bluuebunny/crossref_metadata_2025_split huggingface dataset:
Holographic Augmented Reality for DIEP Flap Harvest
Authors: Wesselius Tycho S. , Meulstee Jene W. , Luijten Gijs , Xi Tong , Maal Thomas J. J. , Ulrich Dietmar J. O. 
Published: December 2020

Background:
During a deep inferior epigastric perforator (DIEP) flap harvest, the identification and localization of the epigastric arteries and its perforators are crucial. Holographic augmented reality is an innovative technique that can be used to visualize this patient-specific anatomy extracted from a computed tomographic scan directly on the patient. This study describes an innovative workflow to achieve this.

Methods:
A software application for the Microsoft HoloLens was developed to visualize the anatomy as a hologram. By using abdominal nevi as natural landmarks, the anatomy hologram is registered to the patient. To ensure that the anatomy hologram remains correctly positioned when the patient or the user moves, real-time patient tracking is obtained with a quick response marker attached to the patient.

Results:
Holographic augmented reality can be used to visualize the epigastric arteries and its perforators in preparation for a deep inferior epigastric perforator flap harvest.

Conclusions:
Potentially, this workflow can be used visualize the vessels intraoperatively. Furthermore, this workflow is intuitive to use and could be applied for other flaps or other types of surgery.
Musculoseptocutaneous Perforator of Anterolateral Thigh Flap: A Clinical Study
Authors: Hsieh Frank , Leow Osbert Qi Yao , Cheong Chon-Fok , Hung Shao-Yu , Tsao Chung-Kan 
Published: December 2020

Background:
The anterolateral thigh flap is one of the most useful workhorse flaps for microsurgical reconstruction. However, it can pose a great challenge to surgeons because of its anatomical variability. As the technology advances, not only septocutaneous or musculocutaneous courses of anterolateral thigh perforators but also a hybrid musculoseptocutaneous perforator pattern have been identified on computerized imaging and on cadaveric study. However, there is a paucity of clinical study in the literature. The aim of this investigation was to identify the features of this pattern.

Methods:
All patients undergoing anterolateral thigh flap harvest between September of 2017 and May of 2018 performed by a single surgeon are included. Every pulsatile perforator was dissected to document its location on the thigh, emerging location (septum/muscle), size, course, and origin.

Results:
Thirty-seven patients with 115 perforators were identified. Ten percent of perforators were septocutaneous, 37 percent were musculoseptocutaneous, and 52 percent were musculocutaneous. Forty-seven percent of perforators emerged on the septum between the rectus femoris and the vastus lateralis. Eighty-one percent of patients had one or more perforators in the “hot zone.” Medium and large perforators were more frequently located in the proximal and hot zones. All perforators originated from the vascular tree of the lateral circumflex femoral artery, with 10 percent originating from the transverse branch, 28 percent originating from the oblique branch, and 62 percent originating from the descending branch.

Conclusions:
A high proportion of musculoseptocutaneous perforators were identified. The clinical relevance of this is to be very cautious on the skin paddle design while harvesting the flap.
Hyperbaric Oxygen Therapy in Management of Diabetic Foot Ulcers: Indocyanine Green Angiography May Be Used as a Biomarker to Analyze Perfusion and Predict Response to Treatment
Authors: Hajhosseini Babak , Chiou Grace J. , Virk Sarah S. , Chandra Venita , Moshrefi Shawn , Meyer Shannon , Kamperman Kathryn J. , Gurtner Geoffrey C. 
Published: December 2020

Summary:
The authors present indocyanine green angiography to assess the effects of hyperbaric oxygen therapy and as a potential biomarker to predict healing of chronic wounds. They hypothesize that favorable initial response to hyperbaric oxygen therapy (improved perfusion) would be an early indicator of eventual response to the treatment (wound healing). Two groups were recruited: patients with chronic wounds and unwounded healthy controls. Inclusion criteria included adults with only one active wound of Wagner grade III diabetic foot ulcer or caused by soft-tissue radionecrosis. Patients with chronic wounds underwent 30 to 40 consecutive hyperbaric oxygen therapy sessions, once per day, 5 days per week; controls underwent two consecutive sessions. Indocyanine green angiography was performed before and after the sessions, and perfusion patterns were analyzed. Healing was determined clinically and defined as full skin epithelialization with no clinical evidence of wound drainage. Fourteen chronic-wound patients and 10 controls were enrolled. Unlike unwounded healthy volunteers, a significant increase in indocyanine green angiography perfusion was found in chronic-wound patients immediately after therapy (p < 0.03). Moreover, the authors found that 100 percent of the wounds that demonstrated improved perfusion from session 1 to session 2 went on to heal within 30 days of hyperbaric oxygen therapy completion, compared with none in the subgroup that did not demonstrate improved perfusion (p < 0.01). This study demonstrates a beneficial impact of hyperbaric oxygen therapy on perfusion in chronic wounds by ameliorating hypoxia and improving angiogenesis, and also proposes a potential role for indocyanine green angiography in early identification of those who would benefit the most from hyperbaric oxygen therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Pushing the Envelope: Skin-Only Mastopexy in Single-Stage Nipple-Sparing Mastectomy with Direct-to-Implant Breast Reconstruction
Authors: Aliotta Rachel E. , Scomacao Isis , Duraes Eliana F. R. , Kwiecien Grzegorz J. , Durand Paul D. , Fanning Alicia , Moreira Andrea 
Published: December 2020

Background:
Despite advances in skin envelope reduction techniques and experienced nipple-sparing mastectomy flap procedures, the rate of nipple malposition and secondary revision in these patients remains high and eligible candidates are limited. In this article, the authors present a novel technique combining skin reduction nipple-sparing mastectomy surgery with single-stage skin-only mastopexy and direct-to-implant reconstruction.

Methods:
A retrospective review was performed at a single institution from 2015 to 2018. All patients were operated on using this technique consecutively, by a breast and plastic surgeon team (A.F. and A.M.). Surgical technique and outcomes were compared with the currently accepted literature.

Results:
Twenty-six patients (40 breasts) underwent this technique; all were single-stage direct-to-implant reconstructions. The average body mass index was 31 kg/m2. A Wise pattern was used in 35 breasts (87.5 percent) and prepectoral placement was used in 25 breasts (62.5 percent). Overall complications included seroma [n = 6 (15 percent)], vertical/T-junction dehiscence [n = 4 (10 percent)], skin necrosis [n = 4 (10 percent)], superficial or partial nipple necrosis [n = 4 (10 percent)], with no total nipple-areola complex lost and no reconstructive failures at 18.7 months’ average follow-up.

Conclusions:
In this article, the authors share a novel reconstructive technique in which the skin envelope is reduced, the nipple-areola complex is repositioned, and a direct-to-implant reconstruction is performed in a single stage at the time of mastectomy. Consideration of pearls and pitfalls accompanies a review of the authors’ experienced complication profile, and is discussed in the context of current literature.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Truth-in-Advertising Laws: Are They Working? A Cross-Sectional Analysis of a “Plastic Surgeon” Patient Search Simulation
Authors: Chattha Anmol , Muste Justin , Chen Austin D. , Lee Bernard T. , Lin Samuel J. , Roth Malcolm Z. 
Published: December 2020

Background:
Non–board-certified plastic surgeons performing cosmetic procedures and advertising as plastic surgeons may have an adverse effect on a patient’s understanding of their practitioner’s medical training and patient safety. The authors aim to assess (1) the impact of city size and locations and (2) the impact of health care transparency acts on the ratio of board-certified and non–American Board of Plastic Surgeons physicians.

Methods:
The authors performed a systematic Google search for the term “plastic surgeon [city name]” to simulate a patient search of online providers. Comparisons of board certification status between the top hits for each city were made. Data gathered included city population, regional location, practice setting, and states with the passage of truth-in-advertising laws.

Results:
One thousand six hundred seventy-seven unique practitioners were extracted. Of these, 1289 practitioners (76.9 percent) were American Board of Plastic Surgery–certified plastic surgeons. When comparing states with truth-in-advertising laws and states without such laws, the authors found no significant differences in board-certification rates among “plastic surgery” practitioners (88.9 percent versus 92.0 percent; p = 0.170). There was a significant difference between board-certified “plastic surgeons” versus out-of-scope practitioners on Google search between large, medium, and small cities (100 percent versus 92.9 percent versus 86.5; p < 0.001).

Conclusions:
Non–board-certified providers tend to localize to smaller cities. Truth-in-advertising laws have not yet had an impact on the way a number of non–American Board of Plastic Surgery–certified practitioners market themselves. There may be room to expand the scope of truth-in-advertising laws to the online world and to smaller cities.
Plastic Surgery and the Malpractice Industry
Authors: Boyd J. Brian , Moon Harry K. , Martin Susan , Mastrogiovanni Dena B. 
Published: December 2020

Summary:
The current status of the plastic surgeon in the medical liability spectrum and ways to avoid litigation are explored by using pooled national data from the Medical Professional Liability Association, private information from Applied Medico-Legal Solutions RRG, and a detailed literature search. The medical liability system in the United States costs $55.6 billion, or 2.4 percent of total health care spending. Plastic surgery accounts for 3.31 percent of reported claims and 3.16 percent of paid claims. Total payments for plastic surgeons represent 1.75 percent of the total paid for all specialties. Malpractice awards are relatively light for plastic surgeons. Nevertheless, they still have a 15 percent chance per year of being sued. However, 93 percent of cases will close with a dismissal or a settlement, and only 7 percent will go to trial. Of these, the plastic surgeon will prevail in 79 percent. Most importantly, 75 percent of all cases will result in no payment. To minimize the chances of a lawsuit, plastic surgeons should maintain excellent communication with their patients and participate in shared decision-making. They should take a leadership role and buy in to the performance of perioperative checklists, embrace patient education, and actively participate in Maintenance of Certification. They should be transparent in their dealings with patients by preoperatively declaring their policies on revisions, refunds, complications, and payments. Plastic surgeons must maintain complete and accurate medical records and participate in hospital-based programs of prophylaxis. They should be aware that postoperative infection is the single costliest adverse outcome and proactively deal with it.
Cellular Mechanisms of Rejection of Optic and Sciatic Nerve Transplants: An Observational Study
Authors: Yonar Merve , Uehara Mayuko , Banouni Naima , Kasinath Vivek , Li Xiaofei , Jiang Liwei , Zhao Jing , Bei Fengfeng , Shin Su Ryon , Cetrulo Curtis L. , Annabi Nasim , Abdi Reza 
Published: December 2020

Background.
Organ transplantation is a standard therapeutic strategy for irreversible organ damage, but the utility of nerve transplantation remains generally unexplored, despite its potential benefit to a large patient population. Here, we aimed to establish a feasible preclinical mouse model for understanding the cellular mechanisms behind the rejection of peripheral and optic nerves.

Methods.
We performed syngenic and allogenic transplantation of optic and sciatic nerves in mice by inserting the nerve grafts inside the kidney capsule, and we assessed the allografts for signs of rejection through 14 d following transplantation. Then, we assessed the efficacy of CTLA4 Ig, Rapamycin, and anti-CD3 antibody in suppressing immune cell infiltration of the nerve allografts.

Results.
By 3 d posttransplantation, both sciatic and optic nerves transplanted from BALB/c mice into C57BL/6J recipients contained immune cell infiltrates, which included more CD11b+ macrophages than CD3+ T cells or B220+ B cells. Ex vivo immunogenicity assays demonstrated that sciatic nerves demonstrated higher alloreactivity in comparison with optic nerves. Interestingly, optic nerves contained higher populations of anti-inflammatory PD-L1+ cells than sciatic nerves. Treatment with anti-CD3 antibody reduced immune cell infiltrates in the optic nerve allograft, but exerted no significant effect in the sciatic nerve allograft.

Conclusions.
These findings establish the feasibility of a preclinical allogenic nerve transplantation model and provide the basis for future testing of directed, high-intensity immunosuppression in these mice.
Isolation of a Highly Purified HSC-enriched CD34+CD90+CD45RA− Cell Subset for Allogeneic Transplantation in the Nonhuman Primate Large-animal Model
Authors: Radtke Stefan , Colonna Lucrezia , Perez Anai M. , Hoffman Michelle , Kean Leslie S. , Kiem Hans-Peter 
Published: December 2020

Background.
Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a common treatment for patients suffering from different hematological disorders. Allo-HCT in combination with hematopoietic stem cell (HSC) gene therapy is considered a promising treatment option for millions of patients with HIV+ and acute myeloid leukemia. Most currently available HSC gene therapy approaches target CD34-enriched cell fractions, a heterogeneous mix of mostly progenitor cells and only very few HSCs with long-term multilineage engraftment potential. As a consequence, gene therapy approaches are currently limited in their HSC targeting efficiency, very expensive consuming huge quantities of modifying reagents, and can lead to unwanted side effects in nontarget cells. We have previously shown that purified CD34+CD90+CD45RA− cells are enriched for multipotent HSCs with long-term multilineage engraftment potential, which can reconstitute the entire hematopoietic system in an autologous nonhuman primate transplant model. Here, we tested the feasibility of transplantation with purified CD34+CD90+CD45RA− cells in the allogeneic setting in a nonhuman primate model.

Methods.
To evaluate the feasibility of this approach, CD34+CD90+CD45RA− cells from 2 fully major histocompatibility complex-matched, full sibling rhesus macaques were sort-purified, quality controlled, and transplanted. Engraftment and donor chimerism were evaluated in the peripheral blood and bone marrow of both animals.

Results.
Despite limited survival due to infectious complications, we show that the large-scale sort-purification and transplantation of CD34+CD90+CD45RA− cells is technically feasible and leads to rapid engraftment of cells in bone marrow in the allogeneic setting and absence of cotransferred T cells.

Conclusions.
We show that purification of an HSC-enriched CD34+ subset can serve as a potential stem cell source for allo-HCTs. Most importantly, the combination of allo-HCT and HSC gene therapy has the potential to treat a wide array of hematologic and nonhematologic disorders.
Postoperative Ultrasound in Kidney Transplant Recipients: Association Between Intrarenal Resistance Index and Cardiovascular Events
Authors: van de Kuit Anouk , Benjamens Stan , Sotomayor Camilo G. , Rijkse Elsaline , Berger Stefan P. , Moers Cyril , Bakker Stephan J.L. , Minnee Robert C. , Yakar Derya , Pol Robert A. 
Published: December 2020

Background.
Doppler ultrasound, including intrarenal resistance index (RI) measurement, is a widely used modality to assess kidney transplantation (KTx) vascularization. The aim of this study is to gain insight in the associations between early postoperative RI measurements and cardiovascular events (CVEs), all-cause mortality, and death-censored graft survival.

Methods.
From 2015 to 2017, a prospective cohort study was conducted in patients in which RI measurement was performed immediately after KTx. The RI was calculated as (peak systolic velocity—end-diastolic velocity)/peak systolic velocity. End points were CVEs, all-cause mortality, and graft failure. Kaplan-Meier analyses (logrank test) were used for differences in end points. Univariate and multivariate associations were investigated by means of Cox regression analyses.

Results.
RI cutoff of 0.70 was used. We included 339 recipients, of which 271 (80%) had an RI ≤ 0.70 and 68 (20%) had an RI > 0.70. CVEs were observed in 27 (8%) patients, 27 (8%) patients died, and 17 (5%) patients had graft failure during a median follow-up of 37 months (interquartile range, 33–43). Kaplan-Meier analyses and univariate Cox regression indicated a significant association with overall CVE-free survival (hazard ratios [HR], 2.79; P = 0.011; logrank test, P = 0.008) and all-cause mortality (HR, 2.59; P = 0.017; logrank test, P = 0.013) for patients with an RI above and below 0.70. An independent association was shown between an RI > 0.70 and CVE-free survival (HR, 2.48; P = 0.042) when deceased donation was not included in the model.

Conclusions.
In the early postoperative period, a high RI showed to be associated with CVEs after adjustment for cardiovascular risk factors, whereas no independent association was found with overall survival and graft failure. For the interpretation of RI measurements after KTx surgery, patients’ cardiovascular state should be taken into consideration.
GARD is a pan-cancer predictor of radiation therapy benefit
Authors: Scott Jacob G. , Sedor Geoffrey , Ellsworth Patrick , Scarborough Jessica A. , Ahmed Kamran , Oliver Daniel E. , Eschrich Steven A. , Torres-Roca Javier F. , Kattan Michael W. 
Published: December 2020

ABSTRACTBackgroundDespite advances in cancer genomics, radiation therapy (RT) is still prescribed based on an empiric one-size-fits-all paradigm. Previously, we proposed a novel algorithm using the genomic adjusted radiation dose (GARD) to personalize RT prescription dose based on the biological effect of a given physical RT dose, calculated using individual tumor genomics. We hypothesize that GARD will reveal interpatient heterogeneity associated with opportunities to improve outcomes compared to physical RT dose alone. To test this hypothesis, and the GARD-based RT dosing paradigm, we performed a pooled pan-cancer analysis in 11 separate clinical cohorts of 1,615 unique patients with 7 different cancer types that represent all available cohorts with the data required to calculate GARD, together with clinical outcome.MethodsUsing 11 previously-published datasets of cancers including breast, head and neck, non-small cell lung, pancreas, endometrium, melanoma and glioma, we defined two clinical endpoints: (i) time to first recurrence and (ii) overall survival, comprising 1,298 (982 +RT, 316 -RT) and 677 patients (424 +RT, 253 -RT), respectively. We used Cox regression stratified by cohort to test association between GARD and outcome with separate models using RT dose and sham-GARD for comparison. Interaction tests between GARD and treatment (+/- RT) were performed using the Wald statistic.ResultsPooled analysis of all available data reveal that GARD as a continuous variable is associated with recurrence (HR = 0.982, CI [0.970, 0.994], p = 0.002) and survival (HR = 0.970, CI [0.953, 0.988], p = 0.001). The interaction test revealed the effect of GARD on survival depends on whether or not that patient received RT (Wald statistic: p=0.011). Physical RT dose and sham-GARD were not significantly associated with either outcome.ConclusionsThe biologic effect of radiation therapy, as quantified by GARD, is significantly associated with recurrence and survival for those patients treated with radiation: it is predictive of RT benefit; and physical RT dose is not. We propose integration of genomics into radiation dosing decisions, using a GARD-based framework, as the new paradigm for personalizing RT prescription dose.
Development and Evaluation of Two Rapid Indigenous IgG-ELISA immobilized with ACE-2 Binding Peptides for Detection Neutralizing Antibodies Against SARS-CoV-2
Authors: Sil Bijon Kumar , Adnan Nihad , Oishee Mumtarin Jannat , Ali Tamanna , Jahan Nowshin , Khandker Shahad Saif , Kobatake Eiry , Mie Masayasu , Khondoker Mohib Ullah , Haq Md. Ahsanul , Jamiruddin Mohd. Raeed 
Published: December 2020

AbstractCOVID-19 pandemic situation demands effective serological tests with a view to adopting and developing policy for disease management, determining protective immunity as well as for sero-epidemiological study. Our study aims to develop and evaluate two rapid in-house ELISA assays targeting neutralizing antibodies (IgG) against S1 subunit of spike in SARS-CoV-2 and Receptor Binding Domain (RBD), as well as comparative analysis with nucleocapsid (NCP) ELISA. The assays were conducted with 184 samples in three panels collected from 134 patients. Panel 1 and 2 consist of RT-PCR positive samples collected within two weeks and after two weeks of symptom onset, respectively. Negative samples are included in panel 3 from healthy donors and pre-pandemic dengue patients. The total assay time has been set 30 minutes for both of the ELISA assays. Results show that S1 and RBD ELISA demonstrates 73.68% and 84.21% sensitivities, respectively for samples collected within two weeks, whereas 100% sensitivities were achieved by both for samples that were collected after two weeks of the onset of symptoms. S1-ELISA shows 0% positivity to panel 3 while for RBD-ELISA the figure is 1%. A strong correlation (rs=0.804, p<0.0001)) has been observed between these two assays. When compared with NCP-ELISA, S1 slightly better correlation (rs=0.800, p<0.0001) than RBD (rs=0.740, p<0.0001). Our study suggests S1-ELISA as more sensitive one than the RBD or nucleocapsid ELISA during the later phase of infection, while for overall sero-monitoring RBD specific IgG ELISA is recommended. Moreover, non-reactivity to dengue emphasize the use of these assays for serosurveillance of COVID-19 in the dengue endemic regions.HighlightsThe total assay time of these assays are 30 minutes.Sensitivity of S1 specific IgG ELISA for samples tested within 14 days of disease presentation is 73.68% while RBD specific ELISA demonstrates a sensitivity of 84.21%,Both of the assays under investigation can successfully detect all the cases (100% sensitivity) if the samples are tested after 14 days of onset of diseases.Specificity of S1-ELISA assay is 100%, whereas RBD specific IgG ELISA is 99% specific.The assays can be employed in dengue-endemic countriesAmong the three in-house IgG ELISA, assay system specific to S1 is found to be more sensitive and specific for retrospective serosurveillance.For acute to late phase, as well as retrospective serosurveillance of COVID-19, RBD-ELISA can be a method of choice for SARS-CoV-2 prevalent areas.