bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral Outpatient Breast Reconstruction with Stacked DIEP and Vertical PAP Flaps
Authors: Martinez Carlos A. , Fairchild Berry , Secchi-del Rio Roberto , Boutros Sean G. 
Published: October 2021

Background:
Stacking free flaps for breast reconstruction is far from novel, even in the case of a deep inferior epigastric perforator (DIEP) plus profunda artery perforator (PAP) configuration, where the latter is always described in the traditional transverse configuration. We present a series of consecutive patients undergoing bilateral breast reconstruction with stacked DIEP and vertical PAP flaps.

Methods:
Patients with inadequate abdominal donor tissue were offered the possibility of a stacking breast reconstruction. The DIEP flap was harvested via microfascial incisions, whereas the vertical PAP flap was harvested in the lithotomy position, following the course of the gracilis muscle.

Results:
In total, 28 consecutive patients with a mean BMI of 24.9 underwent bilateral breast reconstruction with stacked DIEP and vertical PAP flaps. The internal mammary artery and vein were used as recipient vessels in all 56 stacked flaps. Fifty-three PAP flaps were anastomosed to the distal portion of the (primary) DIEP flaps utilizing a sequential flap anastomosis technique, and one DIEP flap was anastomosed to the distal portion of the (primary) PAP flap. Hospitalization for the initial eight patients averaged 35 hours, whereas the following 20 patients were discharged within 23 hours. There were no postoperative takebacks or vascular complications.

Conclusions:
Stacked DIEP/PAP flaps offer an excellent option for patients who require more volume than available from DIEP flaps alone. When compared with transverse PAP flaps, the vertical PAP offers excellent variability of volume and ease of shaping to allow for excellent results, while minimizing donor site tension in the seated position and preserving the gluteal fold.
Association Between Telecommuting Environment and Low Back Pain Among Japanese Telecommuting Workers
Authors: Matsugaki Ryutaro , Muramatsu Keiji , Tateishi Seiichiro , Nagata Tomohisa , Tsuji Mayumi , Hino Ayako , Ikegami Kazunori , Fujino Yoshihisa , Matsuda Shinya 
Published: October 2021

Objectives:
We evaluated the relationship between telecommuting environment and low back pain (LBP) among desk-based workers in Japan.

Methods:
This cross-sectional study included 3663 desk-based, telecommuting workers. LBP was assessed using a 0 to 10 numerical rating scale. The telecommuting environment was evaluated using subjective questions. Mixed-effects logistic regression analysis was used to evaluate this association.

Results:
The results of mixed-effects logistic model revealed that not having a place or room to concentrate on work, desk not well-lit enough for work, lack of space on the desk to work, not having enough legroom, and uncomfortable temperature and humidity conditions in the workspace were significantly associated with higher odds of LBP.

Conclusions:
Our findings suggest that telecommuting environment is associated with the prevalence of LBP.
Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope
Authors: Freeman Michael H. , Gafford Joshua B. , Fichera Loris , Noble Jack , Webster Robert J. , Labadie Robert F. 
Published: October 2021

Objective:
Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear.

Patients:
Three cadaveric temporal bone specimens were used in this work.

Intervention:
Diagnostic transeustachian endoscopy of the middle ear was performed.

Main Outcome Measure:
Diagnostic image quality.

Results:
A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity.

Conclusions:
A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.
Impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography
Authors: Aker Amir , Eitan Amnon , Saliba Walid , Jaffe Ronen , Zafrir Barak 
Published: October 2021

Background
Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We investigated the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease.

Methods
GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3690 elderly patients (aged 70–100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to modification of diet in renal disease (MDRD) and the Cockcroft–Gault equations, and compatibility between estimations was analyzed.

Results
Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.95 (0.77–1.16), 1.04 (0.84–1.29), 1.56 (1.16–1.84), 2.22 (1.65–2.97) and 3.74 (2.20–6.38) in patients with eGFR 60-89, 45–59, 30–44, 15–29 and <15 ml/min/1.73m2, respectively, compared to >90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockcroft–Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations.

Conclusions
Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography.
Impact on the long-term prognosis of FDG PET/CT in luminal-A and luminal-B breast cancer
Authors: Urso Luca , Quartuccio Natale , Caracciolo Matteo , Evangelista Laura , Schirone Alessio , Frassoldati Antonio , Arnone Gaspare , Panareo Stefano , Bartolomei Mirco 
Published: October 2021

Purpose
The aim of the present study was to explore the prognostic role of 2- deoxy-2-[18F]fluoro-D-glucose PET (FDG PET)/CT in recurrent luminal A and luminal B breast cancer.

Materials and methods
From two institutional databases, we retrospectively retrieved data about breast cancer patients undergoing FDG PET/CT between 2011 and 2018 for the assessment of recurrency. Molecular subtypes of breast cancer were defined based on the expression of estrogen, progesterone, human epidermal growth factor receptor 2 (HER2)-b receptors and proliferation index. Overall survival (OS, intended as the time from PET/CT and the time of death) was registered for each patient, by checking the medical charts. Parametric and survival analyses were computed.

Results
Data of 179 patients were retrieved. Sixty-three patients had luminal A, 88 luminal B and 28 luminal B/He breast cancer. At the time of PET/CT scan, cancer antigen (CA) 15.3 levels was within the normal range in 119 patients, whereas it was increased in 60 patients. FDG PET/CT results were suggestive for disease recurrence in 114 (63.7%) patients. The median time lapse from the FDG PET/CT scan to the last clinical follow-up visit was 51 months (1–192 months). Patients with evidence of a PET/CT scan suggestive for disease recurrence showed a significantly shorter OS (P < 0.001) compared to patients with no PET/CT evidence of recurrence, in each subset of luminal breast cancer. Moreover, PET/CT was able to stratify the prognosis of patients independently from the level of tumor marker.

Conclusion
These data suggest that FDG PET/CT may be an attractive prognostic tool in recurrent breast cancer. Our study supports its prognostic role both in luminal A and B-type molecular subtypes, regardless of the CA 15.3 levels.
Surgical treatment options for benign prostatic obstruction: beyond prostate volume
Authors: Deyirmendjian Claudia , Elterman Dean , Chughtai Bilal , Zorn Kevin C. , Bhojani Naeem 
Published: October 2021

Purpose of review
Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization.

Recent findings
A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP.

Summary
BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
The Mathematical Knowledge for Teaching Model as a Pedagogical Framework for Clinical Nursing Educators
Authors: Huber Stacy W. 
Published: October 2021

Background:
Clinical education is essential to the development of nursing students and future nursing practice. However, research often focuses on pedagogies used in the classroom and not in the clinical environment.

Problem:
Presently, there is no framework in nursing education to describe the subject matter and pedagogical knowledge educators draw upon when teaching in the clinical setting.

Approach:
This article describes how the mathematical knowledge for teaching framework was applied to nursing education to examine clinical educators' subject matter and pedagogical knowledge.

Outcomes:
By applying the framework, facets of subject and pedagogical knowledge used by clinical educators were identified, defined, and described.

Conclusions:
Applying the mathematical knowledge for teaching framework to clinical education may be an initial step to describe the types of knowledge that nursing educators draw upon in the clinical setting. It may also be used in the design of professional development and mentoring programs for nurse educators.
Impact of the COVID-19 Pandemic on Centers for Disease Control and Prevention–Funded Sexually Transmitted Disease Programs
Authors: Wright Shauntā S. , Kreisel Kristen M. , Hitt Jeffrey C. , Pagaoa Melissa A. , Weinstock Hillard S. , Thorpe Phoebe G. 
Published: October 2021

Abstract
The COVID-19 pandemic impacted sexually transmitted disease (STD) services. Of 59 US-funded STD programs, 91% reported a great deal to moderate impact from staff reassignment in April 2020, with 28% of respondents reporting permanent reassignment of disease intervention specialist staff. Telemedicine was implemented in 47%. Decreases in STD case reports were reported by most jurisdictions.
Immobilization-Related Hypercalcemia in a COVID-19 Patient With Prolonged Intensive Care Unit Stay
Authors: Mesland Jean-Baptiste , Collienne Christine , Laterre Pierre-François , Hantson Philippe 
Published: October 2021

Abstract
Immobilization-related hypercalcemia is an uncommon finding in patients admitted to intensive care unit. We report a case of severe hypercalcemia in a COVID-19 patient admitted to intensive care unit for hypoxemic respiratory failure. He developed an acute kidney injury requiring continuous renal replacement therapy with regional citrate anticoagulation. Citrate chelates ionized calcium and stop the coagulation cascade locally, preventing filter clotting. Calcium is then given intravenously to a specific target (normocalcemia). It is only when calcium infusion has been stopped that bone resorption and hypercalcemia were unmasked.
Early Life Adversity and Blunted Cardiovascular Reactivity to Acute Psychological Stress: The Role of Current Depressive Symptoms
Authors: Keogh Tracey M. , Howard Siobhán , Gallagher Stephen 
Published: October 2021

ABSTRACT

Objective
The pathways underlying the early life adversity and cardiovascular reactivity association remain unclear. The current study examined the role of current depressive symptoms on this relationship.

Methods
Mediation analyses were conducted using data from 639 participants drawn from the Midlife Development in the United States 2 Biomarker Project. Responses were derived from the Childhood Trauma Questionnaire and Center for Epidemiologic Studies Depression Scale. Participants had their systolic and diastolic blood pressure (SBP, DBP) and heart rate monitored throughout a standardized stress testing protocol.

Results
The association between early life adversity and reactivity was mediated by current depressive symptoms; all adversity factors were linked to higher levels of current depressive symptoms, which, in turn, were associated with lower cardiovascular reactivity. For emotional abuse, this was noted for SBP (β = −0.06 [95% confidence interval {CI}, −0.13 to −0.01]) and DBP (β = −0.04 [−0.07 to −0.01]), physical abuse (SBP: β = −0.05 [−0.11 to −0.01]; DBP: β = −0.03 [−0.06 to −0.01]), sexual abuse (SBP: β = −0.04 [−0.09 to −0.01]; DBP: β = −0.02 [−0.05 to −0.01]), emotional neglect (SBP: β = −0.04 [−0.09 to −0.01]; DBP: β = −0.02 [−0.05 to −0.01]), physical neglect (SBP: β = −0.09 [−0.17 to −0.02]; DBP: β = −0.05 [−0.09 to −0.02]), and total Childhood Trauma Questionnaire score (SBP: β = −0.02 [−0.03 to −0.00]; DBP: β = −0.01 [−0.02 to −0.00]).

Conclusions
The present findings extend research and demonstrate that depression is an underlying mechanism linking early life adversity and blunted cardiovascular reactivity.
Self-Perceived Psychological Stress and Risk of First Stroke in Treated Hypertensive Patients
Authors: Li Huan , He Panpan , Zhang Yuanyuan , Lin Tengfei , Liu Chengzhang , Xie Di , Liang Min , Wang Guobao , Nie Jing , Song Yun , Liu Lishun , Wang Binyan , Zhang Yan , Li Jianping , Huo Yong , Wang Xiaobin , Hou Fan Fan , Xu Xiping , Qin Xianhui 
Published: October 2021

ABSTRACT

Objective
We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and to examine possible effect modifiers among adults with hypertension.

Methods
A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial. Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow-up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal).

Results
The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted hazard ratio = 1.40, 95% confidence interval = 1.01 to 1.94) or first ischemic stroke (adjusted hazard ratio = 1.45; 95% confidence interval = 1.01 to 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure <101 mm Hg (median; p-interaction = .004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke.

Conclusions
Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower mean arterial pressure during the treatment period.
Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy
Authors: Dohrn Niclas , Yikilmaz Helin , Laursen Magnus , Khesrawi Faisal , Clausen Frederik Bjerg , Sørensen Frederik , Jakobsen Henrik Loft , Brisling Steffen , Lykke Jakob , Eriksen Jens Ravn , Klein Mads Falk , Gögenur Ismail 
Published: October 2021

Objective:To determine if minimally invasive right colectomy with intra-corporeal anastomosis improves postoperative recovery compared to extra-corporeal anastomosis.Background:Previous trials have shown that intracorporeal anastomosis improves postoperative recovery; however, it has not yet been evaluated in a setting with optimized perioperative care or with patient-related outcome measures.Methods:This was a multicenter, triple-blind, randomized clinical trial at two high-volume colorectal centers with strict adherence to optimized perioperative care pathways. The patients underwent robotic right colectomy with either intracorporeal or extracorporeal anastomosis. The primary outcome was patient-reported postoperative recovery measured using the “Quality of Recovery–15” questionnaire. ClinicalTrials.gov NCT03130166.Results:A total of 89 patients were randomized and analyzed according to the “Intention-to-treat”-principle. We found no statistically significant differences in patient-reported recovery between the groups. Postoperative pain, nausea, time to ambulation, time to first passage of flatus/stool, length of hospital stay, and pathophysiological tests showed no differences either. The duration of time to create the anastomosis was significantly longer with intracorporeal anastomosis (17 vs 13 min,P= 0.003), while all other intraoperative, postoperative, and pathology variables showed no difference.Conclusion:There were no significant differences in postoperative recovery between the two groups.
Not so FAST—Chest ultrasound underdiagnoses traumatic pneumothorax
Authors: Santorelli Jarrett E. , Chau Harrison , Godat Laura , Casola Giovanna , Doucet Jay J. , Costantini Todd W. 
Published: October 2021

BACKGROUND
Ultrasonography for trauma is a widely used tool in the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST) demonstrating equivalence to computed tomography (CT) for detecting clinically significant abdominal hemorrhage. Initial reports demonstrated high sensitivity of CUST for the bedside diagnosis of pneumothorax. We hypothesized that the sensitivity of CUST would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax.

METHODS
A retrospective analysis of patients diagnosed with pneumothorax from 2018 through 2020 at a Level I trauma center was performed. Patients included had routine supine CXR and CUST performed prior to intervention as well as confirmatory CT imaging. All CUST were performed during the initial evaluation in the trauma bay by a registered sonographer. All imaging was evaluated by an attending radiologist. Subgroup analysis was performed after excluding occult pneumothorax. Immediate tube thoracostomy was defined as tube placement with confirmatory CXR within 8 hours of admission.

RESULTS
There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging. The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma. Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%. After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive (p < 0.01). In this subgroup, CUST had a false-negative rate of 36% (n = 62). Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement.

CONCLUSION
Complete ultrasonography of trauma performed on initial trauma evaluation had lower sensitivity than CXR for identification of pneumothorax including clinically significant pneumothorax requiring tube thoracostomy. Using CUST as the primary imaging modality in the initial evaluation of chest trauma should be considered with caution.

LEVEL OF EVIDENCE
Diagnostic Test study, Level IV.
Immune Responses in Fully Vaccinated Individuals Following Breakthrough Infection with the SARS-CoV-2 Delta Variant in Provincetown, Massachusetts
Authors: Collier Ai-ris Y. , Brown Catherine M. , Mcmahan Katherine , Yu Jingyou , Liu Jinyan , Jacob-Dolan Catherine , Chandrashekar Abishek , Tierney Dylan , Ansel Jessica L. , Rowe Marjorie , Sellers Daniel , Ahmad Kunza , Aguayo Ricardo , Anioke Tochi , Gardner Sarah , Siamatu Mazuba , Bermudez Rivera Lorraine , Hacker Michele R. , Madoff Lawrence C. , Barouch Dan H. 
Published: October 2021

ABSTRACTBackgroundA cluster of over a thousand infections with the SARS-CoV-2 delta variant was identified in a predominantly fully vaccinated population in Provincetown, Massachusetts in July 2021. Immune responses in breakthrough infections with the SARS-CoV-2 delta variant remain to be defined.MethodsHumoral and cellular immune responses were assessed in 35 vaccinated individuals who were tested for SARS-CoV-2 in the Massachusetts Department of Public Health outbreak investigation.ResultsVaccinated individuals who tested positive for SARS-CoV-2 demonstrated substantially higher antibody responses than vaccinated individuals who tested negative for SARS-CoV-2, including 28-fold higher binding antibody titers and 34-fold higher neutralizing antibody titers against the SARS-CoV-2 delta variant. Vaccinated individuals who tested positive also showed 4.4-fold higher Spike-specific CD8+ T cell responses against the SARS-CoV-2 delta variant than vaccinated individuals who tested negative.ConclusionsFully vaccinated individuals developed robust anamnestic antibody and T cell responses following infection with the SARS-CoV-2 delta variant. These data suggest important immunologic benefits of vaccination in the context of breakthrough infections.
Quantifying Cause-Effect Relations Between Walking Speed, Propulsive Force, and Metabolic Cost
Authors: Pimentel Richard E. , Feldman Jordan N. , Lewek Michael D. , Franz Jason R. 
Published: October 2021

AbstractWalking speed is a useful surrogate for health status across the population. Walking speed appears to be governed in part by propulsive force (FP) generated during push-off and simultaneously optimized to minimize metabolic cost. However, no study to our knowledge has established empirical cause-effect relations between FP, walking speed, and metabolic cost, even in young adults. To overcome the potential linkage between these factors, we used a self-paced treadmill controller and real-time biofeedback to independently prescribe walking speed or FP across a range of condition intensities. Walking with larger and smaller FP led to instinctively faster and slower walking speeds, respectively, with about 80% of variance explained between those outcomes. We also found that comparable changes in either FP or walking speed elicited predictable and relatively uniform changes in metabolic cost, each explaining about ∼53% of the variance in net metabolic power and ∼15% of the variance in cost of transport, respectively. These findings build confidence that interventions designed to increase FP will translate to improved walking speed. Repeating this protocol in other populations may identify additional cause-effect relations that could inform the time course of gait decline due to age and disease.