bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Evaluation of Tarsal Coalition Excision Show Significant Improvements in Pain and Function
Authors: Mahan Susan T. , Miller Patricia E. , Kasser James R. , Spencer Samantha A. 
Published: August 2021

Background:
Excision of pediatric tarsal coalition has been successful in most patients. However, some patients have ongoing pain after coalition excision. This study prospectively assessed patient-based clinical outcomes before and after surgical excision of tarsal coalition, with particular emphasis on comparison to radiologic imaging.

Methods:
We prospectively studied 55 patients who had symptomatic coalition excision for 2 years postoperatively. Patients filled out the modified American Orthopaedic Foot and Ankle Society score, the University of California Los Angeles activity score, and the simple question “does foot pain limit your activity” at 4 different time points: preoperative, 6 months postoperative, 12 months postoperative, and 24 months postoperative. Comparisons were done utilizing patient demographics, imaging parameters, and patient-reported outcomes.

Results:
Compared with preoperative levels, patients showed improvements in all outcome parameters. Patients with calcaneonavicular coalitions showed initial rapid improvement with later slight decline, while patients with talocalcaneal coalitions showed more steady improvement; both were similar at 2 years postoperatively.

Conclusions:
This prospective study demonstrated remarkable clinical improvements after tarsal coalition excision regardless coalition type, though postoperative courses differed between calcaneonavicular and talocalcaneal types. Finally, a subset of patients has ongoing activity limiting foot pain after coalition excision which could not be explained by the data in this study.

Level of Evidence:
Level II—prospective cohort study.
Practical Techniques to Ensure Success in Digital Ring Avulsion Injuries
Authors: Gardiner Sonya , Friebel Thessa Rebecca , Bray Juliette , Anadkat Meera , Nikkhah Dariush 
Published: August 2021

Summary:
A ring avulsion results from a longitudinal traction to a digit. We discuss practical microsurgical techniques essential in achieving good functional outcomes in these challenging cases, including aggressive debridement of the affected tissues and vessels, liberal use of vein grafts and arterialized venous flow through flaps when needed, and a meticulous microsurgical technique. We have found that patient selection is key in digit salvage and a good outcome is often achieved with the winning triad of optimal patient factors, surgical factors, and intensive hand therapy. We also include a case performed by our senior author to illustrate what can be achieved.
Reconstruction of Pelvic Exenteration Defect with Free Anterolateral Thigh Flap: A Case Report
Authors: Prasidha Ines , Moisidis Elias , Hsieh Frank 
Published: August 2021

Summary:
The pedicled anterolateral thigh flap, with or without the vastus lateralis muscle, has been described for pelvic exenteration defect reconstruction. However, its use as a free flap for this type of defect is not routinely followed. To reconstruct an extensive pelvic defect in the presence of two ostomies, we describe a free anterolateral thigh flap with deep inferior epigastric pedicles as recipient vessels.
Square-root Palatoplasty: Comparing a Novel Modified-Furlow Double-opposing Z-palatoplasty Technique to Traditional Straight-line Repair
Authors: Tanaka Shoichiro A. , Coombs Demetrius M. , Tuncer Fatma B. , Shikhman Alexander , Keenan Patricia , McNinch Neil L. , Murthy Ananth S. 
Published: August 2021

Background:
The purpose of this study was to introduce a modification of the Furlow double-opposing Z-plasty (DOZ)—the square-root palatoplasty (SRP)—and critically evaluate outcomes compared to children who underwent straight-line repair (SLR).

Methods:
A retrospective review was performed of all nonsyndromic children undergoing primary cleft palate closure either by SRP or SLR at our institution between 2009 and 2017. Outcomes of interest included rates/location of oronasal fistula, secondary surgery, speech delay/deficits, resonance, nasal air emission (NAE), articulation errors, and velopharyngeal function. Logistic regression was used to assess for the effect of surgery type on outcomes while controlling for Veau cleft type, age, and gender.

Results:
Seventy-eight patients were included; 46 (59%) underwent SRP, and 32 (41%) underwent SLR. The mean follow-up was 4.07 years. When compared to SLR, children who underwent SRP were less likely to have oronasal fistula [odds ratio (OR) 4.8, P = 0.0159], speech delay/deficits (OR 7.7, P < 0.001), NAE (OR 9.7, P < 0.001), articulation errors (OR 10.2, P < 0.001), or need for secondary speech surgery (OR 13.2, P < 0.0002). Patients who underwent SRP were also more likely to have normal resonance (78.26% versus 43.75%, respectively; P = 0.0043) and good VP function (84.78% versus 56.25%, respectively; P = 0.0094).

Conclusions:
This study describes and evaluates outcomes following a modified-Furlow DOZ technique—the SRP. After adjusting for Veau classification, age, and gender in nonsyndromic children, SRP is associated with significantly less speech delay/deficits, NAE, articulation errors, and need for secondary speech surgery when compared to children who underwent SLR.
Advances in Tissue Expander Technology Enable Early Targeted Intervention in Prepectoral Breast Reconstruction
Authors: Liu Farrah , Henn Dominic , Shrefren Kerry , Momeni Arash 
Published: August 2021

Background:
Seroma and infection are among the most common complications after staged prepectoral implant-based reconstruction. Advances in tissue expander technology permit seroma aspiration via an integrated drain port, thus, holding promise for improving clinical outcomes.

Methods:
A prospectively maintained database of patients who had undergone immediate prepectoral breast reconstruction using the Sientra AlloX2 tissue expander was used to determine the rate of postoperative seroma formation, its volume and microbiological spectrum, as well as postoperative complications.

Results:
49 patients (mean age: 49 years, mean body mass index: 24.5 kg/m2) underwent 79 prepectoral breast reconstructions. Seroma was clinically suspected in 26 reconstructions (32.9%) and was easily aspirated in all cases via the integrated drain port. Importantly, periprosthetic fluid was successfully aspirated in 45 reconstructions (57%) without any clinical evidence for seroma, with aspirated cumulative fluid volumes exceeding 10 cm3 in 12 reconstructions. Bacterial cultures from aspirated fluid were positive in six patients (12.2%), of whom two developed clinical signs of infection, at which point targeted antibiotic treatment was initiated.

Conclusions:
Our study demonstrates that routine office-based aspiration of periprosthetic fluid via the integrated drain port of the AlloX2 tissue expander not only permits successful aspiration of periprosthetic fluid but also allows aspirated fluid to be sent for culture, thus, providing a lead-time advantage for initiation of targeted antibiotic therapy in cases of postoperative surgical site infection. Furthermore, our observations indicate that positive bacterial cultures in the absence of clinical signs of infection do not mandate antibiotic therapy.
Contamination Resulting From a Broken 125I Seed During a Brachytherapy Procedure
Authors: Buckley Lesley , Fraser Danielle J. , MacPherson Miller , Foottit Claire 
Published: August 2021

Abstract
Brachytherapy programs within radiation therapy departments are subject to stringent radiation safety requirements in order to ensure the safety of the staff and patients. Training programs often include brachytherapy-specific radiation safety training modules that address the specific risks associated with radioactive sources, emergency procedures, and regulatory requirements specific to the use of radioisotopes. Unlike other uses of radioactive materials, brachytherapy uses sealed sources and therefore under routine operations does not encounter radioactive contaminants. This article presents an unusual clinical situation in which an 125I brachytherapy seed was damaged during routine clinical workflow, resulting in radioactive contamination within the clinical environment. Decisions made at the time of the incident resulted in contamination that spread beyond the initial location. The incident highlighted a shortcoming of the radiation safety program in preparing staff for the possibility of having to deal with unsealed radioactivity. Brachytherapy programs would be strengthened by including training specific to radioactive contamination in their emergency training to equip staff to respond to unexpected damage to the sealed sources.
The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia
Authors: Lim Madeline , Li Ziqiang , Xie Huiting , Tan Bhing Leet , Lee Jimmy 
Published: August 2021

Abstract

Purpose/Background
The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined.

Methods/Procedures
Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals.

Findings/Results
Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude.

Implications/Conclusions
Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.
Relational Quality Between the RN and Nursing Assistant
Authors: Campbell Amy Richmond , Kennerly Susan , Swanson Melvin , Forbes Thompson , Anderson Teresa , Scott Elaine S. 
Published: August 2021

OBJECTIVE
Nurse (RN) and nursing assistant (NA) relational quality was examined along with associations between relational quality and evaluations of teamwork and communication.

BACKGROUND
RN and NA teams constitute the primary nursing care delivery method, and the quality of their relationship affects system capacity for improving patient outcomes; adverse events are linked to communication and teamwork breakdowns.

METHODS
RN (N = 889) and NA (263) relational quality was examined using a cross-sectional secondary analysis from system assessment with the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture.

RESULTS
RN and NA perceived relational quality indicated significant differences in teamwork and safety grade ratings, with both groups reporting perceived teamwork as high when patient safety grade was low.

CONCLUSIONS
This study supports the benefits of improving the RN-NA teamwork–communication relationship. An enhanced RN-NA relational quality can be used by nurse leaders to optimize patient care delivery outcomes.
Dual-Contrast Biphasic Liver Imaging With Iodine and Gadolinium Using Photon-Counting Detector Computed Tomography
Authors: Ren Liqiang , Huber Nathan , Rajendran Kishore , Fletcher Joel G. , McCollough Cynthia H. , Yu Lifeng 
Published: August 2021

Purpose
The aims of this study were to develop a single-scan dual-contrast protocol for biphasic liver imaging with 2 intravenous contrast agents (iodine and gadolinium) and to evaluate its effectiveness in an exploratory swine study using a photon-counting detector computed tomography (PCD-CT) system.

Materials and Methods
A dual-contrast CT protocol was developed for PCD-CT to simultaneously acquire 2 phases of liver contrast enhancement, with the late arterial phase enhanced by 1 contrast agent (iodine-based) and the portal venous phase enhanced by the other (gadolinium-based). A gadolinium contrast bolus (gadobutrol: 64 mL, 8 mL/s) and an iodine contrast bolus (iohexol: 40 mL, 5 mL/s) were intravenously injected in the femoral vein of a healthy domestic swine, with the second injection initiated after 17 seconds from the beginning of the first injection; PCD-CT image acquisition was performed 12 seconds after the beginning of the iodine contrast injection. A convolutional neural network (CNN)–based denoising technique was applied to PCD-CT images to overcome the inherent noise magnification issue in iodine/gadolinium decomposition task. Iodine and gadolinium material maps were generated using a 3-material decomposition method in image space. A set of contrast samples (mixed iodine and gadolinium) was attached to the swine belly; quantitative accuracy of material decomposition in these inserts between measured and true concentrations was calculated using root mean square error. An abdominal radiologist qualitatively evaluated the delineation of arterial and venous vasculatures in the swine liver using iodine and gadolinium maps obtained using the dual-contrast PCD-CT protocol.

Results
The iodine and gadolinium samples attached to the swine were quantified with root mean square error values of 0.75 mg/mL for iodine and 0.45 mg/mL for gadolinium from the contrast material maps derived from the denoised PCD-CT images. Hepatic arteries containing iodine and veins containing gadolinium in the swine liver could be clearly visualized. Compared with the original images, better distinctions between 2 liver phases were achieved using CNN denoising, with approximately 60% to 80% noise reduction in contrast material maps acquired with the denoised PCD-CT images compared with the original images.

Conclusions
Simultaneous biphasic liver imaging in a single multienergy PCD-CT acquisition using a dual-contrast (iodine and gadolinium) injection protocol and CNN denoising was demonstrated in a swine study, where the enhanced hepatic arteries (containing iodine) and the enhanced hepatic veins (containing gadolinium) could be clearly visualized and delineated in the swine liver.
Small Brain Lesion Enhancement and Gadolinium Deposition in the Rat Brain
Authors: Violas Xavier , Rasschaert Marlène , Santus Robin , Factor Cécile , Corot Claire , Catoen Sarah , Idée Jean-Marc , Robert Philippe 
Published: August 2021

Objectives
The aim of the set of studies was to compare gadopiclenol, a new high relaxivity gadolinium (Gd)–based contrast agent (GBCA) to gadobenate dimeglumine in terms of small brain lesion enhancement and Gd retention, including T1 enhancement in the cerebellum.

Materials and Methods
In a first study, T1 enhancement at 0.1 mmol/kg body weight (bw) of gadopiclenol or gadobenate dimeglumine was evaluated in a small brain lesions rat model at 2.35 T. The 2 GBCAs were injected in an alternated and cross-over manner separated by an interval of 4.4 ± 1.0 hours (minimum, 3.5 hours; maximum, 6.1 hours; n = 6). In a second study, the passage of the GBCAs into cerebrospinal fluid (CSF) was evaluated by measuring the fourth ventricle T1 enhancement in healthy rats at 4.7 T over 23 minutes after a single intravenous (IV) injection of 1.2 mmol/kg bw of gadopiclenol or gadobenate dimeglumine (n = 6/group). In a third study, Gd retention at 1 month was evaluated in healthy rats who had received 20 IV injections of 1 of the 2 GBCAs (0.6 mmol/kg bw) or a similar volume of saline (n = 10/group) over 5 weeks. T1 enhancement of the deep cerebellar nuclei (DCN) was assessed by T1-weighted magnetic resonance imaging at 2.35 T, performed before the injection and thereafter once a week up to 1 month after the last injection. Elemental Gd levels in central nervous system structures, in muscle and in plasma were determined by inductively coupled plasma mass spectrometry (ICP-MS) 1 month after the last injection.

Results
The first study in a small brain lesion rat model showed a ≈2-fold higher number of enhanced voxels in lesions with gadopiclenol compared with gadobenate dimeglumine. T1 enhancement of the fourth ventricle was observed in the first minutes after a single IV injection of gadopiclenol or gadobenate dimeglumine (study 2), resulting, in the case of gadopiclenol, in transient enhancement during the injection period of the repeated administrations study (study 3). In terms of Gd retention, T1 enhancement of the DCN was noted in the gadobenate dimeglumine group during the month after the injection period. No such enhancement of the DCN was observed in the gadopiclenol group. Gadolinium concentrations 1 month after the injection period in the gadopiclenol group were slightly increased in plasma and lower by a factor of 2 to 3 in the CNS structures and muscles, compared with gadobenate dimeglumine.

Conclusions
In the small brain lesion rat model, gadopiclenol provides significantly higher enhancement of brain lesions compared with gadobentate dimeglumine at the same dose. After repeated IV injections, as expected for a macrocyclic GBCA, Gd retention is minimalized in the case of gadopiclenol compared with gadobenate dimeglumine, resulting in no T1 hypersignal in the DCN.
Quantification of Calcium in Peripheral Arteries of the Lower Extremities
Authors: van der Star Simone , de Jong Daan J. , Bleys Ronald L.A.W. , Kuijf Hugo J. , Schilham Arnold , de Jong Pim A. , Kok Madeleine 
Published: August 2021

Objectives
The aim of this study was to investigate the interscanner and interscoring platform variability of calcium quantification in peripheral arteries of the lower extremities.

Materials and Methods
Twenty human fresh-frozen legs were scanned using 3 different computed tomography (CT) scanners. The radiation dose (CTDIvol) was kept similar for all scanners. The calcium scores (Agatston and volume scores) were quantified using 4 semiautomatic scoring platforms. Comparative analysis of the calcium scores between scanners and scoring platforms was performed by using the Friedman test; post hoc analysis was performed by using the Wilcoxon signed rank test with Bonferroni correction.

Results
Sixteen legs had calcifications and were used for data analysis. Agatston and volume scores ranged from 12.1 to 6580 Agatston units and 18.2 to 5579 mm3. Calcium scores differed significantly between Philips IQon and Philips Brilliance 64 (Agatston: 19.5% [P = 0.001]; volume: 14.5% [P = 0.001]) and Siemens Somatom Force (Agatston: 18.1% [P = 0.001]; volume: 17.5% [P = 0.001]). The difference between Brilliance 64 and Somatom Force was smaller (Agatston: 5.6% [P = 0.778]; volume: 7.7% [P = 0.003]). With respect to the interscoring platform variability, OsiriX produced significantly different Agatston scores compared with the other 3 scoring platforms (OsiriX vs IntelliSpace: 14.8% [P = 0.001] vs Syngo CaScore: 13.9% [P = 0.001] vs iX viewer: 13.2% [P < 0.001]). For the volume score, the differences between all scoring platforms were small ranging from 2.9% to 4.0%. Post hoc analysis showed a significant difference between OsiriX and IntelliSpace (3.8% [P = 0.001]).

Conclusions
The use of different CT scanners resulted in notably different Agatston and volume scores, whereas the use of different scoring platforms resulted in limited variability especially for the volume score. In conclusion, the variability in calcium quantification was most evident between different CT scanners and for the Agatston score.
scFlow: A Scalable and Reproducible Analysis Pipeline for Single-Cell RNA Sequencing Data
Authors: Khozoie Combiz , Fancy Nurun , Marjaneh Mahdi M. , Murphy Alan E. , Matthews Paul M. , Skene Nathan 
Published: August 2021

AbstractAdvances in single-cell RNA-sequencing technology over the last decade have enabled exponential increases in throughput: datasets with over a million cells are becoming commonplace. The burgeoning scale of data generation, combined with the proliferation of alternative analysis methods, led us to develop the scFlow toolkit and the nf-core/scflow pipeline for reproducible, efficient, and scalable analyses of single-cell and single-nuclei RNA-sequencing data. The scFlow toolkit provides a higher level of abstraction on top of popular single-cell packages within an R ecosystem, while the nf-core/scflow Nextflow pipeline is built within the nf-core framework to enable compute infrastructure-independent deployment across all institutions and research facilities. Here we present our flexible pipeline, which leverages the advantages of containerization and the potential of Cloud computing for easy orchestration and scaling of the analysis of large case/control datasets by even non-expert users. We demonstrate the functionality of the analysis pipeline from sparse-matrix quality control through to insight discovery with examples of analysis of four recently published public datasets and describe the extensibility of scFlow as a modular, open-source tool for single-cell and single nuclei bioinformatic analyses.
Development of a Reproducible Porcine Model of Infected Burn Wounds
Authors: Said Sayf Al-deen , Jatana Samreen , Ponti András K. , Johnson Erin E. , Such Kimberly A. , Zangara Megan T. , Madajka Maria , Papay Francis , McDonald Christine 
Published: August 2021

AbstractSevere burns are traumatic and physically debilitating injuries with a high rate of mortality. Bacterial infections often complicate burn injuries, which presents unique challenges for wound management and improved patient outcomes. Currently, pigs are used as the gold standard of pre-clinical models to study infected skin wounds due to the similarity between porcine and human skin in terms of structure and immunological response. However, utilizing this large animal model for wound infection studies can be technically challenging and create issues with data reproducibility. We present a detailed protocol for a porcine model of infected burn wounds based on our experience in creating and evaluating partial thickness burn wounds infected with Staphylococcus aureus on six pigs. Wound healing kinetics and bacterial clearance were measured over a period of 27 days in this model. Enumerated are steps to achieve standardized wound creation, bacterial inoculation, and dressing techniques. Systematic evaluation of wound healing and bacterial colonization of the wound bed is also described. Finally, advice on animal housing considerations, efficient bacterial plating procedures, and overcoming common technical challenges is provided. This protocol aims to provide investigators with a step-by-step guide to execute a technically challenging porcine wound infection model in a reproducible manner. Accordingly, this would allow for the design and evaluation of more effective burn infection therapies leading to better strategies for patient care.Graphical Abstract