bluuebunny/crossref_metadata_2025_split huggingface dataset:
Full-thickness Skin Micro-columns within a Dermal Matrix: A Novel Method for “Donor-free” Skin Replacement
Authors: Cooper Laura , Gronet Edward , Carlsson Anders , Chan Rodney 
Published: January 2021

Summary:
Split-thickness skin graft has been the standard in the coverage of large full-thickness skin defects. However, donor sites can be associated with significant pain and scarring. Further, the recipient sites frequently lack some basic skin functions, such as temperature regulation, uniform texture, appropriate color, normal pliability, elasticity, and lubrication. Full-thickness skin grafts, while able to more adequately recapitulate skin function, have even greater donor site requirements. Implantation of full-thickness skin micro-columns is a relatively novel concept in which the skin is harvested orthogonally rather than tangentially. These micro-columns contain elements of full-thickness skin grafts, including reticular dermal fibroblasts, hair follicles, skin adnexa, and adipose tissue—all elements that contribute to skin function. Notably, it has been shown that the diameter of the skin micro-columns determine donor site morbidity; however, in most cases, full-thickness skin micro-column harvest results in a trivial donor site far less invasive or morbid than a traditional full-thickness skin graft or split-thickness skin graft harvest. Here, we present 2 cases in which full-thickness skin micro-columns were harvested and implanted into a bilayer dermal regeneration matrix (Integra) to achieve durable single-stage skin replacement with practically no donor site morbidity.
Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction
Authors: Jones Stacey J. , Turton Philip , Achuthan Rajgopal , Hogan Brian V. , Mckenzie Shireen N. , Kim Baek 
Published: January 2021

Background:
This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery.

Methods:
Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013–2016).

Results:
In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; P = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; P = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; P = 0.086).

Conclusions:
Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
Successful Ocular Surface Reconstruction in Complete Ankyloblepharon With the Simple Oral Mucosal Epithelial Transplantation Technique: A Case Report
Authors: Ngowyutagon Panotsom , Prabhasawat Pinnita , Chirapapaisan Chareenun , Jaru-ampornpan Pimkwan , Pornpanich Kanograt , Ekpo Pattama , Sukon Nutchaya , Matamnan Sutthicha 
Published: January 2021

Purpose:
To report an outcome of a patient with complete ankyloblepharon successfully managed with simple oral mucosal epithelial transplantation (SOMET).

Methods:
A 55-year-old woman presented with complete adhesion of both lids to the ocular surface as a complication from Stevens-Johnson syndrome. We performed 2-staged reconstructive surgeries: the first stage was to perform ankyloblepharon lysis and surface reconstruction with a mucosal graft on the palpebral area and an amniotic membrane on the bulbar area, and the second stage was to reconstruct the bulbar area with a transplantation of small pieces of oral mucosa (SOMET technique). Postoperatively, the patient was evaluated for ocular surface stability, recurrent symblepharon, in vivo confocal microscopy, and impression cytology with immunofluorescence staining.

Results:
Complete epithelialization of cornea-like epithelium was observed within 6 weeks after SOMET was performed. The ocular surface was stable over 1 year. Both fornices remained deep. In vivo confocal microscopy showed cornea-like epithelium mixed with conjunctival epithelium, as confirmed with immunofluorescence staining, which revealed cytokeratin 3, cytokeratin 7, and cytokeratin 12 positivity.

Conclusions:
SOMET is a simple modified technique using minimal oral mucosal tissue to regenerate epithelialization for complicated ocular surface reconstruction such as a complete ankyloblepharon repair. Although there was evidence of conjunctival invasion, stable ocular surface and deep fornices can be achieved for further visual rehabilitative procedure.
Severe Pediatric Mycoplasma pneumoniae Infection Requiring Veno-venous Extracorporeal Membrane Oxygenation
Authors: Davis Joshua , Ericson Jessica E. , Kavanagh Robert 
Published: January 2021

Abstract:

Mycoplasma pneumoniae (MP) is an atypical bacterial pathogen that typically causes mild respiratory symptoms. Rarely, MP is associated with acute respiratory distress syndrome, a condition marked by widespread inflammation in the lungs that often requires invasive support. We report a case of severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation in an otherwise healthy adolescent because of MP.
Cutaneous Manifestations and Treatment Advances of Adult T-Cell Leukemia/Lymphoma
Authors: Zhang Ying , Chen Hao , Sun Jian-Fang 
Published: January 2021

Abstract
Adult T-cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell lymphoma caused by the human T lymphotropic virus type-1. The skin is affected in approximately half of ATLL patients, and skin lesions may be the first manifestation of the disease. The skin lesions of ATLL are polymorphous, and depend on the type of skin eruption, which makes it possible for doctors to predict the prognosis of the disease based on the characteristics of skin lesions. In this review article, we describe the clinical manifestations and histopathological patterns of skin lesions in ATLL, focus on its diagnostic and prognostic significance, and also summarize the advances in the treatment of ATLL.
The Impact of Hospital and Health System Leadership Development Practices on Bond Ratings
Authors: Garland Nicholas , Garman Andrew N. , O’Neil Patricia S. , Canar W. Jeffrey 
Published: January 2021

EXECUTIVE SUMMARY
Shifts in healthcare policy, patient consumerism, and organizational consolidation are driving the need for hospitals and health systems to adapt if they are to achieve sustainability. Prior research has suggested that businesses with strong leadership development practices also demonstrate greater financial success and competitive performance. However, few studies have examined the impact of leadership development on organization-level outcomes, generally, or in the healthcare industry, specifically.
Our goal in this study was to examine the association between organizational leadership development practices and external perceptions of creditworthiness in the form of bond ratings. Data were drawn from the 2014 and 2016 distributions of the National Center for Healthcare Leadership’s National Health Leadership Survey; organizational credit ratings were obtained from Moody’s Investors Service and S&P Global Solutions. Spearman’s rho correlations and polynomial ranked regressions were used to determine the significance of the relationships between leadership development practices and bond ratings. Results provide preliminary evidence of associations between investing in leadership development and organizational creditworthiness. They also suggest, however, that the most financially successful health systems may de-emphasize certain kinds of leadership development practices relative to their peers. We discuss implications of these findings for organizational leaders investing in human capital as well as healthcare executives evaluating the development potential of prospective employers.
Focusing Research Efforts on the Unique Needs of Women Prosthesis Users
Authors: Major Matthew J. , Hansen Andrew H. , Russell Esposito Elizabeth 
Published: January 2021

ABSTRACT

Introduction
Women with lower-limb loss represent a relevant and growing patient cohort with unique rehabilitation needs. These needs are emphasized in a growing body of literature and the most recent Veteran Affairs/Department of Defense clinical practice guidelines.

Prosthetics Challenges
Women with limb loss experience greater dissatisfaction with prosthetic fit, appearance, and types of footwear they can use. There is a lack of prosthetics solutions to accommodate the desire of women to wear different footwear varieties, including high heels. The choice to wear a variety of footwear is important to attire and hence community participation. Despite these recognized challenges, women are still underserved in prosthetics research, which limits available information to guide the rehabilitation process.

Research Initiatives
This narrative review describes considerations of lower-limb prosthesis prescription and use by women, and examples of current research to address these topics. Research efforts are beginning to explore factors that contribute to prosthetics prescription for women and to design creative prosthetics solutions to expand the range of available footwear options. Research is still needed to characterize the types of footwear women with limb loss prefer to use, and the effects of prosthesis designs, footwear, and lower-limb loss on women mobility outcomes and community participation.

Conclusions
Through targeted research initiatives, scientists and clinicians can be responsive to the specific needs of women to provide evidence-based guidelines for prosthetics prescription and improve the patient-centered care after limb loss.
Students' Perceptions of a New Doctor of Physical Therapy Curriculum Based on Constructivism and Cognitive Load Theories: A Qualitative Study
Authors: Macauley Kelly , Jette Diane U. , Brudvig Tracy J. , Callahan Janet , Levangie Pamela K. 
Published: January 2021

Introduction.
In 2016, faculty at the MGH Institute of Health Professions implemented a new Doctor of Physical Therapy (DPT) curriculum based on constructivist and cognitive load theories. There is recognition that faculty too often overlook the importance of students' perceptions on the effectiveness of teaching methodologies and that student “buy-in” is particularly pivotal in curricula based on contemporary learning theories. Thus, students' perceptions have become a focus in the higher education research literature. The purpose of this article is to explore the perceptions of the first cohort of DPT students in our new curriculum across their academic studies.

Participants.
Nineteen of 70 students from the first cohort of our new curriculum participated in 1 of the 3 focus groups in year 1 (round 1) and 1 of the 2 focus groups in year 2 (round 2), with 4 students participating in both rounds.

Methods.
Qualitative thematic analysis was used to identify, summarize, and interpret students' perceptions regarding their experiences in this new curriculum.

Results.
Six themes emerging from round 1 were class preparation; plusses and minuses of group learning; usefulness of assessments; managing faculty/course differences; finding life balance; and student performance outcomes. A seventh theme emerged from round 2, namely, evolving and adapting approaches to learning.

Discussion and Conclusion.
Themes and subthemes are discussed in the context of other studies on students' perceptions of courses and curricula applying contemporary learning theories in higher education. Some of the themes emerging from our study are not unique to DPT curricula based on constructivist theories. However, our findings reflect both positive aspects of such approaches from the students' viewpoints and challenges that should be considered in supporting student engagement when designing or modifying such curricula. Findings may inform DPT programs considering similar curricular shifts toward contemporary learning practices, facilitating program curricular planning and transition processes.
Artificial intelligence to guide management of acute kidney injury in the ICU: a narrative review
Authors: De Vlieger Greet , Kashani Kianoush , Meyfroidt Geert 
Published: January 2021

Purpose of review
Acute kidney injury (AKI) frequently complicates hospital admission, especially in the ICU or after major surgery, and is associated with high morbidity and mortality. The risk of developing AKI depends on the presence of preexisting comorbidities and the cause of the current disease. Besides, many other parameters affect the kidney function, such as the state of other vital organs, the host response, and the initiated treatment. Advancements in the field of informatics have led to the opportunity to store and utilize the patient-related data to train and validate models to detect specific patterns and, as such, predict disease states or outcomes.

Recent findings
Machine-learning techniques have also been applied to predict AKI, as well as the patients’ outcomes related to their AKI, such as mortality or the need for kidney replacement therapy. Several models have recently been developed, but only a few of them have been validated in external cohorts.

Summary
In this article, we provide an overview of the machine-learning prediction models for AKI and its outcomes in critically ill patients and individuals undergoing major surgery. We also discuss the pitfalls and the opportunities related to the implementation of these models in clinical practices.
Precision renal replacement therapy
Authors: Ricci Zaccaria , Tolwani Ashita , Lumlertgul Nuttha 
Published: January 2021

Purpose of review
This article reviews the current evidence supporting the use of precision medicine in the delivery of acute renal replacement therapy (RRT) to critically ill patients, focusing on timing, solute control, anticoagulation and technologic innovation.

Recent findings
Precision medicine is most applicable to the timing of RRT in critically ill patients. As recent randomized controlled trials have failed to provide consensus on when to initiate acute RRT, the decision to start acute RRT should be based on individual patient clinical characteristics (e.g. severity of the disease, evolution of clinical parameters) and logistic considerations (e.g. organizational issues, availability of machines and disposables). The delivery of a dynamic dialytic dose is another application of precision medicine, as patients may require different and varying dialysis doses depending on individual patient factors and clinical course. Although regional citrate anticoagulation (RCA) is recommended as first-line anticoagulation for continuous RRT, modifications to RCA protocols and consideration of other anticoagulants should be individualized to the patient's clinical condition. Finally, the evolution of RRT technology has improved precision in dialysis delivery through increased machine accuracy, connectivity to the electronic medical record and automated reduction of downtime.

Summary
RRT has become a complex treatment for critically ill patients, which allows for the prescription to be precisely tailored to the different clinical requirements.
How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage
Authors: Rass Verena , Helbok Raimund 
Published: January 2021

Purpose of review
Delayed cerebral ischaemia (DCI) complicates the clinical course of patients with subarachnoid haemorrhage (SAH) in 20--30% and substantially worsens outcome. In this review, we describe a multimodal diagnostic approach based on underlying mechanisms of DCI and provide treatment options with a special focus on the most recently published literature.

Recent findings
Symptomatic vasospasm refers to clinical deterioration in the presence of vasospasm whereas DCI constitutes multiple causes. Pathophysiologic mechanisms underlying DCI range beyond large vessel vasospasm from neuroinflammation, to microthromboembolism, impaired cerebral autoregulation, cortical spreading depolarizations and many others. The current definition of DCI can be challenged by these mechanisms. We propose a pragmatic approach using a combination of clinical examination, cerebral ultrasonography, neuroimaging modalities and multimodal neuromonitoring to trigger therapeutic interventions in the presence of DCI. In addition to prophylactic nimodipine and management principles to improve oxygen delivery and decrease the brain metabolic demand, other specific interventions include permissive hypertension, intra-arterial application of calcium channel blockers and in selected patients angioplasty.

Summary
The complex pathophysiology underlying DCI urges for a multimodal diagnostic approach triggering targeted interventions. Novel treatment concepts still have to be proven in large trials.
Protocol liver biopsies in stable long-term pediatric liver transplant recipients: risk or benefit?
Authors: Ohlsson Sinja , Kathemann Simone , Pilic Denisa , Prusinskas Benas , Baba Hideo Andreas , Theurer Sarah , Dechene Alexander , Paul Andreas , Heinold Andreas , Hoyer Peter Friedrich , Lainka Elke 
Published: January 2021

Background
Follow-up after pediatric liver transplantation (LTX) is challenging and needs to be refined to extend graft survival as well as general functional health and patients´ quality of life. Strategies towards individual immunosuppressive therapy seem to play a key role. Our aim was to evaluate protocol liver biopsies (PLB) as a tool in personalized follow up after pediatric LTX.

Patients and methods
Our retrospective analysis evaluates 92 PLB in clinically asymptomatic pediatric patients after LTX between 2009 and 2019. Histological findings were characterized using the Desmet scoring system. In addition to PLB, other follow-up tools like laboratory parameters, ultrasound imaging and transient elastography were evaluated. Risk factors for development of fibrosis or inflammation were analyzed.

Results
PLB revealed a high prevalence of graft fibrosis (67.4%) and graft inflammation (47.8%). Graft inflammation was significantly (P = 0.0353*) more frequent within the first 5 years after transplantation compared to later time points. Besides conventional ultrasound, the measurement of liver stiffness using transient elastography correlate with stage of fibrosis (r = 0.567, P = <0.0001***). Presence of donor-specific anti-human leukocyte antigen antibodies in blood correlates with grade of inflammation in PLB (r = 0.6040, P = 0.0018 **). None of the patients who underwent PLB suffered from intervention-related complications. Histopathological results had an impact on clinical decision making in one-third of all patients after PLB.

Conclusion
PLB are a safe and useful tool to detect silent immune-mediated allograft injuries in the context of normal liver parameters.
Thirty-day readmission rates, reasons, and costs for gastrointestinal angiodysplasia-related bleeding in the USA
Authors: Khan Ahmad , Gupta Kamesh , Chowdry Monica , Sharma Sachit , Maheshwari Sanjay , Patel Chirag , Naseem Khadija , Pervez Hira , Bilal Mohammad , Ali Khan Muhammad , Singh Shailendra 
Published: January 2021

Background
Patients with gastrointestinal angiodysplasia (GIA)-related bleeding are at high risk for readmissions, resulting in significant morbidity and an economic burden on the healthcare system.

Aim
The aim of the study was to determine the 30-day readmission rate with reasons, predictors, and costs associated with GIA-related bleeding in the USA.

Methods
We queried the National Readmission Database to identify patients hospitalized with GIA-related bleeding in the year 2016 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Primary outcomes included the 30-day readmission rate, and secondary outcomes were in-hospital mortality and resource utilization for index and re-hospitalizations. We also performed univariate and multivariate cox regression analysis to identify predictors of readmissions.

Results
A total of 25 079 index hospitalizations for GIA-related bleeding were identified in 2016. Out of these, 5047 (20.34%) patients got readmitted within the next 30 days. The most common diagnosis associated with readmissions were related to recurrent gastrointestinal bleeding. Readmissions compared to index hospitalization has significantly higher length of stay (5.38 vs. 5.11 days, P = 0.03), but mean hospitalization charges ($52 114 vs. $49 691, P = 0.11) and mean total hospitalization costs ($12 870 vs. $12 405, P = 0.16) were similar. Patients with multiple co-morbidities, length of stay >5 days, and end-stage renal disease were found to be independent predictors for 30-day readmissions.

Conclusion
Our study shows that one in five patients hospitalized with GIA-related bleeding was readmitted within 30 days of index hospitalization, placing a heavy economic burden on the healthcare system. Further research identifying strategies to reduce readmissions in these patients is needed.
Aminotransferase-to-platelet ratio index and Fibrosis-4 index score predict hepatic fibrosis evaluated by transient hepatic elastography in hepatitis C virus-infected hemodialysis patients
Authors: Pestana Nathalia F. , Equi Claudia M.A. , Gomes Carlos P. , Cardoso Ana C. , Zumack João P. , Villela-Nogueira Cristiane A. , Perez Renata M. 
Published: January 2021

Objective
This study aimed to evaluate the performance of aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) in chronic kidney disease stage 5D HCV-infected patients compared to transient hepatic elastography (TE) as the gold standard.

Methods
Hemodialysis HCV-infected patients submitted to TE (FibroScan, Echosens, Paris, France) had APRI and FIB-4 calculated. Based on the best area under receiver operating characteristic curve (AUROC) for significant fibrosis and cirrhosis, APRI and FIB-4 cutoffs were determined and their performances were compared.

Results
Seventy patients were included. Both APRI and FIB-4 showed good performance for identifying significant fibrosis [AUROC = 0.73, 95% confidence interval (CI) 0.61–0.83 and 0.79, 95% CI 0.68–0.88; P < 0.05] and cirrhosis [AUROC = 0.82, 95% CI 0.71–0.90 and 0.85, 95% CI 0.75–0.93; P < 0.05]. APRI ≤ 0.25 excluded significant fibrosis with negative predictive value (NPV) of 81.8% and APRI > 0.61 confirmed it with a positive predictive value (PPV) of 81.8%. Similarly, NPV for FIB-4 ≤ 0.60 regarding significant fibrosis was 90.9%. NPV for cirrhosis for APRI ≤ 0.42 or FIB-4 ≤ 1.40 was 97%. However, APRI > 0.73 or FIB-4 > 2.22 showed a modest PPV of 60 and 70% to confirm cirrhosis, respectively.

Conclusion
APRI and FIB-4 are simple, non-expensive scoring systems with good accuracy to assess fibrosis in HCV-infected hemodialysis patients, mainly excluding both significant fibrosis or cirrhosis and may be an alternative to TE in the evaluation of this population.