bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clicking Eyelids: A New Finding of Prostaglandin-Associated Periorbitopathy
Authors: Skorin Leonid , Dailey Kathryn H. 
Published: April 2016

ABSTRACT

Purpose
To present and discuss a case representing both a new sign and symptom of prostaglandin-associated periorbitopathy.

Case Report
An 83-year-old female patient presented for a 6-month glaucoma follow-up in July 2013 with no specific visual or comfort complaints. The patient had a 14-year history of bilateral primary open angle glaucoma and a 13-year history of once daily bimatoprost use in both eyes. Evaluation at previous examinations revealed long eyelashes, tight eyelids, small palpebral fissures, and deepening of the upper eyelid sulcus. During slit-lamp examination of the anterior segment, it was noted that the patient’s eyelids clicked intermittently when she blinked. The patient had not previously noticed the clicking and it was determined to be present in each eye individually. The eyelid clicking has been noted to be present in every follow-up examination since it was discovered in July 2013.

Conclusions
Prostaglandin-associated periorbitopathy and the resulting cosmetic effects noticed visually by patients are well documented. Our case represents a new audible sign and symptom that may be found with prostaglandin-associated periorbitopathy but has not to our knowledge been reported in the literature.
Pediatric Patient With Altered Mental Status and Hypoxemia
Authors: Root Jeremy M. , Vargas Marcela , Garibaldi Luigi R. , Saladino Richard A. 
Published: April 2016

Abstract
Childhood cases of myxedema coma are extremely rare. We report a case of a 5-year-old girl transferred to a tertiary care pediatric emergency department with hypoxemia and altered mental status and diagnosed with severe hypothyroidism and myxedema coma in the setting of acute influenza infection. Although it is rare, myxedema coma must remain in the differential diagnosis for altered mental status and organ dysfunction in the pediatric population.
Leukocyte-Reduced Platelet-Rich Plasma Alters Protein Expression of Adipose Tissue–Derived Mesenchymal Stem Cells
Authors: Loibl Markus , Lang Siegmund , Hanke Alexander , Herrmann Marietta , Huber Michaela , Brockhoff Gero , Klein Silvan , Nerlich Michael , Angele Peter , Prantl Lukas , Gehmert Sebastian 
Published: April 2016

Background:
Application of platelet-rich plasma and stem cells has become important in regenerative medicine. Recent literature supports the use of platelet-rich plasma as a cell culture media supplement to stimulate proliferation of adipose tissue–derived mesenchymal stem cells. The underlying mechanism of proliferation stimulation by platelet-rich plasma has not been investigated so far.

Methods:
Adipose tissue–derived mesenchymal stem cells were cultured in α-minimal essential medium supplemented with platelet-rich plasma or fetal calf serum. Cell proliferation was assessed with cell cycle kinetics using flow cytometric analyses after 48 hours. Differences in proteome expression of the adipose tissue–derived mesenchymal stem cells were analyzed using a reverse-phase protein array to quantify 214 proteins. Complementary Ingenuity Pathways Analysis and gene set enrichment analysis were performed using protein data, and confirmed by Western blot analysis.

Results:
A higher percentage of adipose tissue–derived mesenchymal stem cells in the S phase in the presence of platelet-rich plasma advocates the proliferation stimulation. Ingenuity Pathways Analysis and gene set enrichment analysis confirm the involvement of the selected proteins in the process of cell growth and proliferation. Ingenuity Pathways Analysis revealed a participation in the top-ranked canonical pathways PI3K/AKT, PTEN, ILK, and IGF-1. Gene set enrichment analysis identified the authors’ protein set as being part of significantly regulated protein sets with the focus on cell cycle, metabolism, and the Kyoto Encyclopedia of Genes and Genomes transforming growth factor-β signaling pathway.

Conclusions:
The present study provides evidence that platelet-rich plasma stimulates proliferation and induces a unique change in the proteomic profile of adipose tissue–derived mesenchymal stem cells. The interpretation of altered expression of regulatory proteins represents a step forward toward achieving good manufacturing practice–compliant criteria for cell-based strategies.
Evidence for Extending the Duration of Chemoprophylaxis following Free Flap Harvest from the Lower Extremity: Prospective Screening for Deep Venous Thrombosis
Authors: Rau Aline S. , Harry Brian L. , Leem Ted H. , Song John I. , Deleyiannis Frederic W.-B. 
Published: April 2016

Background:
The purpose of this study was to investigate the incidence of symptomatic and asymptomatic deep venous thrombosis in patients undergoing harvest of a free flap from the lower extremity who were receiving standard chemoprophylaxis while hospitalized.

Methods:
A retrospective review of 65 consecutive patients undergoing surgery between 2011 and 2013 was performed to determine the incidence of symptomatic deep venous thrombosis. These patients were screened for deep venous thrombosis based on development of symptoms. Prospective evaluation of a similar consecutive population of 37 patients between 2014 and 2015 was then performed to determine the incidence of asymptomatic deep venous thrombosis. These patients underwent routine duplex ultrasonography of both legs at postoperative weeks 1 and 4.

Results:
Symptomatic deep venous thrombosis occurred in 2.9 percent of all patients. In the prospective cohort, 8.1 percent of the patients were found to have an acute deep venous thrombosis by postoperative week 1. At postoperative week 4, 16.7 percent of the patients developed a new, acute deep venous thrombosis. The estimated costs of screening and treating deep venous thrombosis in the retrospective group and the prospective group were $222 and $2259, respectively. The cost of routine chemoprophylaxis without duplex screening for an additional 14 days after discharge was $125 per patient.

Conclusions:
The rate of asymptomatic deep venous thrombosis may be much higher than previously appreciated in this population of very high-risk patients, especially during the 2 weeks after discharge. Extending the duration of chemoprophylaxis to 4 weeks after surgery may be warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Persons Living With HIV in the United States: Fewer Than We Thought
Authors: Xia Qiang , Braunstein Sarah L. , Wiewel Ellen W. , Eavey Joanna J. , Shepard Colin W. , Torian Lucia V. 
Published: April 2016

Objectives:
To estimate the number of persons living with HIV (PLWH) in the United States and to describe their care status.

Methods:
Estimates of diagnosed PLWH in New York City and other 19 jurisdictions based on HIV case reporting were compared with those based on HIV laboratory reporting. A revised HIV care continuum was constructed based on previously published data.

Results:
The estimate of PLWH based on HIV case reporting was 25.6% higher than that based on HIV laboratory reporting data in New York City. There were 819,200 PLWH in the United States at the end of 2011 (plausible range: 809,800–828,800), of whom 86% were diagnosed, 72% were retained in care (≥1 care visit in 2011), 68% were on antiretroviral therapy, and 55% were virally suppressed (≤200 copies/mL).

Conclusions:
The current method based on HIV case reporting may have overestimated PLWH in the United States. While we continue cleaning HIV case reporting data to improve its quality, we should take the opportunity to use comprehensive HIV laboratory reporting data to estimate PLWH at both the national and local levels.
Geriatric Assessments and Association With VACS Index Among HIV-Infected Older Adults in San Francisco
Authors: John Malcolm D. , Greene Meredith , Hessol Nancy A. , Zepf Roland , Parrott Amanda Hutton , Foreman Cameron , Bourgeois James , Gandhi Monica , Hare C. Bradley 
Published: April 2016

Objectives:
To perform geriatric assessments in older HIV-infected adults in San Francisco and examine the association with age and the Veterans Aging Cohort Study (VACS) index scores.

Methods:
A cross-sectional study was conducted from 2012 to 2014 among HIV-infected patients ≥50 years at 2 San Francisco-based HIV clinics. We evaluated 4 health domains: (1) physical health and function (activities of daily living), instrumental activities of daily living (IADL), falls, gait speed, (2) social support (physical and perceived support, loneliness), (3) mental health (depression, anxiety, posttraumatic stress disorder) and cognition, and (4) behavioral and general health (antiretroviral adherence and quality of life). Contingency table and rank-sum analyses examined associations between these domains with age and VACS index scores.

Results:
Three hundred fifty-nine patients completed assessments (median age 57; 85% male; 57% white; 72% >high school education). On functional assessment, 39% reported dependence with ≥1 IADL, and 40% reported falls in the previous year. Fifty-eight percent experienced loneliness, 60% the lowest levels of perceived social support, 55% depression, and 12% posttraumatic stress disorder. Forty percent had possible mild cognitive impairment. Thirty percent reported poor or fair quality of life. Older age was associated with lower CD4 counts, balance problems, slower gait, lower anxiety, poorer general health, and higher antiretroviral adherence. VACS Index score was associated with dependence in ≥1 IADL and antiretroviral adherence.

Conclusion:
In a large sample of older HIV-infected adults, multiple significant aging-related conditions were identified. Integrating geriatric assessment tools into HIV/AIDS clinical care may help target interventions to optimize clinical care and quality of life for older HIV-infected individuals.
HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003–2013
Authors: Chan Brian T. , Tsai Alexander C. 
Published: April 2016

Background:
HIV-related stigma is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). Although ART scale-up may reduce HIV-related stigma, the extent to which levels of stigma in the general population have changed during the era of ART scale-up in sub-Saharan Africa is unknown.

Methods:

Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 31 African countries between 2003 and 2013. We fitted multivariable linear regression models with cluster-correlated robust standard errors and country fixed effects, specifying social distance or anticipated stigma as the dependent variable and year as the primary explanatory variable of interest.

Results:
We estimated a statistically significant negative association between year and desires for social distance (b = −0.020; P < 0.001; 95% confidence interval: −0.026 to −0.015) but a statistically significant positive association between year and anticipated stigma (b = 0.023; P < 0.001; 95% confidence interval: 0.018 to 0.027). In analyses stratified by HIV prevalence above or below the sample median, declines in social distancing over time were more pronounced among countries with a higher HIV prevalence.

Conclusions:
Concomitant with ART scale-up in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in social distancing toward people living with HIV. Although ART scale-up may help reduce social distancing toward people living with HIV, particularly in high-prevalence countries, other interventions targeting symbolic or instrumental concerns about HIV may be needed.
Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care
Authors: Marcus Julia L. , Chao Chun R. , Leyden Wendy A. , Xu Lanfang , Quesenberry Charles P. , Klein Daniel B. , Towner William J. , Horberg Michael A. , Silverberg Michael J. 
Published: April 2016

Background:
It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care.

Methods:
We conducted a cohort study within Kaiser Permanente California during 1996–2011, using abridged life tables to estimate the expected years of life remaining (“life expectancy”) at age 20.

Results:
Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996–1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9–14.8 years) in 2011. In 2008–2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008–2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1–10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors.

Conclusions:
Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics
Authors: Duff Putu , Goldenberg Shira , Deering Kathleen , Montaner Julio , Nguyen Paul , Dobrer Sabina , Shannon Kate 
Published: April 2016

Objective:
Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada.

Methods:
Analyses drew on data (2010–2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (<50 copies/mL).

Results:
Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. Although 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable generalized linear mixed-effects model analyses, ≥95% pharmacy refill adherence (adjusted odds ratio (AOR) = 4.21; 95% confidence interval (CI) 2.16 to 8.19) and length of time since diagnosis (AOR = 1.06; 95% CI: 1.00 to 1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR = 0.35; 95% CI: 0.16 to 0.78) and being homelessness were negatively correlated with undetectable pVL (AOR = 0.22; 95% CI: 0.10 to 0.47).

Discussion/Conclusions:
There is a need to more closely consider the social and structural contexts that shape SWs' experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs' access to and retention in care.
Difference in Aortic Stiffness Between Treated Middle-Aged HIV Type 1–Infected and Uninfected Individuals Largely Explained by Traditional Cardiovascular Risk Factors, With an Additional Contribution of Prior Advanced Immunodeficiency
Authors: Kooij Katherine W. , Schouten Judith , Wit Ferdinand W. N. M. , van der Valk Marc , Kootstra Neeltje A. , Stolte Ineke G. , van der Meer Jan T. M. , Prins Maria , Grobbee Diederick E. , van den Born Bert-Jan H. , Reiss Peter ,   on behalf of the AGEhIV Cohort Study Group
Published: April 2016

Background:
Patients with HIV, even with suppressed viremia on combination antiretroviral therapy, are at increased risk for cardiovascular disease. The underlying pathophysiology remains to be clarified. Aortic stiffness, known to be associated with cardiovascular disease in the general population, was investigated in a cohort of HIV type 1 (HIV 1)–infected and similar but uninfected individuals.

Methods:
Aortic stiffness was assessed by measuring pulse wave velocity (PWV) with an Arteriograph. Five hundred seven HIV-uninfected and 566 HIV 1–infected individuals, predominantly with suppressed viremia on combination antiretroviral therapy, aged ≥45 years, participating in the ongoing AGEhIV Cohort Study were included in the analysis. Multivariable linear regression was used to investigate whether HIV was independently associated with aortic stiffness, adjusting for traditional cardiovascular risk factors.

Results:
Study groups were comparable in demographics; smoking and hypertension were more prevalent in HIV-infected participants. PWV was higher in the HIV-infected group (7.9 vs. 7.7 m/s, P = 0.004). After adjustment for mean arterial pressure, age, gender, and smoking, HIV status was not significantly associated with aortic stiffness. In HIV-infected participants, having a nadir CD4+ T-cell count ≤100 cells per cubic millimeter was independently associated with a higher PWV.

Conclusions:
The increased aortic stiffness in HIV-infected participants was largely explained by a higher prevalence of traditional cardiovascular risk factors, particularly smoking. Although HIV itself was not independently associated with higher aortic stiffness, a prior greater degree of immunodeficiency was. This suggests a detrimental effect of immunodeficiency on the aortic wall, possibly mediated by inflammation.
Brief Report: Cumulative Tenofovir Disoproxil Fumarate Exposure is Associated With Biomarkers of Tubular Injury and Fibrosis in HIV-Infected Men
Authors: Jotwani Vasantha , Scherzer Rebecca , Estrella Michelle M. , Jacobson Lisa P. , Witt Mallory D. , Palella Frank , Macatangay Bernard , Bennett Michael , Parikh Chirag R. , Ix Joachim H. , Shlipak Michael 
Published: April 2016

Abstract:Tenofovir disoproxil fumarate (TDF) can cause kidney damage, but current clinical tests are insensitive for detecting toxicity. Among 884 HIV-infected men enrolled in the Multicenter AIDS Cohort Study, we measured urine biomarkers specific for tubular damage (interleukin-18, kidney injury molecule-1, procollagen type III N-terminal propeptide) and albuminuria. In adjusted analyses, each year of TDF exposure was independently associated with 3.3% higher interleukin-18 (95% CI: 0.8% to 5.8%), 3.4% higher kidney injury molecule-1 (1.1% to 5.7%), and 3.1% higher procollagen type III N-terminal propeptide (0.8% to 5.5%), but not with albuminuria (2.8%; −0.6% to 6.2%). Biomarkers of tubular damage may be more sensitive than albuminuria for detecting toxicity from TDF and other medications.
Nondiagnostic Computed Tomography–guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected
Authors: Haas Brian M. , Elicker Brett M. , Nguyen Janet , Ordovas Karen G. , Jones Kirk D. , Henry Travis S. , Naeger David M. 
Published: April 2016

Purpose:
The purpose of this study was to assess the incidence of nondiagnostic computed tomography–guided lung biopsy results, stratified by biopsy indication, and determine the final diagnosis in such cases.

Materials and Methods:
Following institutional review board approval, pathology results from CT-guided lung biopsies over a 5-year period at 2 institutions were categorized as diagnostic or nondiagnostic. Each biopsy’s indication was categorized as being for a lesion considered likely to be cancer, infection, or uncertain. For all nondiagnostic biopsies, the medical chart was reviewed to determine the final clinical diagnosis.

Results:
A total of 660 biopsies were evaluated, 139 (21%) of which were nondiagnostic. Of these 139 patients, the final clinical diagnosis was infection in 37%, cancer in 30%, and a benign noninfectious diagnosis in 10%; 23% remained undiagnosed at last available follow-up. Among the patients in whom there was a high pretest suspicion for cancer, 13% were nondiagnostic, 45% of which were cancer and 27% were infection. Among biopsies of lesions with pretest probability for both cancer and infection, 51% were nondiagnostic; on clinical follow-up these were determined to be infection in 34% and cancer in 14%. When there was high pretest suspicion for infection, 73% were nondiagnostic, of which 13% were cancer on clinical follow-up, and 88% were infection. The rate of nondiagnostic biopsies was statistically significantly different (P<0.001) among the 3 groups.

Conclusions:
Nondiagnostic biopsies are common and occur most frequently when there is a moderate or high pretest suspicion for infection. Among all nondiagnostic biopsies, regardless of indication, cancer and infection were diagnosed on follow-up in similar proportions.
Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?
Authors: Hajalioghli Parisa , Nemati Masoud , Dinparast Saleh Leila , Fouladi Daniel F. 
Published: April 2016

Purpose:
The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia?

Materials and Methods:
A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated.

Results:
CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively.

Conclusions:
CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.