haochu , Tucker Joseph D. , Wei Chongyi 
Published: February 2017

Background
Human immunodeficiency virus self-testing (HIVST) holds great promise for reaching high-risk key populations who do not access facility-based services. We sought to characterize unsupervised HIVST implementation among men who have sex with men in China.

Methods
We conducted a nationwide online survey in China. Eligible men were at least 16 years, had anal sex with a man, and had recent condomless sex. We assessed benefits (first-time testing, increased testing frequency, confirmatory testing) and potential harms (coercion, violence, suicidality) of HIVST. Among men who have sex with men who reported ever testing for human immunodeficiency virus (HIV), we identified correlates of HIVST as first-time HIV test being a self-test using multivariable logistic regression.

Results
Among 1610 men who met the eligibility criteria and started the survey, 1189 (74%) completed it. Three hundred forty-one (29%) of 1189 reported ever self-testing for HIV. Human immunodeficiency virus prevalence was 7% (24/341) among self-testers and 5% (15/306) among non–self-testers. Two hundred (59%) of 341 men who self-tested reported HIVST as a first-time HIV test. Thirty-one (9%) men experienced coercion with HIVST. Thirty-one (78%) of 40 men with positive HIV self-tests sought confirmation. Multivariable analysis revealed that HIVST as first-time HIV test was associated with younger age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92–0.99), not being “out” (OR, 2.28; 95% CI, 1.60–3.28), not using the internet to meet sex partners (OR, 0.39; 95% CI, 0.22–0.69), and group sex (OR, 1.74; 95% CI, 1.02–2.9).

Conclusions
Human immunodeficiency virus self-testing reached high-risk individuals that had never received facility-based testing. Further implementation research is needed to better understand HIVST outside of research programs.