bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps
Authors: Haddock Nicholas T. , Suszynski Thomas M. , Teotia Sumeet S. 
Published: November 2020

Background:
Multiple perforator flap breast reconstruction is an option that avoids implants in selected patients with minimal donor tissue. The technique addresses the need for additional skin to help create a breast envelope with more natural ptosis and additional volume to help create a body-appropriate breast mound while avoiding serial fat grafting. Using four flaps for the reconstruction of two breasts (bilateral stacked flap reconstruction) has recently become feasible with the advancement of microsurgical techniques, increased experience with alternative perforator flaps, and use of co-surgery. In this article, we describe our early experience with bilateral stacked flap breast reconstruction.

Methods:
From January of 2014 to October of 2018, the senior co-surgeons performed 50 consecutive bilateral stacked flap operations at a single institution. All reconstructions were performed in delayed fashion with a mean operative time of 10 hours. Most breasts (94 percent) were reconstructed with a deep inferior epigastric perforator flap combined with a profunda artery perforator flap. Most flap microanastomoses (91.5 percent) were performed directly with internal mammary vessels. The larger of the two flaps was typically placed inferiorly (66 percent), but there was significant inset variability.

Results:
Of 200 flaps, five were lost (2.5 percent). Seven take-backs were needed for a flap-related concern, which included two negative explorations and a flap salvage. The most common non–flap-related complication was a thigh wound (17 total, eight requiring a procedure).

Conclusion:
The authors’ early experience suggests that bilateral stacked flap breast reconstruction is a powerful tool that can be performed with an acceptable microsurgical risk and an acceptable complication profile in highly selected patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Mindfulness-Based Physical Activity Intervention: A Randomized Pilot Study
Authors: Sala Margaret , Geary Bree , Baldwin Austin S. 
Published: November 2020

ABSTRACT

Objective
Most US adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance. A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared with the control condition.

Methods
Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-laboratory session in the manner in which they were randomized (i.e., mindfulness recording versus using a heart rate monitor) and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer.

Results
The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared with the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity minutes (mean difference = 67.16 minutes) and accelerometer-measured minutes (mean difference = 35.48 minutes) during a 1-week follow-up.

Conclusions
The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.
Mindfulness-Based Analgesia or Placebo Effect? The Development and Evaluation of a Sham Mindfulness Intervention for Acute Experimental Pain
Authors: Davies Jonathan N. , Sharpe Louise , Day Melissa A. , Colagiuri Ben 
Published: November 2020

ABSTRACT

Objective
Meta-analyses indicate that mindfulness meditation is efficacious for chronic and acute pain, but most available studies lack active control comparisons. This raises the possibility that placebo-related processes may account, at least in part, for mindfulness effects. The objective of this study was to develop a closely matched sham mindfulness condition to establish whether placebo effects contribute to mindfulness-based interventions for pain.

Methods
We developed and validated a closely matched sham mindfulness intervention then compared it with 6 × 20-minute sessions of focused-attention mindfulness and a no-treatment condition in 93 healthy volunteers undergoing acute experimental heat pain.

Results
The sham mindfulness intervention produced equivalent credibility ratings and expectations of improvement as the mindfulness intervention but did not influence mindfulness-related processes. In contrast, mindfulness increased “observing” relative to no treatment but not sham. Mindfulness (F(1,88) = 7.06, p = .009, ηp
2 = 0.07) and sham (F(1,88) = 6.47, p = .012, ηp
2 = 0.07) moderately increased pain tolerance relative to no treatment, with no difference between mindfulness and sham (F(1,88) = 0.01, p = .92, ηp
2 < 0.001). No differences were found for pain threshold. Similarly, neither mindfulness nor sham reduced pain intensity or unpleasantness relative to no treatment, although mindfulness reduced pain unpleasantness relative to sham (F(1,88) = 5.03, p = .027, ηp
2 = 0.05).

Conclusions
These results suggest that placebo effects contribute to changes in pain tolerance after mindfulness training, with limited evidence of specific effects of mindfulness training on pain unpleasantness relative to sham, but not no treatment. To disentangle the specific analgesic effects of mindfulness from placebo-related processes, future research should prioritize developing and incorporating closely matched sham conditions.

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618001175268).
Comparative Analysis of Presentation and Outcome After Liver Resection of Patients With Hepatocellular Carcinoma With and Without HIV
Authors: Zhao Hui , Li Jiao , Li Shuqi , Wang Yong , Zhou Jian , Liu Lizhi , Wang Cunchuan 
Published: November 2020

Objective:
Evidence shows that HIV infection may affect the survival outcome of patients with hepatocellular carcinoma (HCC). In this article, we aimed to determine whether HIV affected the overall survival of patients with HCC in China and ascertain the risk factors.

Design:
Retrospective cohort study.

Methods:
Participants were enrolled from a single medical center in Guangzhou, China. Survival was assessed using Kaplan–Meier plots and compared using the log-rank test. A multivariable Cox regression analysis was used to assess the effect of HIV seropositivity on patient overall survival while accounting for common prognostic factors.

Results:
The Kaplan–Meier plots showed that the median survival time of patients who were HIV-positive was 18 months shorter than that of their HIV-negative counterparts (P = 0.00, log rank). The 1- and 3-year rates of survival for HIV-positive patients were 65.4% and 29.9%, which were 93.3% and 79.1% for HIV-negative patients. The death rate due to tumor recurrence and liver failure in the HIV-positive patients was apparently higher than those of the HIV-negative patients (tumor recurrence, 42.3% vs. 17.3%, P = 0.016; liver failure, 19.2% vs. 2.7%, P = 0.012, respectively). Independent factors predicting survival were initial presentation, HIV serostatus, United Network of Organ Sharing–modified tumor-node-metastasis stage, Barcelona Clinic Liver Cancer stage, aspartate aminotransferase, histological pattern, and microvascular invasion.

Conclusions:
HIV-positive subjects with HCC have a poorer survival outcome than their HIV-negative counterparts, with tumor recurrence and liver failure as the main causes of death. Despite adequate curative therapy, HIV serostatus is associated with decreased survival of patients with HCC, independent of symptomatic presentation, tumor staging, and liver function.
Early versus delayed complex abdominal wall reconstruction with biologic mesh following damage-control surgery
Authors: Gogna Shekhar , Latifi Rifat , Choi James , Con Jorge , Prabhakaran Kartik , Anderson Patrice L. , Policastro Anthony J. , Klein Joshua , Samson David J. , Smiley Abbas , Rhee Peter 
Published: November 2020

BACKGROUND
Damage-control surgery for trauma and intra-abdominal catastrophe is associated with a high rate of morbidities and postoperative complications. This study aimed to compare the outcomes of patients undergoing early complex abdominal wall reconstruction (e-CAWR) in acute settings versus those undergoing delayed complex abdominal wall reconstruction (d-CAWR).

METHOD
This study was a pooled analysis derived from the retrospective and prospective database between the years 2013 and 2019. The outcomes were compared for differences in demographics, presentation, intraoperative variables, Ventral Hernia Working Grade (VHWG), US Centers for Disease Control and Prevention wound class, American Society of Anesthesiologists (ASA) scores, postoperative complications, hospital length of stay, and readmission rates. We performed Student’s t test, χ2 test, and Fisher’s exact test to compare variables of interest. Multivariable linear regression model was built to evaluate the association of hospital length of stay and all other variables including the timing of complex abdominal wall reconstruction (CAWR). A p value of <0.05 was considered significant.

RESULTS
Of the 236 patients who underwent CAWR with biological mesh, 79 (33.5%) had e-CAWR. There were 45 males (57%) and 34 females (43%) in the e-CAWR group. The ASA scores of IV and V, and VHWG grades III and IV were significantly more frequent in the e-CAWR group compared with the d-CAWR one. Postoperatively, the incidence of surgical site occurrence, Clavien-Dindo complications, comprehensive complication index, unplanned reoperations, and mortality were similar between the two groups. Backward linear regression model showed that the timing of CAWR (β = −11.29, p < 0.0001), ASA (β = 3.98, p = 0.006), VHWG classification (β = 3.62, p = 0.015), drug abuse (β = 13.47, p = 0.009), and two comorbidities of cirrhosis (β = 12.34, p = 0.001) and malignancy (β = 7.91, p = 0.008) were the significant predictors of the hospital length of stay left in the model.

CONCLUSION
Early CAWR led to shorter hospital length of stay compared with d-CAWR in multivariable regression model.

LEVEL OF EVIDENCE
Therapeutic, level IV.
The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies: A prospective EAST multicenter study
Authors: El Hechi Majed , Kongkaewpaisan Napaporn , Naar Leon , Aicher Brittany , Diaz Jose , O’Meara Lindsay , Decker Cassandra , Rodriquez Jennifer , Schroeppel Thomas , Rattan Rishi , Vasileiou Georgia , Yeh D. Dante , Simonoski Ursula , Turay David , Cullinane Daniel , Emmert Cory , McCrum Marta , Wall Natalie , Badach Jeremy , Goldenberg-Sandau Anna , Carmichael Heather , Velopulos Catherine , Choron Rachel , Sakran Joseph , Bekdache Khaldoun , Black George , Shoultz Thomas , Chadnick Zachary , Sim Vasiliy , Madbak Firas , Steadman Daniel , Camazine Maraya , Zielinski Martin , Hardman Claire , Walusimbi Mbaga , Kim Mirhee , Rodier Simon , Papadopoulos Vasileios , Tsoulfas Georgios , Perez Javier , Kaafarani Haytham M.A. 
Published: November 2020

BACKGROUND
The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL).

METHODS
This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method.

RESULTS
From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively.

CONCLUSION
Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III
The interiors of Uranus and Neptune: current understanding and open questions
Authors: Helled Ravit , Fortney Jonathan J. 
Published: November 2020

Uranus and Neptune form a distinct class of planets in our Solar System. Given this fact, and ubiquity of similar-mass planets in other planetary systems, it is essential to understand their interior structure and composition. However, there are more open questions regarding these planets than answers. In this review, we concentrate on the things we do not know about the interiors of Uranus and Neptune with a focus on why the planets may be different, rather than the same. We next summarize the knowledge about the planets’ internal structure and evolution. Finally, we identify the topics that should be investigated further on the theoretical front as well as required observations from space missions.
This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
The rings and small moons of Uranus and Neptune
Authors: Showalter Mark R. 
Published: November 2020

All four giant planets are encircled by distinctive systems of rings and small, inner satellites. These all reside within or near their central planet's Roche limit, the rough boundary within which bodies held together by self-gravity will be disrupted by tidal forces. However, the similarities of the four ring-moon systems end here; in most other regards, they are remarkably diverse. We study these systems for three key reasons: (1) for the information they reveal about the properties, history and ongoing evolution of the planetary systems of which they are a part; (2) as dynamical analogues for other astrophysical systems such as protoplanetary disks; and (3) for the wealth of fascinating properties and origin scenarios that make them worthy of study in their own right. The inner Uranus system is characterized by 10 narrow rings, some quite dense, as well as a variety of more tenuous structures. These are accompanied by 13 known moons all orbiting interior to Miranda. Nine of these, Bianca through Perdita, comprise the most densely packed set of moons in the solar system, with orbits so close that their interactions appear to drive chaos over time scales approximately 106years. Neptune has five named rings, all optically thin, interleaved with seven inner moons. The most notable feature is a set of arcs embedded within the Adams ring; two of these arcs have been stable for time scales of decades.This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Topography and geology of Uranian mid-sized icy satellites in comparison with Saturnian and Plutonian satellites
Authors: Schenk Paul M. , Moore Jeffrey M. 
Published: November 2020

Newly processed global imaging and topographic mapping of Uranus's five major satellites reveal differences and similarities to mid-sized satellites at Saturn and Pluto. Three modes of internal heat redistribution are recognized. The broad similarity of Miranda's three oval resurfacing zones to those mapped on Enceladus and (subtly) on Dione are likely due to antipodal diapiric upwelling. Conversely, break-up and foundering of crustal blocks accompanied by extensive (cryo)volcanism is the dominant mode on both Charon and Ariel. Titania's fault network finds parallels on Rhea, Dione, Tethys and possibly Oberon. Differences in the geologic style of resurfacing in the satellite systems (e.g. plains on Charon, Dione, Tethys and perhaps Titania versus ridges on Miranda and Ariel) may be driven by differences in ice composition. Surface processes such as volatile transport may also be indicated by bright and dark materials on Oberon, Umbriel and Charon. The more complete and higher quality observations of the Saturnian and Plutonian mid-sized icy satellites by Cassini and New Horizons reveal a wealth of features and phenomena that cannot be perceived in the more limited Voyager coverage of the Uranian satellites, harbingers of many discoveries awaiting us on a return to Uranus.This article is part of a discussion meeting issue ‘Future exploration of ice giant systems'.
Cross-NASA divisional relevance of an Ice Giant mission
Authors: Cohen Ian J. , Rymer Abigal M. 
Published: November 2020

Robotic space exploration to the outer solar system is difficult and expensive and the space science community works inventively and collaboratively to maximize the scientific return of missions. A mission to either of our solar system Ice Giants, Uranus and Neptune, will provide numerous opportunities to address high-level science objectives relevant to multiple disciplines and deliberate cross-disciplinary mission planning should ideally be woven in from the start. In this review, we recount past successes as well as (NASA-focused) challenges in performing cross-disciplinary science from robotic space exploration missions and detail the opportunities for broad-reaching science objectives from potential future missions to the Ice Giants.
This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Poor correlation between antibody titers and neutralizing activity in sera from SARS-CoV-2 infected subjects
Authors: Criscuolo Elena , Diotti Roberta A. , Strollo Marta , Rolla Serena , Ambrosi Alessandro , Locatelli Massimo , Burioni Roberto , Mancini Nicasio , Clementi Massimo , Clementi Nicola 
Published: November 2020

AbstractPlenty of serologic tests for SARS-CoV-2 have been developed so far, thus documenting the importance of evaluating the relevant features of the immune response to this viral agent. The performance of these assays is currently under investigation. Amongst them, LIAISON® SARS-CoV-2 S1/S2 IgG by DiaSorin and Elecsys Anti-SARS-CoV-2 cobas® by Roche are currently used by laboratory medicine hospital departments in Italy and many other countries. In the present study, we have firstly compared two serologic tests on serum samples collected at two different time points from forty-six laboratory-confirmed COVID-19 subjects. Secondly, eighty-five negative serum samples collected before the SARS-CoV-2 pandemic were analyzed. Thirdly, possible correlations between antibody levels and the resulting neutralizing activity against a clinical isolate of SARS-CoV-2 were evaluated. Results revealed that both tests are endowed with low sensitivity on the day of hospital admission, which increased to 97.8 and 100% for samples collected after 15 days for DiaSorin and Roche tests, respectively. The specificity of the two tests ranges from 96.5 to 100%, respectively. Importantly, a poor direct correlation between antibody titers and neutralizing activity levels was evidenced in the present study.
Team contact sports in times of the COVID-19 pandemic- a scientific concept for the Austrian football league
Authors: van der Zee-Neuen Antje , Schaffler-Schaden Dagmar , Herfert Jürgen , O’Brien James , Johansson Tim , Kutschar Patrick , Seymer Alexander , Ludwig Stephan , Stöggl Thomas , Keeley David , Resch Herbert , Osterbrink Jürgen , Flamm Maria 
Published: November 2020

AbstractBackgroundSince the beginning of the COVID -19 pandemic, many contact sport teams are facing major challenges to safely continue training and competition.ObjectiveWe present the design and implementation of a structured monitoring concept for the Austrian national football leagueMethods146 professional players from five clubs of the professional Austrian football league were monitored for a period of 12 weeks. Subjective health parameters, PCR- test results and data obtained from a geo-tracking app were collected. Simulations modelling the consequences of a COVID-19 case with increasing reproduction number were computed.ResultsNo COVID-19 infection occurred during the observation period in the players. Infections in the nearer surroundings lead to increased perceived risk of infection. Geo tracking was particularly hindered due to technical problems and reluctance of users. Simulation models suggested a hypothetical shut-down of all training and competition activities.ConclusionsA structured monitoring concept can help to continue contact sports safely in times of a pandemic. Cooperation of all involved is essential.Trial registrationID: DRKS00022166 15/6/2020 https://www.who.int/ictrp/search/en/Key Points-The results of this study can inform the development of future prevention and monitoring strategies in professional football and beyond, potentially serving as a blueprint for the safe continuation of sports and physical activity, across a broad range of settings, during and following a pandemic such as COVID-19.-Health parameters should be digitally recorded and closely monitored to enable quick response in case of a COVID-19 infection.