bluuebunny/crossref_metadata_2025_split huggingface dataset:
Finite Element Simulation of Prosthetic Foot Adaptation to Mediolateral-Angled Cross-Slopes
Authors: Maitland Murray E. , Allyn Katheryn J. , Ficanha Evandro , Colvin James M. , Wernke Matthew M. 
Published: March 2020

ABSTRACTIntroductionBalance, functional mobility, satisfaction with participation, residual limb comfort, and falls are persistent problems for people with lower-limb amputations (LLAs). Limited mediolateral accommodation of foot prostheses to cross-slope and uneven ground has been suggested to contribute to these problems. The purpose of this study is to examine how variations of prosthetic foot stiffness, width, and split toes alter mediolateral and vertical displacement, forward velocity, and ground-foot orientation during the stance phase of gait on cross-slopes using finite element computer simulation.Materials and MethodsModel construction (material data, geometry, and mesh) and simulations were performed using Ansys LS Dyna. Durawalk foot geometry was used as the base model. Variations included cross-slope angle (5° increments from 10° to −10°), foot stiffness, body mass, foot width, and number of splits. Lateral deviation (millimeter), vertical displacement (millimeter), and change in forward velocity (% of initial) were obtained from the proximal pylon. Foot contact was measured as a percent of the base model foot width.ResultsFor a given foot stiffness, mediolateral displacement, inferior vertical displacement, and forward velocity increased with increased cross-slope. Reduced foot stiffness decreased mediolateral displacement and increased foot contact, inferior vertical displacement, and forward velocity on cross-slopes. Wider foot design increased foot contact but increased mediolateral displacement on cross-slopes. Single- and double-split toes creating two or three cantilever springs improved foot contact and reduced mediolateral displacement compared with full-toe variations.ConclusionsFor full-width foot variations of stiffness, body mass, and width, properties that enabled maintenance of forward velocity during flat-ground walking gait resulted in mixed effectiveness on cross-slopes. Reducing foot stiffness resulted in deformation of the foot on cross-slopes, which reduced mediolateral displacement but increased forward velocity and vertical displacement. Increasing foot stiffness maintained vertical position and forward velocity but reduced foot contact and increased mediolateral displacement. Full-length splits of the foot into two or three cantilever springs resulted in less mediolateral displacement and improved foot contact. Full-length splits reduced performance changes from flat ground to cross-slopes compared with full-width prosthetic feet. Future studies will be necessary to determine which variations are optimal and if these results are sufficient for comfort, skin integrity, and performance for people with LLA who use prosthetic feet.
Insulin resistance in bariatric surgery
Authors: Stenberg Erik , Thorell Anders 
Published: March 2020

Purpose of review
To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery.

Recent findings
The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity.

Summary
At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.
Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
GATA2 +9.5 enhancer: from principles of hematopoiesis to genetic diagnosis in precision medicine
Authors: Soukup Alexandra A. , Bresnick Emery H. 
Published: March 2020

Purpose of review
By establishing mechanisms that deliver oxygen to sustain cells and tissues, fight life-threatening pathogens and harness the immune system to eradicate cancer cells, hematopoietic stem and progenitor cells (HSPCs) are vital in health and disease. The cell biological framework for HSPC generation has been rigorously developed, yet recent single-cell transcriptomic analyses have unveiled permutations of the hematopoietic hierarchy that differ considerably from the traditional roadmap. Deploying mutants that disrupt specific steps in hematopoiesis constitutes a powerful strategy for deconvoluting the complex cell biology. It is striking that a single transcription factor, GATA2, is so crucial for HSPC generation and function, and therefore it is instructive to consider mechanisms governing GATA2 expression and activity. The present review focuses on an essential GATA2 enhancer (+9.5) and how +9.5 mutants inform basic and clinical/translational science.

Recent findings
+9.5 is essential for HSPC generation and function during development and hematopoietic regeneration. Human +9.5 mutations cause immunodeficiency, myelodysplastic syndrome, and acute myeloid leukemia. Qualitatively and quantitatively distinct contributions of +9.5 cis-regulatory elements confer context-dependent enhancer activity. The discovery of +9.5 and its mutant alleles spawned fundamental insights into hematopoiesis, and given its role to suppress blood disease emergence, clinical centers test for mutations in this sequence to diagnose the cause of enigmatic cytopenias.

Summary
Multidisciplinary approaches to discover and understand cis-regulatory elements governing expression of key regulators of hematopoiesis unveil biological and mechanistic insights that provide the logic for innovating clinical applications.
Utility of lymphadenectomy in bladder cancer: where do we stand?
Authors: Sung Hyun Hwan , Lerner Seth P. 
Published: March 2020

Purpose of review
The aim of this review is to provide insight into the current state of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa).

Recent findings
The first prospective, multicenter, randomized, phase III trial to assess the therapeutic benefit of extended versus limited LND at the time of radical cystectomy failed to demonstrate relevant improvement with extended LND, but showed that this approach does not increase overall complications. Although contemporary rate of LND during radical cystectomy has increased, it remains suboptimal. Minimally invasive radical cystectomy with LND is feasible in most patients and has similar lymph node yields and complication rates compared with open procedures when performed by experienced surgeons. Overall major complication, readmission and mortality rates do not significantly differ according to extent of LND.

Summary
Meticulous LND provides both diagnostic and potentially therapeutic benefits in patients with bladder cancer. Results of ongoing trials will provide additional insights regarding the anatomic extent and therapeutic benefit of extended versus standard true pelvic-only LND.
Transurethral resection of bladder tumor and the need for re-transurethral resection of bladder tumor: time to change our practice?
Authors: Soria Francesco , Giordano Andrea , Gontero Paolo 
Published: March 2020

Purpose of review
To summarize the current knowledge on the role of repeated transurethral resection of the bladder (re-TURBT) at the light of recently published trials that indicate the possibility to safely avoid it in well selected patients.

Recent findings
Recently published trials tried to predict the histology of re-TURBT with the aim of improving patients’ selection for this procedure. The en bloc resection technique seems to improve the quality of the resection, thereby diminishing and even eliminating the risk of upstaging and the residual disease rate after TURBT. Moreover, the introduction of multiparametric MRI (mpMRI) in bladder cancer showed initial promising results and aims, in the next future, to play a role in the selection of patients for re-TURBT.

Summary
International guidelines agree to recommend re-TURBT in case of incomplete first resection and in T1 tumors. Conversely, the performance of re-TURBT in case of high-grade/high-risk Ta or in case of absence of detrusor muscle in TURBT specimen remains a matter of debate. Re-TURBT aims to reduce the risk of understaging the disease and to remove residual disease in case of persistent nonmuscle invasive bladder cancer. Actually, upstaging at re-TURBT is not a negligible event in T1 tumors (8–15%), while is quite uncommon in case of Ta tumors (0.4%). Residual disease at re-TURBT is usually found in the majority of patients (55–60%) and seems to impact oncological outcomes, even if recent evidence mitigated its relevance as prognostic factor.
Ureteral and urethral recurrence after radical cystectomy: a systematic review
Authors: Carando Roberto , Shariat Shahrokh F. , Moschini Marco , D’Andrea David 
Published: March 2020

Purpose of review
The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy.

Recent findings
Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69–77 and 83–96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33–93 and 99–100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients’ treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal.

Summary
Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.
Testosterone therapy and risk of breast cancer development: a systematic review
Authors: Ray Al , Fernstrum Austin , Mahran Amr , Thirumavalavan Nannan 
Published: March 2020

Purpose of review
We aim to conduct a systematic review of the literature, document all reported cases of breast cancer development in cis men and female-to-male (FtM) transgender men undergoing testosterone replacement therapy (TRT), and determine if testosterone poses a substantial risk of breast cancer development and recurrence.

Recent findings
A systematic search through December 2019 was performed. Out of 1890, 15 studies were eligible for inclusion in the final analyses. In total, 22 patients have developed breast cancer while on testosterone treatment. Four cases were cis men, whereas 18 cases were FtM. Age ranged from 18 to 61 years. Testosterone treatment duration ranged from 5 weeks up to 25 years.

Summary
There is a relatively higher incidence of BCa in FtM on CSH therapy compared with cis men on TRT. Because of the small sample size of reported cases, we cannot delineate the exact relationship between testosterone therapy and BCa development. Additionally, we have limited data to suggest that TRT should or should not be contraindicated in cis men and FtM with a prior history of breast cancer.
Local Ablative Therapies for Oligometastatic and Oligoprogressive Non–Small Cell Lung Cancer
Authors: Jairam Vikram , Park Henry S. , Decker Roy H. 
Published: March 2020

Abstract
More than half of all patients with non–small cell lung cancer (NSCLC) have metastatic disease at the time of diagnosis. A subset of these patients has oligometastatic disease, which exists in an intermediary state between locoregional and disseminated metastatic disease. In addition, some metastatic patients on systemic therapy may have limited disease progression, or oligoprogression. Historically, treatment of metastatic NSCLC was palliative in nature, with little expectation of long-term survival. However, an accumulation of evidence over the past 3 decades now demonstrates that local ablative therapy to sites of limited metastases or progression can improve patient outcomes for this complex disease. This review examines the evidence behind local ablative therapy in oligometastatic and oligoprogressive NSCLC, with a focus on surgery, stereotactic radiotherapy, and radiofrequency ablation.
Handoff Communication between Remote Healthcare Facilities
Authors: Helmig Sara , Cox Jennifer , Mehta Brinda , Burlison Jonathan , Morgan Jennifer , Russo Carolyn 
Published: March 2020

Introduction:
Handoffs and transitions of care are common weak points in healthcare provider communication as patients move between sites. With no consistent pattern of communication between St. Jude Children’s Research Hospital (St. Jude) and its affiliated clinics, the Affiliate Program Office at St. Jude developed and implemented a standardized communication tool to facilitate patient transitions between different healthcare sites.

Methods:
Each team of providers created flow diagrams to define the current state of communication when patients were transitioning between remote sites. Fishbone diagrams identified the common barriers to effective communication as a lack of consistent communication and ownership. We developed a communication tool to address these barriers, which was disseminated by secure email. We measured the percent usage of the completed hand-off tool before a patient transitioned, staff experience, and the number of errors.

Results:
The time to send or receive the communication bundle was <10 minutes. Within 3 months of implementing the SMART bundle at 3 pilot sites, the bundle was used completely in 6 of 8 patient transitions and was associated with somewhat improved staff satisfaction. We identified no adverse events related to the communication bundle.

Conclusions:
In this small pilot study, we accomplished closed-loop communication between geographically remote healthcare sites by using an electronically transmitted standardized communication bundle.
The Vitals Risk Index—Retrospective Performance Analysis of an Automated and Objective Pediatric Early Warning System
Authors: Gorham Tyler J. , Rust Steve , Rust Laura , Kuehn Stacy , Yang Jing , Lin James Shuhan , Hoffman Jeffrey , Huang Yungui , Lin Simon , McClead Richard , Brilli Richard , Bode Ryan , Maa Tensing 
Published: March 2020

Introduction:
Pediatric in-hospital cardiac arrests and emergent transfers to the pediatric intensive care unit (ICU) represent a serious patient safety concern with associated increased morbidity and mortality. Some institutions have turned to the electronic health record and predictive analytics in search of earlier and more accurate detection of patients at risk for decompensation.

Methods:
Objective electronic health record data from 2011 to 2017 was utilized to develop an automated early warning system score aimed at identifying hospitalized children at risk of clinical deterioration. Five vital sign measurements and supplemental oxygen requirement data were used to build the Vitals Risk Index (VRI) model, using multivariate logistic regression. We compared the VRI to the hospital’s existing early warning system, an adaptation of Monaghan’s Pediatric Early Warning Score system (PEWS). The patient population included hospitalized children 18 years of age and younger while being cared for outside of the ICU. This dataset included 158 case hospitalizations (102 emergent transfers to the ICU and 56 “code blue” events) and 135,597 control hospitalizations.

Results:
When identifying deteriorating patients 2 hours before an event, there was no significant difference between Pediatric Early Warning Score and VRI’s areas under the receiver operating characteristic curve at false-positive rates ≤ 10% (pAUC10 of 0.065 and 0.064, respectively; P = 0.74), a threshold chosen to compare the 2 approaches under clinically tolerable false-positive rates.

Conclusions:
The VRI represents an objective, simple, and automated predictive analytics tool for identifying hospitalized pediatric patients at risk of deteriorating outside of the ICU setting.
Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots Following Tenofovir Alafenamide: The TAF-DBS Study
Authors: Yager Jenna , Castillo-Mancilla Jose , Ibrahim Mustafa E. , Brooks Kristina M. , McHugh Cricket , Morrow Mary , McCallister Scott , Bushman Lane R. , MaWhinney Samantha , Kiser Jennifer J. , Anderson Peter L. 
Published: March 2020

Background:
Tenofovir alafenamide (TAF), in combination with FTC, was recently approved for PrEP in the United States. The objective of this study was to assess the relationship between tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in dried blood spots (DBS) with adherence to TAF/FTC.

Methods:
TAF-DBS was a randomized, crossover clinical study of TFV-DP in DBS, following directly observed dosing of 33%, 67%, or 100% of daily TAF (25 mg)/FTC (200 mg). Healthy volunteers were randomized to 2 different, 12-week dosing regimens, separated by a 12-week washout. DBS were collected weekly. TFV-DP and FTC-TP were extracted from two 7-mm punches and assayed with LC-MS/MS.

Results:
Thirty-seven participants (17 female, 7 African American, and 6 Hispanic) were included. TFV-DP exhibited a mean half-life of 20.8 days (95% confidence interval: 19.3 to 21.3). The slope for TFV-DP versus dosing arm was 1.14 (90% confidence interval: 1.07 to 1.21). The mean (SD) TFV-DP after 12 weeks was 657 (186), 1451 (501), and 2381 (601) fmol/2 7-mm punches for the 33%, 67%, and 100% arms. The following adherence interpretations are proposed: <450 fmol/punches, <2 doses/wk; 450–949 fmol/punches, 2–3 doses/wk; 950–1799 fmol/punches, 4–6 doses/wk; and ≥1800 fmol/punches, 7 doses/wk. FTC-TP was quantifiable for 1 week after drug cessation in 50%, 92%, and 100% of participants in the 33%, 67%, and 100% arms, respectively.

Conclusion:
TFV-DP in DBS after TAF/FTC exhibited a long half-life and was linearly associated with dosing, similar to its predecessor tenofovir disoproxil fumarate. FTC-TP was quantifiable for up to 1 week after drug cessation. Together, these moieties provide complementary measures of cumulative adherence and recent dosing for TAF/FTC.
Is the Vectra 3D Imaging System a Reliable Tool for Predicting Breast Mass?
Authors: Wood Kasey Leigh , Zoghbi Yasmina , Margulies Ilana G. , Ashikari Andrew Y. , Jacobs Jordan , Salzberg Charles Andrew 
Published: March 2020

Background
In selecting breast implants for breast reconstruction, current preoperative planning largely relies on 2-dimensional measurements, which are often limited in suboptimal accuracy and objectivity. Although the introduction of 3-dimensional imaging modalities has further improved preoperative planning, they require in-depth analysis of accuracy if they are to be considered as a standardized part of preoperative planning. Thus, the present study analyzes the reliability of the Vectra 3D Imaging System in predicting breast mass and explores potential confounding variables that may limit its accuracy.

Methods
A retrospective review of 202 breasts that received direct-to-implant reconstruction by a single surgeon between February 2015 and February 2019 was conducted. Variables recorded included Vectra predicted mass (VPM; in grams), mastectomy mass (MM; in grams), ptosis grade, and body mass index (BMI). Body mass index was classified as follows: underweight (BMI < 20 kg/m2), normal (20 kg/m2 ≤ BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). Cup size was approximated as follows: A and smaller (MM ≤250 g), B (250 g < MM ≤ 450 g), C (450 g < MM ≤ 600 g), and D and larger (MM ≥ 600 g). Correlation between MM and VPM was evaluated using 2-tailed Pearson correlation coefficients (r), and associated formula was derived from a linear model. Equality of variances was assessed with the Bartlett test. Correlation coefficients calculated for ptosis and BMI categories were then compared with the overall correlation coefficient. Significance was set at α = 0.05, and analyses were conducted in R 3.6.0, version 1.70.

Results
There was a strong correlation between MM and VPM (R = 0.90, P < 0.0001). The following equation was derived to predict MM: [MM] = 0.8 × [VPM] + 32 (adjusted r
2 = 0.81). The Bartlett test indicated that VPM varies significantly across cup sizes (P < 0.0001). Comparison of correlation coefficients for ptosis and BMI categories revealed a significantly reduced correlation coefficient for pseudoptosis (0.90 vs 0.75, P = 0.0425).

Conclusions
The present study suggests that the reliability of Vectra in predicting breast mass varies across cup sizes and that there exists a significantly decreased association between VPM and MM among pseudoptotic breasts. These are important considerations when using this technology in surgical planning.
Anatomic Study and Clinic Application of Transverse Circumflex Scapular Artery Perforator Flap Repair of Lower Limb Soft Tissue Defects in Children
Authors: Pang Xiaoyang , Cao Zheming , Wu Panfeng , Tang Maolin , Qin Liming , Yu Fang , Zhou Zhenbing , Tang Juyu 
Published: March 2020

Purpose
The aim of this study was to demonstrate the viability of the transverse circumflex scapular artery perforator flap (TCSAPF) in children with soft tissue defects of the lower limb.

Methods
In an anatomic study, 25 fresh cadavers were injected with lead oxide–gelatin for spiral computed tomography and 3-dimensional image reconstruction. In a 3-year clinical application study, children with soft tissue defects and exposed tendons and/or bones in the lower limb underwent free-TCSAPF repair of the defect.

Results
Perforators from the transverse branch of the circumflex scapular artery were identified in both anatomical and clinical studies. The average external diameter was 0.9 ± 0.3 mm. Each perforator supplied an average area of 63.5 ± 16.8 cm2 in anatomical. Twenty-one children were included in this group (9 boys, 12 girls, mean age, 6.6 ± 2.7 years). The size of the flaps ranged from 6 to 17 cm × 4.5 to 7 cm (average, 65.3 ± 22.6 cm2). The average flap harvesting time was 30.1 ± 8.5 minutes, average operation time was 138.6 ± 31.5 minutes, and average blood loss was 89.5 ± 21.9 mL. The average length of the vessel pedicle was 8.2 ± 2.4 cm. Arterial congestion occurred in one child, 18 hours postoperatively; subsequent re-exploration and great saphenous vein transplantation were successful. Of the 3 children who had bulky flaps, 1 patient underwent defatting. Satisfactory outcomes included good appearance and function of the recipient and donor areas.

Conclusions
The TCSAPF provides high-quality skin and vessel flexibility, providing a reliable blood supply in children. The flap has potential benefits over existing perforator flaps.