bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Delay Facilitates Pedicled Nipple-sparing Mastectomy and Reconstruction in the Ptotic Patient
Authors: Schwartz Jean-Claude D. , Skowronksi Piotr P. 
Published: June 2016

Summary:
Significant ptosis is a relative contraindication for nipple-sparing mastectomy and reconstruction. Repositioning of the nipple on the reconstructed breast is best accomplished using a pedicled approach that is risky in the immediate setting. We utilized a surgical delay before reconstruction that allowed for repositioning of the nipple-areola complex on an inferior pedicle. This also allows for resizing of the nipple-areola complex, reliable complete coverage of the prosthesis with viable tissue, and creation of an ideal skin envelope in patients with skin excess. Here, we present the first description of a surgical delay to facilitate pedicled nipple-sparing mastectomy and reconstruction.
Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?
Authors: Offodile Anaeze C. , Guo Lifei 
Published: June 2016

Summary:
Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates.
Ocular Hypotensive Effect of ONO-9054, an EP3/FP Receptor Agonist: Results of a Randomized, Placebo-controlled, Dose Escalation Study
Authors: Harris Alon , Ward Caroline L. , Rowe-Rendleman Cheryl L. , Ouchi Takafumi , Wood Andrew , Fujii Akifumi , Serle Janet B. 
Published: June 2016

Purpose:
To assess pharmacodynamic and safety profiles of ONO-9054 following single and multiple day dosing in subjects with ocular hypertension or open-angle glaucoma.

Materials and Methods:
This was a phase I, single-center, randomized, double-masked, placebo-controlled dose-escalation study. Nine subjects were randomized to each of ONO-9054 3, 10, 20, 30 μg/mL and 12 to placebo. Subjects received a single drop to each eye at 07:00±30 minutes (single dose). Following a 4-day no-treatment period, subjects were dosed once daily for 14 consecutive days (multiple day dosing). Intraocular pressure (IOP) was measured regularly and compared with baseline measurements. Ocular examinations assessed safety and tolerability.

Results:
Mean IOP decreased dose dependently. Following single dosing, IOP decreased from 22.9±4.0 to 15.9±2.3 mm Hg (ONO-9054, 30 μg/mL) at peak effect 9 hours postdose; the reduction in placebo-treated subjects was from 22.3±2.4 to 21.5±3.3 mm Hg. Following multiple day dosing, the greatest reduction in IOP occurred 1 hour postdose on day 18, from 23.3±0.6 to 15.1±2.4 mm Hg (ONO-9054, 10 μg/mL); the smallest reduction at this time was from 23.9±0.8 to 18.6±2.0 mm Hg (ONO-9054, 3 μg/mL). Pressures remained reduced on day 19, 25 hours after the last dose, when the lowest measurement was 15.8±2.1 mm Hg (ONO-9054, 10 μg/mL). Anterior uveitis and vitreous detachment were each reported in 2 subjects and considered moderate by the Investigator. Ocular hyperemia and tolerability symptoms were generally mild and transient.

Conclusions:
ONO-9054 was well-tolerated and elicited dose-dependent reductions in IOP, which were sustained for at least 24 hours following 2 weeks of consecutive daily dosing.
Influence of Test Strategy on Octopus Perimeter Cluster Mean Defect Values: Adaptive Bracketing Normal Strategy Versus Tendency-oriented Perimetry
Authors: Holló Gábor 
Published: June 2016

Background/Purpose:
Using adaptive bracketing “normal” (N) strategy it has been shown that cluster trend analysis is useful for early detection of glaucomatous progression with Octopus perimetry. However, in clinical practice “tendency-oriented perimetry” (TOP) is mostly used. In TOP, responses given at neighboring points modify the threshold values, and this process does not respect cluster borders. In the current investigation, we evaluated the influence of test strategy on the cluster mean defect (cluster MD) values.

Materials and Methods:
Sixty-nine eyes with normal visual field and 63 glaucoma eyes with predominantly mild to moderate glaucomatous visual field defect underwent Octopus perimetry with N and TOP strategy on the same day. Cluster MD values and global parameters were compared between test strategies in each group.

Results:
In the normal group, all global parameters (P≤0.0003) and cluster MD for 6 uncorrected and 5 corrected clusters differed significantly between the strategies (P≤0.0052). In the glaucoma group, no significant difference was seen for global mean sensitivity and global MD, but square loss variance reflecting inhomogeneity was 1.0 dB lower with TOP (P<0.0001). Two uncorrected and 3 corrected clusters differed significantly (P≤0.0026) and several other clusters differed almost significantly between the strategies. The differences spread up to 1.9 dB without any systematic direction.

Conclusions:
Using TOP, cluster MD determined for one cluster is statistically and clinically significantly influenced by responses given at points outside the cluster. This may also influence cluster trend analysis for glaucomatous progression. Therefore, TOP, although fast and easily performed, is not the optimal procedure for cluster and corrected cluster analyses.
Combined Ahmed Glaucoma Valve Placement, Intravitreal Fluocinolone Acetonide Implantation and Cataract Extraction for Chronic Uveitis
Authors: Chang Ingrid T. , Gupta Divakar , Slabaugh Mark A. , Vemulakonda Gurunadh A. , Chen Philip P. 
Published: June 2016

Purpose:
To report the outcomes of combined Ahmed glaucoma valve (AGV) placement, intravitreal fluocinolone acetonide implant, and cataract extraction procedure in the treatment of chronic noninfectious uveitis.

Patients and Methods:
Retrospective case series of patients with chronic noninfectious uveitis who underwent AGV placement, intravitreal fluocinolone acetonide implantation, and cataract extraction in a single surgical session performed at 1 institution from January 2009 to November 2014. Outcome measures included intraocular pressure (IOP) and glaucoma medication use. Secondary outcome measures included visual acuity, systemic anti-inflammatory medications, number of uveitis flares, and complications.

Results:
Fifteen eyes of 10 patients were studied, with a mean age of 40.3±15.7 and mean follow-up duration of 26 months (range, 13 to 39 mo). Before surgery, the IOP was 18.5±7.3 mm Hg and patients were using 1.5±1.5 topical glaucoma medications. At the 12-month follow-up, IOP was 12.8±3.2 mm Hg (P=0.01) and patients were using 0.5±0.8 (P=0.03) topical glaucoma medications. At 36 months of follow-up, late, nonsustained hypotony had occurred in 3 eyes (20%), and 1 eye (6%) had received a second AGV for IOP control. Before treatment, patients had 2.7±1.5 uveitis flares in the year before surgery while on an average of 2.1±0.6 systemic anti-inflammatory medications, which decreased to an average of 0.1±0.3 (P<0.01) flares the year after surgery while on an average of 0.4±1.1 (P<0.01) systemic medications.

Conclusion:
Combined AGV, intravitreal fluocinolone acetonide implant, and cataract extraction is effective in controlling IOP and reducing the number of glaucoma medications at 12 months after treatment in patients with chronic uveitis.
A Procedural and Educational Experience Following Creation of an Advanced Pediatric Endoscopy Service
Authors: Mezoff Ethan A. , Lin Tom K. , Kaul Ajay , Kocoshis Samuel , Putnam Phil , Pentiuk Scott 
Published: June 2016

ABSTRACTAdvanced endoscopic procedures occur infrequently enough in pediatric patients to preclude effective maintenance of competence among all pediatric gastroenterologists. A recent study suggests that fellows are largely unable to achieve the prescribed case volume recommended to achieve competence. We sought to describe the procedural and educational experience following the creation of an advanced pediatric endoscopy service in response to declining confidence among practice members regarding advanced procedures. We found most advanced endoscopy cases (90%) were accomplished during routine business hours with little seasonal variation. Esophageal dilations occurred far more than all other procedures provided by this service. Control of nonvariceal bleeding, feeding tube placement, enteroscopy, and needle knife therapy, among others, were performed exclusively but relatively infrequently by members of this advanced endoscopy service. Fellows were present for many cases, although they participated in relatively few. We conclude that the creation of an advanced endoscopy service permits distillation of rare but technically demanding cases to few providers, ensuring maintenance of skills, although the role of fellows remains in question.
Impact of Environmental and Familial Factors in a Cohort of Pediatric Patients With Inflammatory Bowel Disease
Authors: Strisciuglio Caterina , Giugliano Francesca , Martinelli Massimo , Cenni Sabrina , Greco Luigi , Staiano Annamaria , Miele Erasmo 
Published: June 2016

AbstractObjectives:The primary role of environment on inflammatory bowel disease (IBD) onset has been recently stressed. We aimed to investigate the effect of environmental factors in an IBD pediatric cohort.Methods:A total of 467 subjects (264 IBD and 203 controls) were enrolled. All patients underwent a questionnaire including 5 different groups of environmental risk factors: family history of IBD and autoimmune diseases, perinatal period, home amenities and domestic hygiene, childhood diseases and vaccinations, and diet.Results:In a multivariate model, mother's degree (odds ratio [OR]: 5.5; 2.5–11.6), duration of breast feeding >3rd month (OR: 4.3; 1.6–10.5), father's employment (OR: 3.7; 1.2–8.7), gluten introduction <6th month (OR: 2.8; 1.5–5), number of siblings <2 (OR: 2.8; 1.5–5.3), and family history of autoimmune diseases (OR: 2.7; 1.4–5.3) were significant risk factors for Crohn disease. Low adherence to Mediterranean diet (OR: 2.3; 1.2–4.5), gluten introduction <6th month (OR: 2.8; 1.6–4.9), and number of siblings <2 (OR: 2; 1.1–3.6) were significant risk factors for ulcerative colitis. Owning pets (OR: 0.3; 0.1–0.7) and bed sharing (OR: 0.2; 0.1–0.6) were protective factors for Crohn disease, whereas owning pets (OR: 0.4; 0.2–0.8) and family parasitosis (OR: 0.07; 0.01–0.4) were protective factors for ulcerative colitis.Conclusions:Our study confirms that environmental factors are closely linked to IBD onset and may partly explain IBD rise in developed countries.
Remission in Pediatric Inflammatory Bowel Disease Correlates With Prescription Refill Adherence Rates
Authors: Samson Charles M. , Mager Douglas , Frazee Sharon , Yu Feliciano 
Published: June 2016

ABSTRACTObjectives:The aim of the study was to use pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD.Methods:We identified 362 pediatric patients with IBD seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts’ member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%.Results:Among our 362 patients, we matched 228 (63%) within Express Scripts’ eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication prescribed. Their mean MPR was 0.63 ± 0.31 (standard deviation) and 40% had an MPR ≥80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72 ± 0.28 vs 0.51 ± 0.32, P = 0.002) and patients whose MPR were ≥80% were more likely to have a PGA of remission than those with whose MPR were <80% (84% vs 43%, P = <0.001).Conclusions:We found a significant association between refill adherence and clinical remission. Nonadherence was common and was more common in adolescents. Use of PBM databases to identify and intervene on patients with poor adherence may improve outcomes in pediatric IBD.
The Expression Pattern of p120-Catenin is Associated With Acquired Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Non–Small Cell Lung Cancer
Authors: Liu Yang , Wang Si , Dong Qian-Ze , Liu Nan , Han Yong , Zhang Xiu-Peng , Fan Chui-Feng , Wang En-Hua 
Published: June 2016

Background:
Previous research connects p120-catenin (p120ctn) with epidermal growth factor receptor (EGFR) signaling pathways, which presents a potential role for p120ctn in EGFR tyrosine kinase inhibitor (EGFR-TKIs) resistance. However, a direct correlation between the expression pattern of p120ctn in solid tumors and the therapeutic effect of EGFR-TKIs has not yet been demonstrated.

Methods and Results:
In this study, the expression pattern of p120ctn was examined in patients with the EGFR gene mutation in lung adenocarcinoma, and p120ctn was found to have different patterns of expression even in the same mutation type. The therapeutic effect of EGFR-TKIs was investigated in these patients, and patients with an abnormal expression of p120ctn were found to be more likely to have drug resistance. A gefitinib-resistant lung cancer cell line was established and alterations in the p120ctn expression pattern were also observed in vitro.

Conclusions:
Therefore, this study demonstrates that the expression pattern of p120ctn is associated with acquired resistance to EGFR-TKIs in lung cancer, providing information toward addressing the problem of drug resistance in patients with non–small cell lung cancer.
Point-of-Care Ultrasound Integrated Into a Staged Diagnostic Algorithm for Pediatric Appendicitis
Authors: Doniger Stephanie J. , Kornblith Aaron 
Published: June 2016

Objectives
We hypothesized that point-of-care ultrasound (POCUS) is as accurate as radiology-performed ultrasound in evaluating children with clinical concern for appendicitis. As part of a staged approach, we further hypothesized that POCUS could ultimately decrease computed tomography (CT) utilization.

Methods
This was a prospective, convenience sampling of patients aged 2 to 18 years presenting with abdominal pain to a pediatric emergency department. Those patients with prior abdominal imaging, pregnant, or unable to tolerate the examination were excluded. An algorithm was followed: POCUS was first performed, followed by a radiology-performed ultrasound, and then a CT as necessary. The main outcome measure was the accuracy of the POCUS in diagnosing of appendicitis. This was compared with radiology-performed ultrasound. We also examined whether certain patient or clinical characteristics influenced the performance of POCUS. Lastly, we determined the amount by which CT scans were decreased through this staged algorithm.

Results
Forty patients were enrolled and underwent a POCUS examination. A total of 16 (40%) had pathology-confirmed appendicitis. Point-of-care ultrasound had a sensitivity of 93.8% (95% confidence interval [CI], 69.7%–98.9%) and specificity of 87.5% (95% CI, 67.6%–97.2%). Radiology-performed ultrasound had a sensitivity of 81.25% (95% CI, 54.3%–95.7%) and specificity of 100% (95% CI, 85.6%–100%). The radiology-performed and POCUS examinations had very good agreement (κ = 0.83, P < 0.0005). Patient characteristics including body mass index did not have an affect on the POCUS. However, POCUS identified all patients with an Alvarado score higher than 6. Overall, the reduction in CT examinations was 55%.

Conclusions
In pediatric patients presenting with clinical concern for acute appendicitis, a staged algorithm that incorporates POCUS is accurate and has the potential to decrease CT scan utilization.
Measuring the Transrectal Diameter on Point-of-Care Ultrasound to Diagnose Constipation in Children
Authors: Doniger Stephanie J. , Dessie Almaz , Latronica Cornelia 
Published: June 2016

Objectives
The aim of the study was to determine the test performance characteristics for point-of-care ultrasound in diagnosing constipation, through measuring the transrectal diameter (TRD). We sought to develop a sonographic numeric cutoff value for diagnosing constipation. Secondary objectives included whether certain patient characteristics would affect the TRD measurement and the accuracy of the TRD in comparison with abdominal radiographs.

Methods
We conducted a prospective, cohort study of pediatric patients between the age of 4 and 17 years, presenting with abdominal pain to a pediatric emergency department. A point-of-care ultrasound was performed with a phased array transducer (5-1 MHz). In addition to a thorough history and physical examination, each patient was administered with the Rome III questionnaire, which served as the criterion standard for the diagnosis of constipation. Radiographs and enema treatments were performed at the discretion of the treating attending physician. When enemas were administered, a postenema TRD measurement was obtained.

Results
Fifty subjects were “constipated” or “nonconstipated,” as determined by the Rome III questionnaire. A TRD cutoff of 3.8 cm or greater correlated with the diagnoses of constipation (P < 0.001). Ultrasound-diagnosed constipation had a sensitivity of 86% (95% confidence interval, 69%–96%), specificity of 71% (95% CI, 53%–85%), negative predictive value of 0.87 (95% CI, 0.68–0.95), and positive predictive value of 0.70 (95% CI, 0.52–0.84). The TRD measurement was not affected by patient physical characteristics or bladder fullness. In 7 patients, an enema was administered. There was an overall mean (SD) decrease of 1.22 (1.62) cm; this difference was not statistically significant (P = 0.093). Abdominal radiographs were performed in 25 patients. When compared with abdominal radiographs, ultrasound had a higher specificity of 71% (95% CI, 53%–85%), but this difference was not statistically significant. Ultrasound performed similarly to abdominal radiographs with regard to sensitivity 86% (95% CI, 67%–95%), positive predictive value of 0.70 (95% CI, 0.52–0.84), and negative predictive value of 0.87 (0.68–0.95). In 22 of 25 patients who received radiographs, the ultrasound diagnosis was the same as the radiologist read of the radiographs. Potentially, 88% of radiographs could have been avoided in these patients.

Conclusions
In pediatric patients with abdominal pain, there is a strong correlation of an enlarged TRD with constipation. Our results suggest that point-of-care ultrasound is a useful adjunct for diagnosing constipation and has the potential to replace the use of abdominal radiographs.
Cannabinoid Poisoning by Hemp Seed Oil in a Child
Authors: Chinello Matteo , Scommegna Salvatore , Shardlow Alison , Mazzoli Francesca , De Giovanni Nadia , Fucci Nadia , Borgiani Paola , Ciccacci Cinzia , Locasciulli Anna , Calvani Mauro 
Published: June 2016

Abstract
We report a case of mild cannabinoid poisoning in a preschool child, after 3-week ingestion of hemp seed oil prescribed by his pediatrician to strengthen his immune system. The patient presented neurological symptoms that disappeared after intravenous hydration. A possible mild withdrawal syndrome was reported after discharge. The main metabolite of Δ9-tetrahydrocannabinol was detected in urine, and very low concentration of Δ9-tetrahydrocannabinol was detected in the ingested product. This is, as far as we know, the first report of cannabinoid poisoning after medical prescription of hemp seed oil in a preschool child.
Postexposure prophylaxis after hepatitis C occupational exposure in the interferon-free era
Authors: Hughes Heather Y. , Henderson David K. 
Published: June 2016

Purpose of review
Healthcare personnel are at risk for occupational exposures to bloodborne pathogens. Primary prevention remains the first line of defense, but secondary prevention measures known to be effective should be implemented when percutaneous exposures occur. Hepatitis C virus (HCV) is a major infectious cause of liver-related morbidity and mortality. Chronic HCV treatment has changed dramatically, with many all-oral directly acting anti-HCV antiviral (DAA) regimens now available. Evidence for the use of DAAs as postexposure prophylaxis (PEP) after occupational exposures to HCV is summarized here.

Recent findings
Little new evidence supports the use of antivirals in acute HCV infection. Several preliminary studies have examined the use of DAAs or host target agents in chronic HCV treatment. Effective HCV PEP requirements likely include pan-genotypic activity and a high barrier to resistance. One investigational DAA has shown promising results as an efficacious option for all genotypes in chronic HCV treatment and may ultimately represent a potential HCV PEP agent.

Summary
Insufficient supporting data exist to endorse the use of DAAs for PEP after HCV occupational exposures; additional studies examining efficacy, duration, and cost-effectiveness are needed. Development of more oral drugs possessing a high barrier of resistance and equal activity against all HCV genotypes is anticipated.
Healthcare-associated infections in the elderly: what's new
Authors: Katz Morgan J. , Roghmann Mary-Claire 
Published: June 2016

Purpose of review
The high-risk population and current lack of knowledge regarding appropriate infection prevention in the long-term care (LTC) setting has contributed to substantial rates of resistance and healthcare-associated infections in this arena. More evidence-based research on LTC is necessary, particularly now that the elderly population is increasing.

Recent findings
Proposed government mandates highlight the urgent need to combat antimicrobial resistance in the LTC setting. Recent studies focusing on unique strategies for the prevention of transmission and infection with multidrug-resistant organisms in nursing homes are discussed, as well as attempts to formulate clear antimicrobial stewardship programs.

Summary
The long-term setting has unique challenges to instituting effective infection control precautions, therefore current accepted methods used in acute-care facilities need to be modified. Recent data suggest that prevention of transmission in LTC may be achieved with focus on high-risk patients or specific care-based activities rather than colonization status. Antimicrobial stewardship and consultation with specialized physicians may be important measures to combat resistance and adverse events in LTC. The prevention of unnecessary antibiotic use in palliative care may reduce rates of resistance as well as discomfort for terminal patients.