bluuebunny/crossref_metadata_2025_split huggingface dataset:
Large-Volume Vascularized Muscle Grafts Engineered From Groin Adipose Tissue in Perfusion Bioreactor Culture
Authors: An Yang , Reimers Kerstin , Allmeling Christina , Liu Jieli , Lazaridis Andrea , Strauss Sarah , Vogt Peter M. 
Published: January 2020

Background:Muscle tissue engineering still remains a major challenge. An axial vascular pedicle and a perfusion bioreactor are necessary for the development and maintenance of a large-volume engineered muscle tissue to provide circulation within the construct. This study aimed to determine whether large-volume vascularized muscle-like constructs could be made from rat groin adipose tissue in a perfusion bioreactor.Methods:Epigastric adipofascial flaps based on the inferior superficial epigastric vessels were elevated bilaterally in male Lewis rats and connected to the bioreactor. The system was run using a cable pump and filled with myogenic differentiation medium in the perfusion bioreactor for 1, 3, 5, or 7 weeks. The resulting tissue constructs were characterized with respect to the morphology and muscle-related expression of genes and proteins.Results:The histological examination demonstrated intact muscle-like tissue fibers; myogenesis was verified by the expression of myosin, MADS box transcription enhancer factor 2 D, desmin—a disintegrin and metalloproteinase domain (ADAM) 12—and M-cadherin using reverse transcription–polymerase chain reaction. Western blot analysis for desmin, MyoD1, N-cadherin, and ADAM12 was performed to verify the myogenic phenotype of the extracted differentiated tissue and prove the formation of muscle-like constructs.Conclusions:A large-volume vascularized muscle tissue could be engineered in a perfusion bioreactor. The resulting tissue had muscle-like histological features and expressed muscle-related genes and proteins, indicating that the trans-differentiation of adipose tissue into muscle tissue occurred.
Proenkephalin Compared to Conventional Methods to Assess Kidney Function in Critically Ill Sepsis Patients
Authors: Beunders Remi , van Groenendael Roger , Leijte Guus P. , Kox Matthijs , Pickkers Peter 
Published: January 2020

ABSTRACT

Background:
The assessment of renal function in clinical practice remains challenging. Using creatinine to assess the glomerular filtration rate (GFR) is notoriously inaccurate, and determination of the true GFR, e.g., using inulin or iohexol, is laborious and not feasible in daily practice. Proenkephalin (PENK) is a novel candidate biomarker for kidney function that is filtrated in the glomerulus, has shown to represent steady-state GFR in patients with different severities of renal insufficiency. In this pilot study in non-steady-state critically ill patients, we compared plasma PENK concentrations with creatinine-based GFR assessments and validated both against the “true GFR” measured using a gold standard method: iohexol plasma clearance.

Methods:
Twenty-three critically ill patients with septic shock were included. Kidney function was determined using the Modification of Diet in Renal Disease formula (eGFRMDRD), Endogenous Creatinine Clearance (GFRECC), and iohexol plasma clearance (GFRiohexol) during a 6-h window. Plasma PENK concentrations were measured using the penKid immunoassay.

Results:
The eGFRMDRD and GFRECC correlated with the GFRiohexol (R

2
= 0.82, P < 0.0001 and R

2
= 0.82, P < 0.0001 respectively); however, bias and variability were considerable: the eGFRMDRD overestimated the true GFR with 31 ± 35% (95% limits of agreement: −37% to 100%) and the GFRECC with 37 ± 49% (95% limits of agreement: −59% to 133%). Plasma PENK concentrations showed a very strong inverse correlation with the GFRiohexol (R

2
= 0.90, P < 0.0001) which tended to be better compared with the correlation of eGFRMDRD (P = 0.06) and GFRECC (P = 0.08) with the GFRiohexol.

Conclusions:
In this pilot study in non-steady-state critically ill sepsis patients, GFR appears to be more accurately reflected by plasma PENK concentrations compared to conventional creatinine-based methods. Therefore, PENK holds promise as an accurate and feasible biomarker to determine kidney function during non-steady-state conditions in the critically ill.
A Randomized Controlled Trial of Endovenous Laser Ablation Versus Mechanochemical Ablation With ClariVein in the Management of Superficial Venous Incompetence (LAMA Trial)
Authors: Mohamed Abduraheem Hussein , Leung Clement , Wallace Tom , Smith George , Carradice Daniel , Chetter Ian 
Published: January 2020

Objective:
This RCT compares the clinical, technical and quality of life outcomes after EVLA and MOCA.

Summary of Background Data:
Thermal ablation is the current mainstay treatment for SVI. Newer nonthermal methods of treatment have been developed which do not require the use of tumescent anesthesia. The potential advantages of these newer methods should be tested in RCTs to ascertain their role in the future treatments of SVI.

Methods:
This single-center RCT enrolled patients with symptomatic, unilateral, single-axis SVI. Eligible patients were equally randomized to either EVLA or MOCA, both with concomitant phlebectomy when necessary. The joint primary outcomes were intraprocedural axial ablation pain scores and anatomical occlusion at 1 year. Secondary outcomes included postprocedural pain, venous clinical severity score (VCSS), quality of life (Aberdeen varicose veins questionnaire and EuroQol 5-domain utility index), patient satisfaction and complication rates.

Results:
One hundred fifty patients were randomized equally between the 2 interventions. Both groups reported low intraprocedural pain scores; on a 100 mm visual analog scale, pain during axial EVLA was 22 (9–44) compared to 15 (9–29) during MOCA; P = 0.210. At 1 year, duplex derived anatomical occlusion rates after EVLA were 63/69 (91%) compared to 53/69 (77%) in the MOCA group; P = 0.020. Both groups experienced significant improvement in VCSS and AVVQ after treatment, without a significant difference between groups. Median VCSS improved from 6 (5–8) to 0 (0–1) at one year; P < 0.001. Median AVVQ improved from 13.8 (10.0–17.7) to 2.0 (0.0–4.9); P < 0.001. One patient in the MOCA group experienced DVT.

Conclusions:
Both EVLA and MOCA were highly efficacious in treating SVI; patients improved significantly in terms of disease severity, symptoms, and QoL. Both resulted in low procedural pain with a short recovery time. Axial occlusion rates were higher after EVLA. Long term follow-up is warranted to assess the effect of recanalization on the rate of clinical recurrence.
Preoperative Progressive Pneumoperitoneum Enables Defect Closure and Laparoscopic Repair of Large Parastomal Hernias
Authors: Tang Fuxin , Ma Ning , Li Ying-Ru , Gan Wen-Chang , Zong Zhen , Zhou Tai-Cheng , Chen Shuang 
Published: January 2020

Purpose:
Preoperative progressive pneumoperitoneum (PPP) has not been reported in the management of parastomal hernias; therefore, the present study evaluated its effectiveness in the surgical management of large parastomal hernias.

Patients and Methods:
This prospective, observational study included 23 consecutive patients with large parastomal hernias who underwent PPP between January 2016 and September 2018. The volume of parastomal hernia (VPH), volume of the abdominal cavity (VAC), and the VPH/VAC ratio were measured before and after PPP using abdominal computed tomography scan data. All the hernias were repaired by a laparoscopic or laparoscopic-open-laparoscopic approach using the intraperitoneal Sugarbaker technique.

Results:
Before and after PPP, the mean VPH was 1442 and 1581 mL (P<0.01), and the mean VAC was 5667 and 9194 mL (P<0.01). The VAC increased by 3527 mL (P<0.01) and was greater than the mean VPH before PPP. The VPH/VAC ratio after PPP was reduced at an average of 8.1% (P<0.01). Fascial closure was achieved in all patients, with no clinical evidence of elevated intra-abdominal pressures. The mean follow-up was 24 months (13 to 40 mo), and, to date, no hernia recurrences have been reported in these patients.

Conclusions:
PPP is a feasible and useful tool in the surgical management of large parastomal hernias. It passively expands the abdominal volumes, thereby resulting in respiratory adaptation to elevated intra-abdominal pressures.
Hand-assisted Laparoscopic Repeat Hepatectomy for Secondary Liver Neoplasm
Authors: Mahamid Ahmad , Berger Yael , Halim Nasser A. , Goldberg Natalia , Sawaied Muneer , Bitterman Arie , Sadot Eran , Haddad Riad 
Published: January 2020

Background:
Hand-assisted laparoscopic surgery is a widely accepted alternative to an open approach. The use of this technique in repeat liver resection is limited due to technical difficulties caused by postsurgical adhesions. We aimed to assess the feasibility and safety of hand-assisted laparoscopic repeat hepatectomy (HALRH).

Materials and Methods:
This was a retrospective study of the medical files of patients who had undergone HALRH between 2010 and 2017 in 2 university-affiliated medical centers.

Results:
Sixteen patients with repeat hepatectomy were included with a median age of 67.5 years. The first liver resection was a traditional laparotomy for 9 patients and hand-assisted laparoscopic surgery for 7 patients. The conversion rate to open surgery was 6%. The median operative time, blood loss during surgery, and postoperative hospital stay were 166 minutes, 400 mL, and 7 days, respectively. R0 resections were achieved in 88% of patients. The median number of tumors and tumor size were 1 and of 25 mm, respectively. There were no mortalities or major complications postoperatively. For patients with colorectal liver metastases, the median follow-up and overall survival were 21 and 43 months, respectively.

Conclusion:
The findings suggest HALRH to be safe and feasible. Future ERAS guidelines should evaluate this approach for liver surgery.
Adjunctive use of hepatic angioembolization following hemorrhage control laparotomy
Authors: Matsushima Kazuhide , Hogen Rachel , Piccinini Alice , Biswas Subarna , Khor Desmond , Delapena Samantha , Strumwasser Aaron , Inaba Kenji , Demetriades Demetrios 
Published: January 2020

BACKGROUND
Severe liver injuries pose a challenge to trauma surgeons. While the use of hepatic angioembolization (HAE) has been evaluated as a component of the nonoperative management of liver injury, little is known about the efficacy of postoperative HAE in patients who require hemorrhage control laparotomy (HCL) for liver injury. The purpose of this study is to evaluate the impact of HAE following HCL on patient survival.

METHODS
This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2014. In propensity score matched (2:1) patients who underwent HCL-only or HCL + HAE, the impact of adjunctive use of HAE on patient survival was examined with the Cox proportional hazards regression analysis adjusting for transfusion requirement within 4 hours. We also performed a subgroup analysis in patients without severe traumatic brain injury (Abbreviated Injury Scale head ≤3).

RESULTS
A total of 1,675 patients met our inclusion criteria. Of those, 75 (4.5%) patients underwent HAE after HCL (median hours to HAE, 5 hours after admission). In 225 propensity score-matched patients, the use of HAE following HCL was significantly associated with improved 24-hour mortality, but not in-hospital mortality. In the subgroup of patients without severe traumatic brain injury (n = 189), we observed significant survival benefits (24-hour and in-hospital mortality) associated with the adjunctive use of HAE.

CONCLUSION
The results of our study suggest that the adjunctive use of HAE might improve survival of patients who require HCL for liver injury. Further prospective study to determine the indication for postoperative HAE is still warranted.

LEVEL OF EVIDENCE
Therapeutic study, level III.
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness
Authors: Tignanelli Christopher J. , Silverman Greg M. , Lindemann Elizabeth A. , Trembley Alexander L. , Gipson Jon C. , Beilman Gregory , Lyng John W. , Finzel Raymond , McEwan Reed , Knoll Benjamin C. , Pakhomov Serguei , Melton Genevieve B. 
Published: January 2020

BACKGROUND
Incomplete prehospital trauma care is a significant contributor to preventable deaths. Current databases lack timelines easily constructible of clinical events. Temporal associations and procedural indications are critical to characterize treatment appropriateness. Natural language processing (NLP) methods present a novel approach to bridge this gap. We sought to evaluate the efficacy of a novel and automated NLP pipeline to determine treatment appropriateness from a sample of prehospital EMS motor vehicle crash records.

METHODS
A total of 142 records were used to extract airway procedures, intraosseous/intravenous access, packed red blood cell transfusion, crystalloid bolus, chest compression system, tranexamic acid bolus, and needle decompression. Reports were processed using four clinical NLP systems and augmented via a word2phrase method leveraging a large integrated health system clinical note repository to identify terms semantically similar with treatment indications. Indications were matched with treatments and categorized as indicated, missed (indicated but not performed), or nonindicated. Automated results were then compared with manual review, and precision and recall were calculated for each treatment determination.

RESULTS
Natural language processing identified 184 treatments. Automated timeline summarization was completed for all patients. Treatments were characterized as indicated in a subset of cases including the following: 69% (18 of 26 patients) for airway, 54.5% (6 of 11 patients) for intraosseous access, 11.1% (1 of 9 patients) for needle decompression, 55.6% (10 of 18 patients) for tranexamic acid, 60% (9 of 15 patients) for packed red blood cell, 12.9% (4 of 31 patients) for crystalloid bolus, and 60% (3 of 5 patients) for chest compression system. The most commonly nonindicated treatment was crystalloid bolus (22 of 142 patients). Overall, the automated NLP system performed with high precision and recall with over 70% of comparisons achieving precision and recall of greater than 80%.

CONCLUSION
Natural language processing methodologies show promise for enabling automated extraction of procedural indication data and timeline summarization. Future directions should focus on optimizing and expanding these techniques to scale and facilitate broader trauma care performance monitoring.

LEVEL OF EVIDENCE
Diagnostic tests or criteria, level III.
The Influence of Antithymocyte Globulin Dose on the Incidence of CMV Infection in High-risk Kidney Transplant Recipients Without Pharmacological Prophylaxis
Authors: de Paula Mayara I. , Bae Sunjae , Shaffer Ashton A. , Garonzik-Wang Jacqueline , Felipe Claudia R. , Cristelli Marina P. , Waldram Madeleine M. , Massie Allan B. , Medina-Pestana Jose , Segev Dorry L. , Tedesco-Silva Helio 
Published: January 2020

Background.
Optimizing antithymocyte globulin (ATG) dosage is critical, particularly for high-risk kidney transplant (KT) recipients without cytomegalovirus (CMV) prophylaxis.

Methods.
We studied 630 KT recipients with expanded criteria donors or panel reactive antibody ≥50% at Hospital do Rim, Brazil (January 1, 2013 to May 21, 2015) to determine whether a single ATG dose was safe and effective in patients without CMV prophylaxis. Patients received ≥4 doses (1–1.5 mg/kg/per dose) until June 17, 2014, when the induction protocol changed to a single ATG dose (3 mg/kg). We used Cox regression to compare the risk of CMV infection and acute rejection (AR) among KT recipients by ATG dose.

Results.
Adjusting for clinical and transplant factors, a single ATG dose was associated with a lower risk of CMV infection (adjusted hazard ratio [aHR]: 0.63; 95% confidence interval [CI], 0.42-0.93; P = 0.02) and a similar risk of AR (aHR: 1.16; 95% CI, 0.47-2.83; P = 0.8), compared to multiple doses. We found no differences in death-censored graft loss (5.0% versus 4.8%, aHR: 1.06; 95% CI, 0.51-2.23; P = 0.9) or mortality (4.7% versus 3.4%; aHR: 1.42; 95% CI, 0.62-3.24; P = 0.4) at 1-year post-KT by ATG dose.

Conclusions.
In our study of high-risk KT recipients without CMV prophylaxis, a single ATG dose decreased the risk of CMV infection without increasing the risk of AR or compromising graft or patient survival.
Pretransplant NT-proBNP, Dialysis Vintage, and Posttransplant Mortality in Kidney Transplant Recipients
Authors: Yeung Stanley M.H. , van Londen Marco , Nakshbandi Uzma , Said M. Yusof , Eisenga Michele F. , Hepkema Bouke G. , Nolte Ilja M. , Berger Stefan P. , de Borst Martin H. , Bakker Stephan J.L. 
Published: January 2020

Background.
End-stage kidney disease and dialysis vintage are characterized by accelerated atherosclerosis, volume overload, and progressive left ventricular hypertrophy, leading to elevated N-terminal probrain natriuretic peptide (NT-proBNP) levels. Pretransplant dialysis vintage is associated with excess mortality after transplantation. We want to study whether pretransplant NT-proBNP is associated with posttransplantation mortality and if it explains the association of dialysis vintage with posttransplantation mortality in kidney transplant recipients (KTR).

Methods.
We measured plasma NT-proBNP on arrival at the hospital before kidney transplantation in 658 KTR between January 1995 and December 2005 in our center. Multivariable Cox regression analyses, adjusted for potential confounders, were used to prospectively study the associations of dialysis vintage and NT-proBNP with all-cause mortality.

Results.
During median 12.7 (7.8–15.6) years of follow-up after transplantation, 248 (37.7%) KTR died. Dialysis vintage was associated with an increased risk of posttransplant mortality in the fully adjusted model (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.03-1.43; P = 0.02), independent of potential confounders. The association weakened materially and lost significance after further adjustment for NT-proBNP (HR, 1.14; 0.96–1.34; P = 0.14). NT-proBNP was independently associated with all-cause mortality in the fully adjusted model (HR, 1.34; 1.16–1.55; P < 0.001). The association remained independent of adjustment for dialysis vintage (HR, 1.31; 1.13–1.52; P < 0.001).

Conclusions.
Our study shows that longer dialysis vintage is associated with a higher mortality risk in KTR, and this association might be explained for a considerable part by variation in pretransplant NT-proBNP at the time of transplantation.
Breach Rhythm May Be Suppressed as a Form of Todd's Paralysis
Authors: Lyudmilov Cristina , Petersone Daina , Schmidt Christian , Bösel Julian , Rösche Johannes 
Published: January 2020

Summary:
This case report will provide further evidence for the fact that breach rhythm is not the effect of a bone abnormality only. We present the case of an 84–year-old woman, who had a craniotomy 14 month before admission to our emergency department with a focal inhibitory status epilepticus. Even after clinical recovery, electroencephalography revealed frequent subclinical seizure patterns. When seizure activity was suppressed by anticonvulsive medication with levetiracetam, breach rhythm appeared. Breach rhythm develops usually some months after craniotomy and therefore should have been established in our patient at the time of admission. Therefore, it is reasonable to assume that it was in some way suppressed by the seizure activity in our primary EEG recordings. The appearance of the breach rhythm after the complete suppression of seizure activity by antiepileptic drug treatment shows that breach rhythm is not purely the result of a skull defect but is related to the functional state of the brain tissue beneath.
Immunotherapy Implication of Signature-Guided Biomarker Discovery for Trastuzumab-Resistant HER2-Positive Breast Cancer
Authors: Sand Andrea , Duffin Aspen T. , Riddell Geoffrey T. , Piacsek Mitchel , Last Brittany , Sun Chaoyang , Rovin Richard A. , Tjoe Judy A. , Yin Jun 
Published: January 2020

AbstractDespite the great improvement of patient outcomes by trastuzumab, a monoclonal antibody targeted on HER2-positive breast cancer, approximately 23% of patients with early-stage disease treated with adjuvant trastuzumab either fail to respond or experience recurrence within 10 years, highlighting the importance of identifying which HER2-positive patients would benefit from trastuzumab upfront. Efforts to identify biomarkers predictive of response to trastuzumab in initial breast tumor core biopsies have been complicated by the clinical and biological heterogeneity of HER2-positive tumors. Therefore, we identified a trastuzumab-resistant (TrR) signature that accurately predicts response to trastuzumab quantitively and qualitatively in vitro and in vivo, via repurposing transcriptome profiles in an engineered cell line model. We additionally demonstrated that our TrR signature was associated with tumor progression and capable of stratifying patient prognosis. Our study further illustrated the possible mechanism of this resistance as being less inherited cytotoxic T cell infiltration and failure to secrete Interferon-γ upon trastuzumab treatment in TrR tumors. These findings highlight the potential clinical application of TrR signature in treatment management and identifying possible immunotherapy interventions.
Machine Learning Approaches for the Prediction Bone Mineral Density by using genomic and phenotypic data of 5,130 older Men
Authors: Wu Qing , Nasoz Fatma , Jung Jongyun , Bhattarai Bibek , Han Mira V 
Published: January 2020

AbstractBackgroundThe study aimed to utilize machine learning (ML) approaches and genomic data to develop the prediction model for bone mineral density (BMD), and to identify the best modeling approach for BMD prediction.MethodThe genomic and phenotypic data of Osteoporotic Fractures in Men Study (n=5,130), was analyzed. Genetic risk score (GRS) was calculated from 1,103 associated SNPs for each participant after a comprehensive genotype imputation. Data were normalized and divided into a training set (80%) and a validation set (20%) for analysis. Random forest, gradient boosting, neural network, and linear regression were used to develop prediction models for BMD separately. The 10-fold cross-validation was used for hyperparameter optimization. Mean square error and mean absolute error were used to assess model performance. Results: When using GRS and phenotypic covariates as the predictors, the performance of all ML models and linear regression in BMD prediction is similar. However, when replacing GRS with the 1,103 individual SNPs in the model, ML models performed significantly better than linear regression, and the gradient boosting model performed the best. Conclusion: Our study suggested that ML models, especially gradient boosting, can improve BMD prediction in genomic data.