bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstructing Discontinuous Facial Defects with Simultaneous Ulnar Perforator Free Flaps
Authors: Thomas Carissa M. , Sokoya Mofiyinfolu , Deleyiannis Frederic W.-B. 
Published: April 2017

Summary:
Multiple, simultaneous skin cancers of the face are common. This is the first description of reconstructing discontinuous facial defects (i.e., separate sites of the face) with simultaneous ulnar perforator flaps. The distinct innovations of this multiple flap design are the ability to restrict the harvest site to one extremity, to obtain vein and arterial grafts from the same extremity, and to create multiple flaps with minimal hirsutism and bulk. We present a case of a 57-year-old male with multiple basal cell carcinomas who underwent wide local excisions of the right upper lip and cheek and of the left lower eyelid and infraorbital cheek. Two left-sided ulnar perforator free flaps were used for reconstruction with the outcome of normal oral competence and eyelid function. When faced with discontinuous facial defects, reconstruction with simultaneous ulnar perforator flaps is a useful option because of the advantages of matching the thinness and pliability of the resected skin, reducing the number of harvest sites and preventing the distortion and contraction that can be seen with local advancement flaps or skin grafts.
Rab7—a novel redox target that modulates inflammatory pain processing
Authors: Kallenborn-Gerhardt Wiebke , Möser Christine V. , Lorenz Jana E. , Steger Mirco , Heidler Juliana , Scheving Reynir , Petersen Jonas , Kennel Lea , Flauaus Cathrin , Lu Ruirui , Edinger Aimee L. , Tegeder Irmgard , Geisslinger Gerd , Heide Heinrich , Wittig Ilka , Schmidtko Achim 
Published: April 2017

Abstract
Chronic pain is accompanied by production of reactive oxygen species (ROS) in various cells that are important for nociceptive processing. Recent data indicate that ROS can trigger specific redox-dependent signaling processes, but the molecular targets of ROS signaling in the nociceptive system remain largely elusive. Here, we performed a proteome screen for pain-dependent redox regulation using an OxICAT approach, thereby identifying the small GTPase Rab7 as a redox-modified target during inflammatory pain in mice. Prevention of Rab7 oxidation by replacement of the redox-sensing thiols modulates its GTPase activity. Immunofluorescence studies revealed Rab7 expression to be enriched in central terminals of sensory neurons. Knockout mice lacking Rab7 in sensory neurons showed normal responses to noxious thermal and mechanical stimuli; however, their pain behavior during inflammatory pain and in response to ROS donors was reduced. The data suggest that redox-dependent changes in Rab7 activity modulate inflammatory pain sensitivity.
Calculating the Tumor Volumes in Vestibular Schwannomas: Are the ABC/2 and Volumetric Methods Comparable?
Authors: Bathla Girish , Policeni Bruno , Hansen Marlan R. , Berbaum Kevin 
Published: April 2017

Purpose:
To assess the efficacy of the ABC/2 method for calculating the volume of vestibular schwannomas as compared with 3-D planimetric method.

Study Design:
Retrospective.

Methods:
Fifty eight cases of pathologically confirmed sporadic vestibular schwannomas (VS) were analyzed. Tumors volumes were calculated for each tumor twice, once through semiautomated 3-D volumetric method and subsequently through ABC/2 (AP × ML × CC/2) methodology after calculating the maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions. Tumor volumes were initially correlated as a group and subsequently by dividing them into three groups using the Hannover classification.

Results:
The two methodologies were highly correlated when tumors were analyzed as a group (rho = 0.913, p < 0.0001). In the sub-group analysis, tumor volumes were again strongly correlated for larger tumors (rho = 0.918, p < 0.0001) but the correlation progressively reduced as tumor volumes decreased.

Conclusion:
Given the ease and universal accessibility of linear measurement applications, the ABC/2 methodology is a robust substitute for calculating tumor volumes, especially for larger tumors.
Cardiopulmonary monitoring of shock
Authors: Simmons James , Ventetuolo Corey E. 
Published: April 2017

Purpose of review
We will briefly review the classification of shock and the hallmark features of each subtype. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls, and practical considerations of each method.

Recent findings
As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and noninvasive tests such as passive leg raising have gained popularity. Newer forms of minimally invasive or noninvasive monitoring (such as pulse contour analysis and chest bioreactance) show promise but will need further investigation before they are considered validated for practical use. There remains no ‘ideal’ test or standard of care for cardiopulmonary monitoring of shock patients.

Summary
Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should be based on institutional expertise.
EBM vs. EBM: combining evidence-based and experienced-based medicine in resuscitation research
Authors: Pepe Paul E. , Aufderheide Tom P. 
Published: April 2017

Purpose of review
To discuss the clear rationale for evidence-based medicine (EvBM) in the challenging realms of resuscitation research, yet also provide case examples in which even the well designed, multicentered randomized clinical trial may have had unrecognized limitations, and thus misleading results. This is where experienced-based medicine (ExBM) helps to resolve the issue.

Recent findings
Recent publications have brought to task the conclusions drawn from various clinical trials of resuscitative interventions. These articles have indicated that some major clinical trials that later determined the universal guidelines for resuscitative protocols may have been affected by unrecognized confounding variables, effect modifiers and other problems such as delayed timing. Many interventions, deemed to be ineffective because of these study factors, may actually have lifesaving effects that would have been confirmed had the proper circumstances been in place. With the right mindset, the clinician-researcher can often identify and address those situations.

Summary
When clinical trials indicate ineffectiveness of an intervention that worked very well in other circumstances, both preclinical and clinical, clinician-investigators should continue to re-search the issues and not always take conclusions at face value.
Ultrasound‐guided Liver Biopsies in Children
Authors: Bilreiro Carlos , Noruegas Maria J. , Gonçalves Isabel , Moreira Ângela 
Published: April 2017

ABSTRACTObjectives:The aim of the study was to analyze the institution's experience in ultrasound‐guided liver biopsies performed on children and identify risk factors for complications, following a previous study performed in our institution.Methods:Retrospective analysis of a consecutive series of ultrasound‐guided pediatric liver biopsies, between 2011 and 2016. Demographic and anthropometric data, biopsy indications, international normalized ratio (INR) and platelet count, biopsy technique, complications, and pathologic outcomes were recorded.Results:A total of 228 procedures were performed on 203 children with a median age of 9.25 years (range: 0.08–18.42): 107 girls (47%) and 121 boys (53%). One hundred twenty‐seven biopsies were performed on transplanted livers (55.7%) and 101 on native livers (44.3%). There were 27 cases with immediate complications (11.84%), all due to minor bleeding. There were no major complications. Increasing needle passes were shown to be a reliable predictor for bleeding (P = 0.0023), whereas transplanted livers predicted protection against bleeding (P = 0.0007). Age younger than 3 years, bodyweight <16 kg, platelet count <70 g/L and INR >1.25 revealed association with increased bleeding incidence, but no predictive value.Conclusion:Ultrasound‐guided liver biopsies in pediatric age are a safe procedure with a high diagnostic yield. Increasing the number of needle passes predicts a higher incidence of minor bleeding. Other factors to account for minor bleeding risk may include age younger than 3 years, bodyweight <16 kg, platelet count <70 G/L, and INR >1.25. Transplanted livers present a lower bleeding risk.
Retrospective Review of Gonococcal and Chlamydial Cases of Epididymitis at 2 Canadian Sexually Transmitted Infection Clinics, 2004–2014
Authors: Chen Justin Z , Gratrix Jennifer , Brandley Judith , Smyczek Petra , Parker Penny , Read Ron , Singh Ameeta E 
Published: April 2017

AbstractFifty-seven cases of gonococcal and chlamydial infections complicated by acute epididymitis seen at 2 Alberta STI clinics from 2004 to 2014 were reviewed. The majority responded to treatment recommended by national guidelines. Three of 6 treatment failures were not treated according to guidelines.
Impact of Eligibility Criteria on Participant Enrollment for a Randomized Clinical Trial of Gonorrhea Treatment
Authors: Long Jill E. , Wierzbicki Michael R. , Hook Edward W. 
Published: April 2017

Background
High rates of failure to qualify for clinical trial participation increase time and cost required for study completion. Identification of remediable reasons for prescreen failure can help reduce prescreen failure rates and improve study cost effectiveness.

Methods
Reasons for prescreen failure to qualify for participation in a phase 2 randomized clinical trial of treatment of uncomplicated urogenital gonorrhea were collected from prescreening logs. Reasons were categorized based on whether the reason was that the subject failed to meet eligibility criteria or declined participation. Subjects who failed prescreening but could have been enrolled under protocol amendments were used to estimate potential cost savings had enrollment completed sooner.

Results
Over 88% (1373/1554) of potential study candidates were not enrolled. The majority (68.8%) of nonenrolled subjects failed prescreening due to not meeting eligibility criteria, whereas 31.0% declined to participate. The most common reasons for failure to qualify were having only nonurogenital gonorrhea (16.4%), limited time (13.1%), and being on antiretroviral therapy (7.5%). Potential cost savings if protocol amendments affecting eligibility had been instituted earlier were estimated at US $127,500.

Conclusions
Careful attention to reasons for prescreen failure can inform clinical trial protocol development to address trial design features that may impact successful enrollment. More efficient subject enrollment can result in substantial cost savings.
Chlamydia trachomatis Incidence Using Self-Reports and Serology by Gender, Age Period, and Sexual Behavior in a Birth Cohort
Authors: Righarts A. Antoinette , Morgan Jane , Horner Paddy J. , Wills Gillian S. , McClure Myra O. , Dickson Nigel P. 
Published: April 2017

Background
Although understanding chlamydia incidence assists prevention and control, analyses based on diagnosed infections may distort the findings. Therefore, we determined incidence and examined risks in a birth cohort based on self-reports and serology.

Methods
Self-reported chlamydia and behavior data were collected from a cohort born in New Zealand in 1972/3 on several occasions to age 38 years. Sera drawn at ages 26, 32, and 38 years were tested for antibodies to Chlamydia trachomatis Pgp3 antigen using a recently developed assay, more sensitive in women (82.9%) than men (54.4%). Chlamydia incidence by age period (first coitus to age 26, 26–32, and 32–38 years) was calculated combining self-reports and serostatus and risk factors investigated by Poisson regression.

Results
By age 38 years, 32.7% of women and 20.9% of men had seroconverted or self-reported a diagnosis. The highest incidence rate was to age 26, 32.7 and 18.4 years per 1000 person-years for women and men, respectively. Incidence rates increased substantially with increasing number of sexual partners. After adjusting age period incidence rates for partner numbers, a relationship with age was not detected until 32 to 38 years, and then only for women.

Conclusions
Chlamydia was common in this cohort by age 38, despite the moderate incidence rates by age period. The strongest risk factor for incident infection was the number of sexual partners. Age, up to 32 years, was not an independent factor after accounting for partner numbers, and then only for women. Behavior is more important than age when considering prevention strategies.
Portrait of an Epidemic: Extremely High Human Immunodeficiency Virus Prevalence and Incidence Among Young Black Men Having Sex With Men and Residing in a Southern City
Authors: Mena Leandro , Crosby Richard A. 
Published: April 2017

Abstract
A 12-month prospective cohort study of 609 young black men who have sex with men (YBMSM) assessed human immunodeficiency virus seroconversion. One-hundred-seventy men (27.9%) were either human immunodeficiency virus–infected before enrollment or tested positive within 30 days afterward. Thirty (4.9%) were classified as incident infections occurring in a 12-month period. Subtracting the 170 from the denominator, incidence was 6.8%.
Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries
Authors: Newton-Levinson Anna , Leichliter Jami S. , Chandra-Mouli Venkatraman 
Published: April 2017

Background
The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet.

Methods
We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10–24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies.

Results
The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth's help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost.

Conclusions
Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality.
A Survey of 25 North Carolina Health Departments/Districts on Knowledge, Attitudes, and Current Practices to Seeking Reimbursement From Third-Party Payers for Sexually Transmitted Disease Services
Authors: Kovar Cheryl L. , Carter Susan 
Published: April 2017

Background
North Carolina Administrative Code 10A Chapter 41A.0204 (a) states “local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient.” Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown. Because of its high STD morbidity, the eastern region of North Carolina was targeted.

Methods
Using a Qualtrics Survey developed to measure attitudes as well as knowledge and reimbursement practices, this descriptive study was performed with staff from 25 eastern North Carolina health departments/districts. Snowball sampling was used to allow for greater inclusion. Analysis of data was performed at the individual and agency level based on types of questions in the survey.

Results
For knowledge, 87% of the respondents reported being aware of the possibility of reimbursement from third-party payers/commercial insurance carriers for STD services. In regard to current billing of these services, 20 health departments/districts (80%) reported they were billing these payers. When asked about their attitude of seeking reimbursement from commercial insurance, 92% reported it was acceptable or very acceptable. But when asked if STD services should remain a free service at the health department, 55% supported and 45% did not.

Conclusions
These data provide a knowledge base for assisting health departments/districts to move forward in improving STD services as well as maximizing reimbursement from third-party payers/commercial insurance carriers when possible.
Maternal Syphilis: An Independent Risk Factor for Mother to Infant Human Immunodeficiency Virus Transmission
Authors: Kinikar Aarti , Gupte Nikhil , Bhat Jayalakshmi , Bharadwaj Renu , Kulkarni Vandana , Bhosale Ramesh , McIntire Katherine N , Mave Vidya , Suryavanshi Nishi , Patil Sandesh , Bollinger Robert , Gupta Amita 
Published: April 2017

Abstract
Syphilis is associated with increased human immunodeficiency virus acquisition and sexual transmission; we examined impact on human immunodeficiency virus mother-to-child transmission among mother-infant pairs enrolled in the India Six-Week Extended-Dose Nevirapine study. Maternal syphilis, diagnosed serologically using Venereal Disease Research Laboratory titer plus Treponema Pallidum Hemagglutination Assay, was associated with 2.5-fold greater risk.
Brief Report: Prevalence of Posttreatment Controller Phenotype Is Rare in HIV-Infected Persons After Stopping Antiretroviral Therapy
Authors: Perkins Matthew J. , Bradley William P. , Lalani Tahaniyat , Agan Brian K. , Whitman Timothy J. , Ferguson Tomas M. , Okulicz Jason F. , Ganesan Anuradha 
Published: April 2017

Background:
Posttreatment control of HIV infection is a rare phenomenon primarily described among those initiating treatment with antiretroviral therapy (ART) during early/acute HIV infection.

Methods:
We examined a large, well-characterized cohort of HIV-infected Department of Defense beneficiaries for the presence of posttreatment controllers (PTCs) whom we defined as individuals with sustained viral suppression for ≥6 months after discontinuation of ART. We defined those who became viremic within 6 months of discontinuing ART as rapid viremics (RVs) and compared demographic and clinical characteristics, CD4 counts, and viral loads prior, during, and after ART discontinuation between the 2 groups.

Results:
From a cohort of 6070 patients, we identified 95 who had been treated with ART for 2 years or more who subsequently discontinued ART and had viral load assessments available after discontinuation. Four (4.2%) of these 95 met our definition of PTC. The duration of viral suppression off of ART ranged from 267 to 1058 days with 1 of the 4 restarting ART without having redeveloped a significant viremia. All 4 patients initiated ART during chronic HIV infection. Demographic and clinical characteristics of PTCs were similar to RVs.

Conclusions:
While posttreatment control has predominantly been described among individuals who initiated ART in early/acute HIV infection, we identified 4 PTCs who started ART during chronic infection suggesting that posttreatment control also occurs among such patients. The rarity of PTCs identified in our cohort is consistent with reports from previous studies.
Association of CD4+ T-cell Count, HIV-1 RNA Viral Load, and Antiretroviral Therapy With Kaposi Sarcoma Risk Among HIV-infected Persons in the United States and Canada
Authors: Dubrow Robert , Qin Li , Lin Haiqun , Hernández-Ramírez Raúl U. , Neugebauer Romain S. , Leyden Wendy , Althoff Keri N. , Achenbach Chad J. , Hessol Nancy A. , Modur Sharada P. , D'Souza Gypsyamber , Bosch Ronald J. , Grover Surbhi , Horberg Michael A. , Kitahata Mari M. , Mayor Angel M. , Novak Richard M. , Rabkin Charles S. , Sterling Timothy R. , Goedert James J. , Justice Amy C. , Engels Eric A. , Moore Richard D. , Silverberg Michael J. ,   for the North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS
Published: April 2017

Background:
Kaposi sarcoma (KS) remains common among HIV-infected persons. To better understand KS etiology and to help target prevention efforts, we comprehensively examined a variety of CD4+ T-cell count and HIV-1 RNA viral load (VL) measures, as well as antiretroviral therapy (ART) use, to determine independent predictors of KS risk.

Setting:
North American AIDS Cohort Collaboration on Research and Design.

Methods:
We followed HIV-infected persons during 1996–2009 from 18 cohorts. We used time-updated Cox regression to model relationships between KS risk and recent, lagged, trajectory, and cumulative CD4 count or VL measures, as well as ART use. We used Akaike's information criterion and global P values to derive a final model.

Results:
In separate models, the relationship between each measure and KS risk was highly significant (P < 0.0001). Our final mutually adjusted model included recent CD4 count [hazard ratio (HR) for <50 vs. ≥500 cells/μL = 12.4; 95% confidence interval (CI): 6.5 to 23.8], recent VL (HR for ≥100,000 vs. ≤500 copies/mL = 3.8; 95% CI: 2.0 to 7.3), and cumulative (time-weighted mean) VL (HR for ≥100,000 vs. ≤500 copies/mL = 2.5; 95% CI: 1.0 to 5.9). Each P-trend was <0.0001. After adjusting for these measures, we did not detect an independent association between ART use and KS risk.

Conclusions:
Our results suggested a multifactorial etiology for KS, with early and late phases of development. The cumulative VL effect suggested that controlling HIV replication promptly after HIV diagnosis is important for KS prevention. We observed no evidence for direct anti-KS activity of ART, independent of CD4 count and VL.