bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock
Authors: Wikström Maria B. , Smårs Martin , Karlsson Christina , Stene Hurtsén Anna , Hörer Tal M. , Nilsson Kristofer F. 
Published: January 2021

BACKGROUND
Mortality from traumatic retrohepatic venous injuries is high and methods for temporary circulatory stabilization are needed. We investigated survival and hemodynamic and metabolic effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) and vena cava inferior (REBOVC) in anesthetized pigs.

METHODS
Twenty-five anesthetized pigs in normovolemia or severe hemorrhagic shock (controlled arterial bleeding in blood bags targeting systolic arterial pressure of 50 mm Hg, corresponding to 40–50% of the blood volume) were randomized to REBOA zone 1 or REBOA+REBOVC zone 1 (n = 6–7/group) for 45 minutes occlusion, followed by 3-hour resuscitation and reperfusion. Hemodynamic and metabolic variables and markers of end-organ damage were measured regularly.

RESULTS
During occlusion, both the REBOA groups had higher systemic mean arterial pressure (MAP) and cardiac output (p < 0.05) compared with the two REBOA+REBOVC groups. After 60 minutes reperfusion, there were no statistically significant differences between the two REBOA groups and the two REBOA+REBOVC groups in MAP and cardiac output. The two REBOA+REBOVC groups had higher arterial lactate and potassium concentrations during reperfusion, compared with the two REBOA groups (p < 0.05). There was no major difference in end-organ damage markers between REBOA and REBOA+REBOVC. Survival after 1-hour reperfusion was 86% and 100%, respectively, in the normovolemic REBOA and REBOA+REBOVC groups, and 67% and 83%, respectively, in the corresponding hemorrhagic shock REBOA and REBOA+REBOVC groups.

CONCLUSION
Acceptable hemodynamic stability during occlusion and short-term survival can be achieved by REBOA+REBOVC with adequate resuscitation; however, the more severe hemodynamic and metabolic impacts of REBOA+REBOVC compared with REBOA must be considered.

LEVEL OF EVIDENCE
Prospective, randomized, experimental animal study. Basic science study, therapeutic.
Effect of Hepatitis C Virus Infection on Heart Transplants in the Current Era
Authors: Fujisaki Tomohiro , Mikami Takahisa , Kuno Toshiki , Moss Noah , Itagaki Shinobu 
Published: January 2021

Background.
The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011.

Methods.
Using the United Network for Organ Sharing registry, 24 871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV-infected recipients and in utilization of HCV-infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression.

Results.
HCV antibody–positive recipients (n = 520, 2.1%) had stable prevalence (P = 0.18). They had a lower survival estimate when compared with HCV antibody–negative recipients in the past era (55.3% versus 70.9% at 7 y; hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.27-1.91; P < 0.001), however not in the current era (73.1% versus 71.5% at 7 y; HR, 1.00; 95% CI, 0.75-1.32; P = 0.98) (P
interaction < 0.001). Organ use from HCV antibody–positive donors (n = 371, 1.5%) was concentrated in the recent years (P < 0.001) and provided the similar survival estimate up to 2 y (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; P = 0.87). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test.

Conclusions.
Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or nucleic acid amplification test–positive donors are rapidly more prevalent and appeared to be promising up to 2 y posttransplant.
Evaluation of Graft Fibrosis, Inflammation, and Donor-specific Antibodies at Protocol Liver Biopsies in Pediatric Liver Transplant Patients: A Single-center Experience
Authors: Pinon Michele , Pizzol Antonio , Chiadò Cristina , David Ezio , Chiusa Luigi , Dell’Olio Dominic , Isolato Giuseppe , Amoroso Antonio , Deaglio Silvia , Catalano Silvia , Tandoi Francesco , Romagnoli Renato , Calvo Pier Luigi 
Published: January 2021

Background.
The impact of graft fibrosis and inflammation on the natural history of pediatric liver transplants is still debated. Our objectives were to evaluate the evolution of posttransplant fibrosis and inflammation over time at protocol liver biopsies (PLBs), risk factors for fibrosis, presence of donor-specific antibodies (DSAs), and/or their correlation with graft and recipient factors.

Methods.
A single-center, retrospective (2000–2019) cross-sectional study on pediatric liver transplant recipients who had at least 1 PLB, followed by a longitudinal evaluation in those who had at least 2 PLBs, was conducted. Fibrosis was assessed by the Liver Allograft Fibrosis Semiquantitative score, inflammation by the rejection activity index, DSAs by Luminex.

Results.
A total of 134 PLBs from 94 patients were included. Fibrosis was detected in 87% (30% mild, 45% moderate, and 12% severe), 80% in the portal tracts. There was an increase in fibrosis between the 1–3 and the 4–6 y group (P = 0.01), then it was stable. Inflammation was observed in 44% (30% mild, 13% moderate, and 1% severe), 90% in the portal tracts. Anti-HLA II (IgG) DSAs were detected in 14 of 40 (35%). Portal fibrosis was associated with portal inflammation in the 1–3 y group (P = 0.04). Low immunosuppression levels were correlated with sinusoidal fibrosis (P = 0.04) and DSA positivity (P = 0.006). There was no statistically significant correlation between DSA positivity and the presence of graft fibrosis or inflammation.

Conclusions.
This study corroborates the concept of an early evolution of silent graft fibrosis. Suboptimal immunosuppression may play a role in the development of fibrosis and DSAs.
Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study
Authors: Meier Raphael P.H. , Noguchi Hiroshi , Kelly Yvonne M. , Sarwal Minnie , Conti Giulia , Ward Casey , Halleluyan Ran , Tavakol Mehdi , Stock Peter G. , Freise Chris E. 
Published: January 2021

Background.
Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants.

Methods.
We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients.

Results.
Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5–9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group (P < 0.001). Patient and kidney graft survival were not statistically different between groups (P = 0.851 and P = 0.357, respectively). A multivariate Cox regression analysis showed that patients with a low PMI were 5 times more likely to lose their pancreas allograft (hazard ratios, 5.4; 95% confidence intervals, 1.4-20.8; P = 0.015). Three out of 6 patients lost their pancreas graft due to rejection in the low PMI group, compared with 1 out of 9 patients in the normal PMI group. Among low PMI patients who had a follow-up CT scan, 62.5% (5/8) of those with a functional pancreas graft either improved or resolved sarcopenia, whereas 75.0% (3/4) of those who lost their pancreas graft continued to lose muscle mass.

Conclusion.
Sarcopenia could represent one of the predictors of pancreas graft failure and should be evaluated and potentially optimized in SPK recipients.
Feasibility of Serial Ultrasound Measurements of the Rectus Femoris Muscle Area to Assess Muscle Loss in Patients Awaiting Liver Transplantation in the Intensive Care Unit
Authors: Pita Alejandro , Ziogas Ioannis A. , Ye Fei , Chen Yufan , Rauf Muhammad A. , Matsuoka Lea K. , Kaur Navpreet , Whang Gilbert , Zielsdorf Shannon M. , Bastas Gerasimos , Izzy Manhal , Alexopoulos Sophoclis P. 
Published: January 2021

Background.
End-stage liver disease (ESLD) patients requiring intensive care unit (ICU) care before liver transplantation (LT) often experience significant muscle mass loss, which has been associated with mortality. In this exploratory study, we primarily aimed to assess the feasibility of serial ultrasound (US) rectus femoris muscle area (RFMA) measurements for the evaluation of progressive muscle loss in ICU-bound potential LT candidates and describe the rate of muscle loss as assessed by sequential US RFMA measurements. Secondarily, we sought to identify patient characteristics associated with muscle loss and determine how muscle loss is associated with survival.

Methods.
We prospectively enrolled 50 ESLD adults (≥18 y old) undergoing evaluation for LT candidacy in the ICU. A baseline computed tomography measurement of psoas muscle area (PMA) and serial bedside US measurements of RFMA were obtained. The associations between patient characteristics, PMA, RFMA, ICU stay, and survival were analyzed.

Results.
Rapid decline in muscle mass by RFMA measurements was ubiquitously present and correlated to baseline PMA and length of ICU stay. RFMA normalized by body surface area decreased by 0.013 cm2/m2 (95% confidence interval, 0.010-0.016; P < 0.001) for each day in the ICU. Decreased RFMA normalized by body surface area was associated with poor overall survival (adjusted hazard ratio, 0.42; 95% confidence interval, 0.18-0.99; P = 0.047).

Conclusions.
In this exploratory, prospective study, serial US RFMA measurements in ESLD patients in the ICU are feasible, demonstrate progressive time-dependent muscle loss, and are associated with mortality. Further large-scale assessment of this modality compared with static PMA or performance-based dynamic assessments should be performed.
A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature
Authors: Azzi Yorg , Nair Gayatri , Loarte-Campos Pablo , Ajaimy Maria , Graham Jay , Liriano-Ward Luz , Pynadath Cindy , Uehlinger Joan , Parides Michael , Campbell Alesa , Colovai Adriana , Alani Omar , Le Marie , Greenstein Stuart , Kinkhabwala Milan , Rocca Juan , Akalin Enver 
Published: January 2021

Background.
Kidney allocation system allows blood type B candidates accept kidneys from A2/A2B donors. There is no mandate by UNOS on which the anti-A2 level is acceptable. We aimed to investigate the safety of kidney transplant in blood group B patients with anti-A2 titers ≤16.

Methods.
We performed 41 A2-incompatible kidney transplants in blood group B recipients between May 2015 and September 2019. Clinical outcomes were compared with a control group of 75 blood group B recipients who received blood group compatible kidney transplantation at the same period.

Results.
Of the 41 recipients, 85% were male, 48% African American, with a median age of 53 (20–73) y. Thirty-eight (93%) were deceased-donor and 3 (7%) were living-donor kidney transplant recipients. Pretransplant anti-A2 IgG titers were 2 in 16, 4 in 9, 8 in 6, and 16 in 5 and too weak to titer in 5 recipients. Eight patients had pretransplant donor-specific antibodies. During a median follow-up of 32.6 mo (6–57.3) patient and graft survival were 100% and 92% in the A2-incompatible kidney transplant group, and 91% and 92% in the blood group compatible group, respectively. Twelve A2-incompatible recipients underwent a 21 clinically indicated kidney biopsies at a median 28 d (6–390) after transplantation. None of the patients developed acute antibody-mediated rejection and 2 patients (5%) had acute T-cell–mediated rejection. Interestingly, peritubular capillary C4d positivity was seen in 7 biopsies which did not have any findings of acute rejection or microvascular inflammation but not in any of the rejection-free biopsies in the control group. C4d positivity was persistent in 5 of those patients who had follow-up biopsies.

Conclusions.
A2-incompatible transplantation is safe in patients with anti-A2 titers ≤16 with excellent short-term kidney allograft outcomes. C4d positivity is frequent in allograft biopsies without acute rejection.
Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?
Authors: Goss Matthew B. , Galván N. Thao N. , Geha Joseph D. , Moreno Nicolas F. , Cotton Ronald T. , Rana Abbas , O’Mahony Christine A. , Goss John A. 
Published: January 2021

Background.
Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT.

Methods.
The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board.

Results.
Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits.

Conclusions.
Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.
Vascularized Bone Marrow Cellular Depletion or Discontinuity Abrogates Protection of Vascularized Composite Allografts in Nonhuman Primates
Authors: Shockcor Nicole , Buckingham Evan B. , Hassanein Wessam , Dhru Urmil , Khalifeh Ali , Uluer Mehmet , Woodall Jhade , Brazio Philip , Drachenberg Cynthia , Nam Arthur J. , Barth Rolf N. 
Published: January 2021

Background.
Vascularized composite allografts (VCA) have demonstrated good clinical outcomes dependent on chronic immunosuppression. Previous work by our group and others supports that cotransplanted vascularized bone marrow (VBM) as a component of VCA offers immunologic protection to prolong graft survival. We aimed to characterize the requirements and potential mechanisms of VBM-mediated protection of VCA by modifying grafts through various strategies.

Methods.
Experimental groups of mismatched cynomolgus macaque recipients received VCA transplants modified by the following approaches: heterotopic separation of the VCA and VBM components; T-cell depletion of either donor or recipient; irradiation of donor VCA; and infusion of donor bone marrow. All groups received standard immunosuppression with tacrolimus and mycophenolate mofetil.

Results.
Experimental modifications to donor, recipient, or graft all demonstrated short-graft survivals (31 d). Chimerism levels without bone marrow infusion were transient and minimal when detected and were not associated with prolonged survival. Donor bone marrow infusion increased levels of chimerism but resulted in alloantibody production and did not improve graft survival.

Conclusions.
VCA graft survival is significantly reduced compared with previously reported VCA with VBM transplants (348 d; P = 0.01) when the hematopoietic niche is removed, altered, or destroyed via irradiation, depletion, or topographical rearrangement. These experimental manipulations resulted in similar outcomes to VCA grafts without cotransplanted VBM (25 d). These data support the presence of a radiosensitive, T-cell population within the VBM compartment not reconstituted by reinfusion of bone marrow cells.
REPEATABILITY OF A CALIBRATED DIGITAL SPECTROPHOTOMETER FOR DENTAL SHADE EVALUATION IN CURRENT, FORMER AND NEVER SMOKERS – STUDY PROTOCOL
Authors: Conte Gianluca , Pacino Sebastiano Antonio , Urso Salvatore , Emma Rosalia , Cibella Fabio , Pedullà Eugenio , Polosa Riccardo 
Published: January 2021

ABSTRACTDespite the negative impact of cigarette smoking on oral health and teeth appearance, there is no data available on dental shade changes in smokers who quit smoking. Dental discoloration caused by smoking may be permanent, with minimal restoration after stopping smoking. If this is valid, former smokers can show dental shade values equivalent to those of current smokers.The aim of this study is to compare the dental shade assessment by digital spectrophotometry (VITA Easyshade V) in current, former and never smokers and to verify the short (7 days) and long-term (30 days) repeatability of these measurements.Confirmation of good reproducibility of VITA Easyshade V with clear objective discrimination of dental shade measurements among current, former, and never smokers will improve the power of this measurement giving more confidence in clinical research findings of dental shades in these populations.It is also anticipated that results from the study will expand the application of this measurements to include medical and regulatory research applied to combustion-free tobacco products (e.g. e-cigarettes, heated tobacco products, oral tobacco/nicotine products, etc.), smoking cessation medications, and to consumer care product for oral hygiene and dental aesthetics.
SARS-CoV-2 Airborne Surveillance Using Non-Powered Cold Traps
Authors: Gehrke Sven G. , Förderer Claudia , Stremmel Wolfgang 
Published: January 2021

AbstractBackgroundCOVID-19 pandemic is a worldwide challenge requiring efficient containment strategies. High-throughput SARS-CoV-2 testing and legal restrictions are not effective in order to get the current outbreak under control. Emerging SARS-CoV-2 variants with a higher transmissibility require efficient strategies for early detection and surveillance.MethodsSARS-CoV-2 RNA levels were determined by quantitative RT-PCR in aerosols collected by non-powered cold traps. SARS-CoV-2 spreading kinetics and indoor hotspots could be identified in isolation units and at public places within a high-endemic area. These included an outpatient endoscopy facility, a concert hall, and a shopping mall.ResultsIndoor COVID-19 hotspots were found in non-ventilated areas and in zones that are predisposed to a buoyancy (chimney) effect. SARS-CoV-2 RNA in those aerosols reached concentrations of 105 copies/mL. Extensive outdoor air ventilation reliably eliminates SARS-CoV-2 aerosol contamination.ConclusionsThe method presented herein could predict SARS-CoV-2 indoor hotspots and may help to characterize SARS-CoV-2 spreading kinetics. Moreover, it can be used for the surveillance of emerging SARS-CoV-2 variants. Due to low costs and easy handling, the procedure might enable efficient algorithms for COVID-19 prevention and screening.
A Community-Based Participatory Research to Assess the Feasibility of Ayurveda Intervention in Patients with Mild-to-Moderate COVID-19
Authors: Kulkarni Vishwesh , Sharma Neha , Modi Dipa , Kumar Abnimanyu , Joshi Jaydeep , Krishnamurthy Nagamani 
Published: January 2021

AbstractInnovative strategies are required to manage COVID-19 in the communities. Back to Roots was a collaborative, community-based pilot intervention project in the British Asian community. To assess the efficacy and safety of Ayurveda intervention in relieving symptoms of mild-to-moderate COVID-19, a community based participatory research framework was used. Twenty-eight patients were enrolled with confirmed COVID-19 clinical stages of mild-to-moderate COVID-19, symptomatic, and between 20 to 70□years of age. Routine management was followed by all patients managing at home, additionally patents taking Ayurveda intervention for 14 consecutive days. The efficacy and safety of Ayurveda intervention were evaluated. There were suggestions of Ayurveda’s advantage in improved symptoms relief, clinical recovery in 7 days. However, a control group was not included but data triangulations from separate usual care found the difference statistically significant. Ayurveda intervention may potentially have a beneficial effect on patients with COVID-19, especially for those with mild to moderate symptoms. A further definitive large-scale clinical trial is necessary.ClinicalTrials.govIdentifierNCT04716647
A 3D CNN Classification Model for Accurate Diagnosis of Coronavirus Disease 2019 using Computed Tomography Images
Authors: Li Yifan , Pei Xuan , Guo Yandong 
Published: January 2021

AbstractThe coronavirus disease (COVID-19) has been spreading rapidly around the world. As of August 25, 2020, 23.719 million people have been infected in many countries. The cumulative death toll exceeds 812,000. Early detection of COVID-19 is essential to provide patients with appropriate medical care and protect uninfected people. Leveraging a large computed tomography (CT) database from 1,112 patients provided by China Consortium of Chest CT Image Investigation (CC-CCII), we investigated multiple solutions in detecting COVID-19 and distinguished it from other common pneumonia (CP) and normal controls. We also compared the performance of different models for complete and segmented CT slices. In particular, we studied the effects of CT-superimposition depths into volumes on the performance of our models. The results show that the optimal model can identify the COVID-19 slices with 99.76% accuracy (99.96% recall, 99.35% precision and 99.65% F1-score). The overall performance for three-way classification obtained 99.24% accuracy and the area under the receiver operating characteristic curve (AUROC) of 0.9986. To the best of our knowledge, our method achieves the highest accuracy and recall with the largest public available COVID-19 CT dataset. Our model can help radiologists and physicians perform rapid diagnosis, especially when the healthcare system is overloaded.
Estimating COVID-19 Cases on University Campuses Prior To Semester
Authors: Fout Alex , Bayham Jude , Gutilla Margaret J , Fosdick Bailey K , Pidcoke Heather , Kirby Michael , van Leeuwen Peter Jan , Anderson Chuck 
Published: January 2021

AbstractFor many institutions of higher learning, the beginning of each semester is marked by a significant migration of young adults into the area. In the midst of the COVID19 pandemic, this presents an opportunity for active cases to be introduced into a community. Prior to the Fall 2020 semester, Colorado State University researchers combined student home locations with recent case counts compiled by the New York Times to assign a probability to each individual of arriving with COVID19. These probabilities were combined to estimate that there would be 7.8 new cases among the on-campus population. Comprehensive testing of arriving students revealed 7 new cases, which validated the approach. The procedure was repeated to explore what could happen if students had returned to campus after Fall break. The estimate of 48 cases corroborated the University’s early decision to transition to fully remote learning after break.