bluuebunny/crossref_metadata_2025_split huggingface dataset:
Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand
Authors: Moog Philipp , Kükrek Haydar , Palm-Bröking Katrin , Kirkegaard Simone , Germann Günter , Betzl Julia , Megerle Kai 
Published: March 2021

Introduction
There are many types of intrinsic flaps to cover wound defects on the hand, which have been well described in scientific literature. However, the donor sites are often neglected in such studies. Therefore, we aimed to evaluate donor site morbidity for homodigital island flaps, cross-finger flaps, Foucher's pedicle flaps, and flaps of the dorsal metacarpal artery system (DMCA).

Materials and Methods
A total of 106 intrinsic flap procedures were performed on 106 patients (16 women, 90 men). The donor sites were retrospectively followed up after an average of 3.4 years by a questionnaire, a Disability of the Arm, Shoulder and Hand score, and clinical examination. Donor sites of different flap types were compared for aesthetic outcome, trophic level, and sensation, including 2-point discrimination, temperature, sharp/dull discrimination, the Semmes-Weinstein monofilament test, pain (visual analog scale), and functionality.

Results
In general, primarily closed donor sites showed more favorable results than did grafted donor sites. Satisfaction among patients regarding aesthetics of the donor site was highest in patients who had received homodigital island flaps. Grip strength and pain at the operated hand were very heterogeneous and rather influenced by the primary trauma than the type of flap. Homodigital island flap donor sites demonstrated the best results for 2-point discrimination and sharp/dull discrimination, and those for DMCA flaps in the Semes-Weinstein test.

Conclusions
Overall, intrinsic flaps demonstrated low donor site morbidity with reliable coverage of the defects. Of these, the DMCA (especially after primary closure) and homodigital island flaps seemed to produce the best donor site results.
Early Surgical Treatment of Both Tumor and Fracture in Patients With Enchondroma of the Hand Combined With Pathologic Fracture
Authors: Li Qingyuan , Kim Jihyeung , Kim Sang Yoon , Baek Goo Hyun 
Published: March 2021

Purpose
The aims of this study were to evaluate the degree of cortical thinning and the tumor area in simple radiographs in patients with enchondroma of the hand combined with pathologic fracture and to determine the surgical outcome of simultaneous tumor curettage and internal fixation of fracture.

Methods
We enrolled 23 bone lesions of 21 patients diagnosed with enchondroma of the hand. Of them, 9 bone lesions of 8 patients had pathologic fracture. We evaluated the degree of cortical thinning and tumor area in simple radiographs and compared them between patients with and without pathologic fracture. For patients with pathologic fracture, we performed curettage of the tumor through the fracture site and fixed the fracture using K-wires. We then evaluated the clinical outcome of these patients using the visual analog scale to measure pain intensity and Takigawa's criteria 1 year after surgery.

Results
There was a significant difference in the degree of cortical thinning between the 2 groups (P < 0.001); however, there was no significant difference in the percentage of tumor area (P = 0.259). The average time from surgery to bony union was 8.5 weeks in patients with pathologic fracture. The patients reported that they could return to their previous activities of daily living within 12 weeks of surgery. The average visual analog scale score was 0.6 at 1 year after surgery, and 6 patients were graded as excellent and 2 as good according to Takigawa's criteria.

Conclusions
Cortical thinning seems to be related to pathologic fracture. Our scoring system for cortical thinning may be helpful in evaluating the risk for pathologic fracture. Early 1-stage surgical treatment for pathologic hand fracture with enchondroma is a very useful method with satisfactory outcomes that could shorten the treatment period.
Donor Site Wound Healing in Radial Forearm Flap
Authors: Di Giuli Riccardo , Dicorato Paolo , Kaciulyte Juste , Marinari Niccolò , Conversi Francesco , Mazzocchi Marco 
Published: March 2021

Abstract
Radial forearm flap (RFF) is one of the most used flaps in reconstructive surgery. Despite its versatility and effectiveness, the donor site is affected by aesthetic and functional issues. In the group of techniques described to improve the donor site morbidity, dermal substitutes offer a valid approach in the wound management. A bilayered bioresorbable dermal substitute (Hyalomatrix) was used to provide the primary coverage of the RFF harvest site followed after 3 weeks by a split-thickness skin graft placement. In this study, 37 patients underwent RFF donor site reconstruction and subjected to a minimum follow-up of 1 year. The dermal substitute was applied on 15 patients, and their outcomes were compared with the data achieved by 22 patients submitted to immediate reconstruction with autologous full-thickness skin graft. Results were documented by digital photographs, the visual analog scale, the Vancouver Scar Scale, and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Data were analyzed and compared through statistical analysis. Total wound coverage was achieved in 4 to 6 weeks, and no tendon impairments were reported in the dermal substitute group. In our experience, the use of the dermal substitute is a valuable mean to minimize RFF donor site morbidity with excellent functional and aesthetic outcomes.
Tibialis Posterior Tendon Transfers to Correct Bilateral Postburn Ankle Equinus
Authors: Chee Shu Ying , McKenna Johnny , Shelley Odhran P. 
Published: March 2021

Abstract
Treatment of joint contractures after burn injury is challenging because various factors influence the treatment options including the lack of local tissue, significant fibrotic changes with associated loss of joint pliability, increased prevalence of infection in burn patients, and patient-related medical comorbidities.
We present a case of a 60-year-old woman who had severe bilateral postburn ankle equinus deformities after self-immolation in the setting of significant soft tissue injury, fibrosis, and loss of joint movement. This deformity deprived her of the ability to walk, even aided, and she was unable to progress with her rehabilitation. We used the tibialis posterior tendon transfer to completely correct her postburn ankle equinus allowing for the restoration of both her feet to a neutral position, which enabled the patient to walk unaided after the surgery. This is a simple and effective solution to a complex problem when soft tissue reconstruction is limited. Patients with this complication are wheelchair dependent, and we suggest that posterior tibialis transfer should be considered as a surgical intervention for burns with severe equinus contracture even if there is a fixed deformity to allow for their full rehabilitation after injury.
Surgical Team Trips to Vietnam
Authors: Sue Gloria R. , Deptula Peter L. , Chang James 
Published: March 2021

Background
ReSurge International is a nongovernmental organization that organizes surgical team trips to low- and middle-income countries. Cleft palate repair is commonly performed on these trips. A comprehensive cleft care program was implemented to help reduce postoperative palatal fistula rates.

Methods
A retrospective review of all patients undergoing cleft palate repair surgery with ReSurge International in Vietnam from 2013 through 2019 was performed. The cleft care program was implemented in 2018. This intervention involved preoperative education of patients and close postoperative monitoring. Critically, this program also provided closer access to providers. Subsequent follow-up was performed by a ReSurge physician. Parent-reported outcomes were assessed preoperatively and postoperatively using 5-point Likert-like survey questions.

Results
Two hundred three patients underwent cleft palate repair. The patients were older and of higher Veau classification than is usually seen in the United States. The palatal fistula rate in the preintervention group was 37.5% and 14.3% in the intervention group (P = 0.014). Patients without fistulas demonstrated improvements on parent-reported outcomes compared with those with fistulas, with food less likely to go up their nose (P < 0.001), less difficulty eating (P < 0.001), and more understandable speech (P = 0.015).

Conclusions
Implementation of a comprehensive cleft palate program reduced postoperative fistula rates by more than 50%. Improvements in parent-reported outcomes were observed after surgery among patients without fistulas. The blueprint for improved outcomes in these more complex patients includes enhanced perioperative patient counseling, close follow-up, and maintenance of communication with patients.
Surgical Lymphoedema Treatment of Morbihan Disease
Authors: Hattori Yoshitsugu , Hino Haruko , Niu Atsushi 
Published: March 2021

Abstract
Morbihan disease is a rare condition characterized by persistent erythema and solid edema of the upper two thirds of the face, leading to visual impairment and significant esthetic disfigurement. The underlying etiology of the disease remains uncertain, but its correlation with lymphoedema has been conjectured. Definitive treatment options are also lacking, and most current topical, systemic, and surgical interventions provide transient or partial results.
In this report, we describe a case of Morbihan disease in a 32-year-old man. He suffered from erythema and swelling over the left periorbital region for 6 years, and was diagnosed with Morbihan disease. As the edema was unresponsive to drug therapy, he was referred to our department. Indocyanine green lymphography was performed, and the diagnosis of facial lymphoedema was confirmed. Manual lymphatic drainage was not effective, so we proceeded with surgical procedures. Lymphaticovenous anastomosis was performed to improve lymphatic drainage, and blepharoplasty was performed to debulk the enlarged tissue of lymphoedema. The visual field improved significantly, and the patient remains free from reexpansion of the lesion during the 1-year follow-up.
The surgical approach for lymphoedema treatment can be a viable option for severe Morbihan disease unresponsive to nonsurgical therapies.
Outcomes Associated With Norepinephrine Use Among Cardiac Intensive Care Unit Patients with Severe Shock
Authors: Burstein Barry , Vallabhajosyula Saraschandra , Ternus Bradley , Murphree Dennis , Barsness Gregory W. , Kashani Kianoush , Jentzer Jacob C. 
Published: March 2021

ABSTRACT

Background:
Recent data suggests improved outcomes among cardiac intensive care unit (CICU) patients treated with norepinephrine, especially patients with severe shock. We aimed to describe the association between norepinephrine and mortality in CICU patients with severe shock, defined as those requiring high-dose vasopressors (HDV).

Materials and Results:
We retrospectively evaluated Mayo Clinic CICU patients treated with vasopressors from 2007 to 2015. HDV was defined as a peak Cumulative Vasopressor Index of four for any vasopressor. Peak norepinephrine equivalent (NEE) dose was used to compare vasopressor doses. Multivariable logistic regression was used to determine predictors of hospital mortality.

Results:
We included 2,090 patients with a median age of 69 years (IQR 59–78), including 35% females; 44% of patients received HDV. Hospital mortality was higher among patients receiving HDV (42% vs. 16%, unadjusted OR 3.87, 95% CI 3.16–4.75, P < 0.01). On multivariable analysis in HDV patients, hospital mortality increased with rising peak NEE (adjusted OR 1.02 per 0.01 mcg/kg/min, 95% CI 1.01–1.02, P
< 0.01) and the use of NE was associated with lower hospital mortality (adjusted OR 0.46, 95% CI 0.31–0.72, P < 0.01). After adjustment for illness severity, peak NEE and norepinephrine use were not associated with mortality among patients who did not require HDV.

Conclusions:
Mortality is high among CICU patients requiring HDV, and rises with increasing vasopressor requirements. Use of NE was associated with lower mortality among patients requiring HDV, but not among those without HDV, implying that patients with more severe shock may benefit from preferential use of NE.
Escalation and Withdrawal of Treatment for Patients on Extracorporeal Membrane Oxygenation
Authors: Hadler Rachel A. , Clapp Justin T. , Chung Jamison J. , Gutsche Jacob T. , Fleisher Lee A. 
Published: March 2021

Objective:
The aim of this study was to describe decisions about the escalation and withdrawal of treatment for patients on extracorporeal membrane oxygenation (ECMO).

Summary Background Data:
Interventions premised on facilitating patient autonomy have proven problematic in guiding treatment decisions in intensive care units (ICUs). Calls have thus been made to better understand how decisions are made in critical care. ECMO is an important form of cardiac and respiratory support, but care on ECMO is characterized by prognostic uncertainty, varying time course, and high resource use. It remains unclear how decisions about treatment escalation and withdrawal should be made for patients on ECMO and what role families should play in these decisions.

Methods:
We performed a focused ethnography in 2 cardiothoracic ICUs in 2 US academic hospitals. We conducted 380 hours of observation, 34 weekly interviews with families of 20 ECMO patients, and 13 interviews with unit clinicians from January to September 2018. Qualitative analysis used an iterative coding process.

Results:
Following ECMO initiation, treatment was escalated as complications mounted until the patient either could be decannulated or interventional options were exhausted. Families were well-informed about treatment and prognosis but played minimal roles in shaping the trajectory of care.

Conclusions:
Discussion between clinicians and families about prognosis and goals was frequent but did not occasion decision-making moments. This study helps explain why communication interventions intended to maintain patient autonomy through facilitating surrogate participation in decisions have had limited impact. A more comprehensive understanding of upstream factors that predispose courses of critical care is needed.
Long-term Home Video EEG for Recording Clinical Events
Authors: Jamal Omidi Shirin , Hampson Johnson P. , Lhatoo Samden D. 
Published: March 2021

Summary:
Around 50 years after the first EEG acquisition by Hans Berger, its use in ambulatory setting was demonstrated. Ever since, ambulatory EEG has been widely available and routinely used in the United States (and to a lesser extent in Europe) for diagnosis and management of patients with epilepsy. This technology alone cannot help with semiological characterization, and absence of video is one of its main drawbacks. Addition of video to ambulatory EEG potentially improves diagnostic yield and opens new aspects of utility for better characterization of patient's events, including differential diagnosis, classification, and quantification of seizure burden. Studies evaluating quality of ambulatory video EEG (aVEEG) suggest good quality recordings are feasible. In the utilization of aVEEG, to maximize yield, it is important to consider pretest probability. Having clear pretest questions and a strong index of suspicion for focal, generalized convulsive or non-epileptic seizures further increases the usefulness of aVEEG. In this article, which is part of the topical issue “Ambulatory EEG,” the authors compare long-term home aVEEG to inpatient video EEG monitoring, discuss aVEEG's use in diagnosis and follow-up of patients, and present the authors' own experience of the utility of aVEEG in a teaching hospital setting.
An updated assembly strategy helps parsing the cryptic mitochondrial genome evolution in plants
Authors: Feng Yanlei , Xiang Xiaoguo , Fu Zhixi , Pan Ronghui , Jin Xiaohua 
Published: March 2021

AbstractAlthough plant mitogenomes are small in size, their variations are no less than any other complex genomes. They are under rapid structure and size changes. These characters make the assembly a great challenge. This caused two intertwined problems, a slow growth of known mitogenomes and a poor knowledge of their evolution. In many species, mitogenome becomes the last genome that undeciphered. To have a better understanding of these two questions, we developed a strategy using short sequencing reads and combining current tools and manual steps to get high quality mitogenomes. This strategy allowed us to assembled 23 complete mitogenomes from 5 families in Fagales. Our large-scale comparative genomic analyses indicated the composition of mitogenomes is very mosaic that “horizontal transfers” can be from almost all taxa in seed plants. The largest mitogenome contains more homologous DNA with other Fagales, rather than unique sequences. Besides of real HGTs, sometimes mitovirus, nuclear insertions and other third-part DNA could also produce HGT-like sequences, accounting partially for the unusual evolutionary trajectories, including the cryptic size expansion inCarpinus. Mitochondrial plasmid was also found. Its lower GC content indicates that it may be only an interphase of a foreign DNA before accepting by the main chromosome. Our methods and results provide new insights into the assembly and mechanisms of mitogenome evolution.
Comparative Population Genetics in the Human Gut Microbiome
Authors: Shoemaker William R. , Chen Daisy , Garud Nandita R. 
Published: March 2021

AbstractThe genetic variation in the human gut microbiome is responsible for conferring a number of crucial phenotypes like the ability to digest food and metabolize drugs. Yet, our understanding of how this variation arises and is maintained remains relatively poor. Thus, the microbiome remains a largely untapped resource, as the large number of co-existing species in this microbiome presents a unique opportunity to compare and contrast evolutionary processes across species to identify universal trends and deviations. Here we outline features of the human gut microbiome that, while not unique in isolation, as an assemblage make it a system with unparalleled potential for comparative population genomics studies. We consciously take a broad view of comparative population genetics, emphasizing how sampling a large number of species allows researchers to identify universal evolutionary dynamics in addition to new genes, which can then be leveraged to identify exceptional species that deviate from general patterns. To highlight the potential power of comparative population genetics in the microbiome, we re-analyzed patterns of purifying selection across ~40 prevalent species in the human gut microbiome to identify intriguing trends which highlight functional categories in the microbiome that may be under more or less constraint.
Ribovirus classification by a polymerase barcode sequence
Authors: Babaian Artem , Edgar Robert C. 
Published: March 2021

Abstract
RNA viruses encoding a polymerase gene (riboviruses) dominate the known
eukaryotic virome. Next-generation sequencing is revealing a wealth of new
riboviruses with uncharacterised phenotypes, precluding classification by
traditional taxonomic methods. These are often classified on the basis of
polymerase sequence identity, but standardised methods to support this approach
are currently lacking. To address this need, we describe the polymerase
palmprint, a well-defined segment of the palm sub-domain delineated by
well-conserved catalytic motifs. We present a novel algorithm,
Palmscan, which identifies palmprints in
nucleotide and amino acid sequences. We describe PALMdb, a reference database of
palmprints derived from public sequence databases.
Palmscan source code and PALMdb data are
deposited at https://github.com/rcedgar/palmscan and https://github.com/rcedgar/palmdb, respectively.
Metabolic independence drives gut microbial colonization and resilience in health and disease
Authors: Watson Andrea R. , Füssel Jessika , Veseli Iva , DeLongchamp Johanna Zaal , Silva Marisela , Trigodet Florian , Lolans Karen , Shaiber Alon , Fogarty Emily , Runde Joseph M. , Quince Christopher , Yu Michael K. , Söylev Arda , Morrison Hilary G. , Lee Sonny T.M. , Kao Dina , Rubin David T. , Jabri Bana , Louie Thomas , Eren A. Murat 
Published: March 2021

AbstractChanges in microbial community composition as a function of human health and disease states have sparked remarkable interest in the human gut microbiome. However, establishing reproducible insights into the determinants of microbial succession in disease has been a formidable challenge. Here we use fecal microbiota transplantation (FMT) as an in natura experimental model to investigate the association between metabolic independence and resilience in stressed gut environments. Our genome-resolved metagenomics survey suggests that FMT serves as an environmental filter that favors populations with higher metabolic independence, the genomes of which encode complete metabolic modules to synthesize critical metabolites, including amino acids, nucleotides, and vitamins. Interestingly, we observe higher completion of the same biosynthetic pathways in microbes enriched in IBD patients. These observations suggest a general mechanism that underlies changes in diversity in perturbed gut environments, and reveal taxon-independent markers of ‘dysbiosis’ that may explain why widespread yet typically low abundance members of healthy gut microbiomes can dominate under inflammatory conditions without any causal association with disease.
The “two-brain” approach reveals the active role of task-deactivated default mode network in speech comprehension
Authors: Liu Lanfang , Li Hehui , Ren Zhiting , Zhou Qi , Zhang Yuxuan , Lu Chunming , Qiu Jiang , Chen Hong , Ding Guosheng 
Published: March 2021

AbstractDuring speech comprehension, as listeners need to keep tracking the external audio streams, the default mode network (DMN) is often de-activated and anticorrelated with task-positive networks. Such a pattern has been interpreted as the suppression of the DMN to support externally-oriented cognitive processes. Taking a “two-brain” approach, the current study demonstrated that, despite exhibiting deactivation and anticorrelated with the language network and executive control network, the DMN was not suppressed but played an active role in spoken narrative comprehension. This was evidenced by significant listener-speaker neural couplings in both the posterior and anterior DMN and the positive correlation between the coupling strength and listener’s speech comprehension. Moreover, we demonstrated that the functionality of posterior DMN depended on its interaction with the executive control network, rather than its level of activation. Finally, Dynamic Causal Modeling together with the two-brain results indicates the language and executive control networks, the anterior DMN, and the posterior DMN occupied the bottom, intermediate and top layers of a hierarchical system, respectively. These results suggest that the DMN may primarily serve as an internally-oriented system that cooperates with the externally-oriented networks, which may allow the transformation of external acoustic signals into internal mental representations during language comprehension.