bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada
Authors: Bocking Natalie , Matsumoto Cai-lei , Loewen Kassandra , Teatero Sarah , Marchand-Austin Alex , Gordon Janet , Fittipaldi Nahuel , McGeer Allison 
Published: December 2016

AbstractBackgroundWorldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.MethodsIndividuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.ResultsSixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different emm types were identified among 42 isolates, with the most common being emm114 (17.4%), emm11 (15.2%), and emm118 (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.ConclusionsRural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of emm types included in candidate GAS vaccines.
Estimation of Mycophenolic Acid Area Under the Curve With Limited-Sampling Strategy in Chinese Renal Transplant Recipients Receiving Enteric-Coated Mycophenolate Sodium
Authors: Jia Yichen , Peng Bo , Li Long , Wang Jina , Wang Xuanchuan , Qi Guisheng , Rong Ruiming , Wang Liming , Qiu Jianxin , Xu Ming , Zhu Tongyu 
Published: December 2016

Background:
The enteric-coated mycophenolate sodium (EC-MPS), whose active constituent is mycophenolic acid (MPA), has been widely clinically used for organ transplant recipients. However, its absorption is delayed due to its special designed dosage form, which results in difficulty to monitor the exposure of the MPA in patients receiving the EC-MPS. This study was aimed at developing a relatively practical and precise model with limited sampling strategy to estimate the 12-hour area under the concentration–time curve (AUC0–12 h) of MPA for Chinese renal transplant recipients receiving EC-MPS.

Methods:
A total of 36 Chinese renal transplant recipients receiving the EC-MPS and tacrolimus were recruited in this study. The time point was 2 weeks after the transplantation for all the patients. The MPA concentrations were measured with enzyme-multiplied immunoassay technique for 11 blood specimens collected predose and at 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, and 12 hours after the morning dose of EC-MPS. The measured AUC was calculated with these 11 points of MPA concentrations with the linear trapezoidal rule. Limited sampling strategy was used to develop models for estimated AUC in the model group (n = 18). The bias and precision of different models were evaluated in the validation group (n = 18).

Results:
C4 showed the strongest correlation with the measured AUC. The best 3 time point equation was 6.629 + 8.029 × C0 + 0.592 × C3 + 1.786 × C4 (R
2 = 0.910; P < 0.001), whereas the best 4 time point equation was 3.132 + 5.337 × C0 + 0.735 × C3 + 1.783 × C4 + 3.065 × C8 (R
2 = 0.959; P < 0.001). When evaluated in the validation group, the 4 time point model had a much better performance than the 3 time point model: for the 4 time point model: R
2 = 0.873, bias = 0.505 [95% confidence interval (CI), −10.159 to 11.170], precision = 13.370 (95% CI, 5.186–21.555), and 77.8% of estimated AUCs was within 85%–115% of the measured AUCs; for the 3 time point model: R
2 = 0.573, bias = 6.196 (95% CI, −10.627 to 23.018), precision = 21.286 (95% CI, 8.079–34.492), and 50.0% of estimated AUCs was within 85%–115% of the measured AUCs.

Conclusions:
It demanded at least 4 time points to develop a relatively reliable model to estimate the exposure of MPA in renal transplant recipients receiving the EC-MPS. The long time span needed restricted its application, especially for the outpatients, but it could be a useful tool to guide the personalized prescription for the inpatients.
Detection of Hydrocodone and Morphine as Metabolites in Oral Fluid by LC-MS/MS in Patients Prescribed Codeine
Authors: West Robert E. , Guevara Maria G. , Mikel Charles , Gamez Ruben 
Published: December 2016

Abstract:
A retrospective analysis of oral fluid drug testing results using LC-MS/MS was performed to determine the prevalence rates in oral fluid for codeine (COD) and 3 COD metabolites—morphine (MOR), norhydrocodone (NHC), and hydrocodone (HCOD). Oral fluid samples were collected using Quantisal oral fluid collection device (Immunalysis Inc.) and submitted to Millennium Health, LLC for the routine drug analysis by LC-MS/MS. Consistent with previously published literature, COD was the primary analyte detected in oral fluid after the use of COD. In COD-positive samples, HCOD, MOR, and NHC were detected at rates of 68.4%, 18.4%, and 6.3%, respectively. Concentration ranges of these analytes were 1.0 to >2000 ng/mL for COD, 1.0–20.2 ng/mL for MOR, 1.0–740.0 ng/mL for HCOD, and 2.1–47.5 ng/mL for NHC. In contrast to urine, where HCOD is typically detected as a minor metabolite of COD, HCOD was the most commonly detected metabolite in oral fluid in samples testing positive for COD with reported prescriptions for COD. This observation suggests that care should be taken when interpreting HCOD positives in oral fluid results, and that the use of COD should be considered as one possible explanation for HCOD positives.
Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus
Authors: Sundaram Hema , Huang Po-Han , Hsu Nai-Jen , Huh Chang Hun , Wu Woffles T.L. , Wu Yan , Cassuto Daniel , Kerscher Martina J. , Seo Kyle Koo-Il 
Published: December 2016

Background:
Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA.

Methods:
A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed.

Results:
For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A (“mesotoxin”), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation.

Conclusions:
This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations.
Management of a Complex Excoriation Disorder–induced Wound with a Viable Cryopreserved Placental Membrane
Authors: Bain Michael A. , Vincent Jennifer 
Published: December 2016

Summary:
Excoriation disorder (ED), also known as dermatotillomania, is a condition characterized by repeated “skin picking” that leads to the formation of skin lesions. Because of the similarity of its symptoms to obsessive compulsive disorder, ED is classified as a subcategory of obsessive compulsive disorder by Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Although the majority of the self-inflicted wounds are not clinically significant, many wounds lead to social and occupational dysfunction by becoming infected, chronic, and life threatening. This report describes the successful use of a viable intact cryopreserved human amniotic membrane in conjunction with selective serotonin re-uptake inhibitors in treating an ED patient who presented with a large calvarial wound of 3-year duration that had failed previous extensive medical and surgical interventions.
OCULAR MANIFESTATIONS AND TREATMENT OUTCOMES IN CHINESE PATIENTS WITH POEMS SYNDROME
Authors: Zhang Xiao , Cai Qian-qian , Huang Xu-fei , Cao Xin-xin , Cai Hao , Zhou Dao-bin , Dai Rong-ping , Li Jian 
Published: December 2016

Purpose:
To evaluate the relationship of serum vascular endothelial growth factor (VEGF) levels and ocular manifestations in Chinese patients with POEMS syndrome.

Methods:
This is a prospective study. Forty-one treatment-naive patients were enrolled from April 2014 to November 2014. Among the 41 patients, 40 had complete ocular examination, spectral domain optical coherence tomography scan, and serum VEGF measurement before treatment and every 3-month interval after lenalidomide and dexamethasone treatment.

Results:
Twenty-seven (67.5%) patients had optic disk edema (ODE) at baseline. Retinal manifestations included retinal hemorrhage, subretinal fluid, macular edema, and cotton wool spot. The difference in mean serum VEGF concentrations between patients with and without ODE was significant (P = 0.017). Among patients with ODE, there was a significant positive correlation between mean serum VEGF levels and the binocular mean retinal nerve fiber layer thickness (P = 0.008), as well as mean peripapillary retinal thickness (P = 0.020) before treatment. After 3 months to 17 months treatment, mean serum VEGF concentrations decreased significantly (P < 0.001). Mean retinal nerve fiber layer thickness and mean peripapillary retinal thickness decreased significantly (P < 0.001). The remission rate of ODE was 87.5%, and complete remission rate was 58.3%.

Conclusion:
The ODE is a common manifestation in POEMS syndrome, and raised VEGF might explain the development and mechanism. Systemic treatment could lead to decrease in serum VEGF levels accompanied by regression of ODE.
OCCULT GLOBE PERFORATION DURING MEDIAL CANTHOPEXY
Authors: Manjunath Deepa , Kaiser Peter K. , Ehlers Justis P. 
Published: December 2016

Purpose:
To report a case of occult globe perforation following craniofacial surgery.

Methods:
A 16-year-old girl presented with vision loss and hypotony of her left eye following a craniofacial procedure, including bilateral medial canthopexy. This report describes the evaluation and findings following the craniofacial surgery.

Results:
After recognition of vision loss and concern for rupture, surgical exploration was performed by an ophthalmologist at an outside institution on suspicion of globe penetration/perforation. Surgical exploration did not identify any scleral entry/exit sites. She was then referred for vitreoretinal consultation. Serous choroidal detachments and associated retinal detachment were identified on ultrasound. The patient was maintained on her postoperative oral antibiotics and followed closely. As the intraocular pressure improved, the choroidals began to resolve. Two retinal break sites were identified on opposite sides of the globe in the retinal periphery. Laser retinopexy was performed at the two penetration sites. The patient recovered excellent vision without any additional complications.

Conclusion:
Early recognition and high suspicion of globe injury is critical in cases of postoperative vision loss following craniofacial surgery.
SELF-PEELING EPIRETINAL MEMBRANE
Authors: Ozgonul Cem , Besirli Cagri G. 
Published: December 2016

Purpose:
To present a self-peeling epiretinal membrane (ERM) in a patient with spontaneously improved retinal capillary hemangioma in the left eye.

Methods:
The authors demonstrate the improvement of an untreated retinal capillary hemangioma and resolution of ERM with fundus photography, fluorescein angiography, and spectral domain optical coherence tomography. Genetic testing excluded von Hippel–Lindau disease in this patient.

Results:
Evaluation of a patient with rheumatoid arthritis revealed retinal capillary hemangioma with retinal exudates at the temporal peripheral fundus and an ERM in the left eye. Patient was asymptomatic and elected observation. Three years after the initial examination, visual acuity and macular appearance improved after spontaneous resolution of the ERM. Capillary hemangioma was smaller and retinal exudates resolved without treatment.

Conclusion:
This case report demonstrates a self-peeling ERM associated with a retinal capillary hemangioma. This case contributes the literature describing the natural history of ERMs associated with peripherally located capillary hemangiomas in patients without von Hippel–Lindau disease.
Excimer Laser Versus Phakic Intraocular Lenses for Myopia and Astigmatism: A Meta-Analysis of Randomized Controlled Trials
Authors: Chen Haiting , Liu Yu , Niu Guangzeng , Ma Jingxue 
Published: December 2016

Objective:
Meta-analysis of randomized controlled trials (RCTs) which compared excimer laser refractive surgery and phakic intraocular lenses (PIOLs) for the treatment of myopia and astigmatism.

Methods:
An electronic literature search was performed using the PubMed, EBSCO, CNKI, and Cochrane Library database to identify prospective RCTs which compared excimer laser refractive surgery and PIOL with a follow-up time of at least 12 months. Efficacy, accuracy, safety outcomes, and complications were analyzed by standardized mean difference, risk ratio, and the pooled estimates according to a fixed effect model or random effect model.

Results:
This review included 5 RCTs with a sum of 405 eyes. The range of myopia was 6.0 to 20.0 D with up to 4.0 D of astigmatism. The PIOL group was more likely to achieve a spherical equivalence within±1.0 D of target refraction at 12 months postoperatively (P=0.009), and was less likely to lose one or more lines of best spectacle corrected visual acuity than the LASER group (P=0.002). On the whole, there is no significant difference in efficacy and complications between the two kinds of surgeries.

Conclusions:
This meta-analysis indicated that PIOLs were safer and more accurate within 12 months of follow-up compared with excimer laser surgical for refractive errors.
Effect of Rivastigmine Augmentation in Treatment of Male Patients With Combat-Related Chronic Posttraumatic Stress Disorder
Authors: Rezaei Ardani Amir , Hosseini Golkoo , Fayyazi Bordbar Mohammad Reza , Talaei Ali , Mostafavi Toroghi Hesam 
Published: December 2016

Abstract

Background
Posttraumatic stress disorder (PTSD) is one of the chronic and disabling psychiatric disorders, particularly in combat veterans. In a case series, rivastigmine was suggested to be an effective augmentation in treatment of PTSD. The aim of the present study was to evaluate this finding in a randomized controlled trial.

Method
A 12-week, double-blind, placebo-controlled clinical trial was performed on 36 male patients (aged 42–60 years) diagnosed with chronic, combat-related PTSD. Subjects were screened for apparent cognitive deficits by means of Mini-Mental State Examination. All patients received selective serotonin reuptake inhibitors plus sodium valproate for 4 weeks and then reevaluated. Subjects who did not show adequate response were randomly assigned into 3 groups receiving rivastigmine (up to 6 mg/d), placebo, or the prior treatment regimen. Efficacy of medication was measured by administering PTSD Check List–Military Version at baseline and weeks 2, 4, 8, and 12. Collected data were analyzed by analysis of variance and repeated measurement. Reported differences were considered significant at the level of 0.05 or less.

Results
The 3 groups showed statistically significant reductions in the total PTSD Check List–Military Version, avoidance subscale, and the reexperience subscale but not in the hyperarousal subscale. No significant differences were found between the 3 groups.

Conclusions
In contrast to the previous case series, findings of the current study did not support the efficacy of adjunctive rivastigmine in treatment of PTSD. This hypothetically could be due to the fact that all the study's subjects scored higher than 25 on Mini-Mental State Examination.
Necrobiosis Lipoidica
Authors: Leigh Katherine , Miller Barbara , Mason Shawna M. , Armstrong Brittney 
Published: December 2016

ABSTRACT
Necrobiosis lipoidica (NL) is a rare skin disorder that occurs more frequently among diabetic patients than the general population. The etiology is unknown for this disfiguring chronic condition. Typically, patients present with well-circumscribed papules and nodules with telangiectasias developing beneath the epidermis. It is estimated that 30% of lesions are induced by trauma. There are no specific laboratory tests required to establish the diagnosis of NL. Clinical management is challenging. The mainstay of treatment is topical steroids, intralesional steroids, immunosuppressants, platelet inhibitors, and phototherapy. Other options available include photodynamic therapy, hyperbaric oxygen, and CO2 laser. The cosmetic outcome for this disorder is poor, which can lead to other conditions such as depression. Long-term compliance is necessary for improved patient outcomes. Providers should stay abreast of available treatment options and individualized patient care support to assist in managing NL.
Medical Simulation Technology
Authors: Montgomery Jennifer 
Published: December 2016

Abstract
Medical simulation technology as a whole allows the clinical situation to be better understood, controlled, and practiced and is a reproduction of reality that provides a replication of clinical situations through the use of interactive videos, mannequins, and role playing (Cannon-Diehl, 2009). With the use of medical simulation technology, learners are able to practice skills and role-play different scenarios without causing harm to a patient, thus lessening stressful experiences during similar real-life situations (Hebda & Czar, 2013). This practice helps to improve the quality of care given to patients and, in turn, helps to save lives. Simulation also leads to increased confidence and skills of participants.
With an ever increasing importance placed on patient outcomes in regard to reimbursement from insurance companies and the Centers for Medicare & Medicaid Services, it is the responsibility of all medical professionals to perform at peak levels during all patient care situations, especially during emergent ones. This harkens back to both the Hippocratic Oath and the Nightingale Pledge in which respondents promise to practice to the best of their abilities and keep the patient's best interest in mind (American Nurses Association, 2012). The opportunity to participate in simulation allows these oaths to be upheld and patients to be cared for by practitioners who are comfortable conducting themselves appropriately and competently within high-stress situations.
Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment
Authors: Nellis Jason C. , Sharon Jeff D. , Pross Seth E. , Ishii Lisa E. , Ishii Masaru , Dey Jacob K. , Francis Howard W. 
Published: December 2016

Objective:To identify factors associated with treatment modality selection in acoustic neuromas.Study Design:Prospective observational study.Setting:Tertiary care neurotology clinic.Patients:Data were prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have magnetic resonance imaging (MRI), demographic, psychometric, or audiometric data were excluded from analysis.Intervention:Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis.Main Outcome Measure:The decision to pursue acoustic neuroma surgical resection versus active surveillance.Results:A total of 216 patients with acoustic neuroma (mean age 55 years, 58% women) were included. Ninety eight patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age less than 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache, and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p < 0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (odds ratio [OR] 0.19; 0.05–0.69) and increased in patients with medium (OR 4.34; 1.36–13.81), moderately large (OR 33.47; 5.72–195.83), large grade tumors (OR 56.63; 4.02–518.93), tumor growth present (OR 4.51; 1.66–12.28), Class D hearing (OR 3.96; 1.29–12.16), and higher headache severity scores (OR 1.03; 95% confidence interval [CI] 1.01–1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing.Conclusions:Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.