bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidental Finding of Endometrioid Adenocarcinoma of the Ovary on 131I Whole-Body Scan
Authors: Mohd Rohani Mohd Fazrin , Amir Hassan Siti Zarina 
Published: May 2021

Abstract
A 57-year-old woman was referred for radioactive iodine therapy 12 weeks after completion thyroidectomy and left modified radical neck dissection for pT2N1Mx follicular variant papillary thyroid carcinoma. After 4 weeks of l-thyroxine withdrawal, stimulated serum thyroglobulin level was less than 0.1 ng/mL with positive thyroglobulin antibody. Posttherapy 131I scintigraphy with SPECT/CT of the head and abdominopelvic region showed thyroid residual in the neck, occipital bone metastasis, and heterogenous tracer uptake in a large peritoneal mass, likely arising from the left ovary. Left salpingo-oophorectomy was performed, and histopathologic examination revealed endometrioid carcinoma of left ovary.
68Ga-FAPI PET/CT Imaging of Graves Ophthalmopathy in a Patient With Esophageal Cancer
Authors: Liu Huipan , Yang Xiao , Wang Yingwei , Wang Peng , Chen Yue 
Published: May 2021

Abstract

68Ga-FAPI PET/CT has been used in the assessment of a variety of malignancies. In addition, FAPI uptake in nonmalignant diseases has also been reported. Herein, we present a case of Graves ophthalmopathy detected by 68Ga-FAPI PET/CT.
De-epithelialized Skin Flaps to Minimize Complications in Large Breast Reconstruction
Authors: Lanitis Sophocles , Kontos Michalis , Chortis Panagiotis , Gkanis Vasilios , Peristeraki Styliani , Lainas Spyridon , Hadjiminas Dimitri J. 
Published: May 2021

Abstract
Mastectomy and immediate reconstruction may be challenging in patients with large breasts, especially when significant ptosis is also present. Skin-reducing mastectomy (SRM) is usually indicated in these cases, although with increased morbidity. The aims of the study were to introduce 2 modifications of the classic technique and to incorporate them in the management algorithm to improve the outcomes.
Twenty patients fulfilling the criteria for SRM underwent mastectomy and reconstruction either with the “classic SRM” (8 patients) or with 1 of the 2 modifications described here: modification A “vertical limb bridging” (for patients with very large breasts, 2 patients) and modification B “dual coverage” (for patients with moderate breasts, 10 patients). All reconstructions were performed using a slow progressive expansion of the implant. Herein, we describe the techniques along with the proposed indications for each one of them.
There was no reconstruction failure, and all patients were satisfied with the final results. There were 2 cases with T junction, lateral skin flap partial ischemia managed with delayed revision of the wound on the fifth postoperative day to allow less skin excision. One patient (smoker) developed severe lower pole cellulitis, which was managed conservatively. Finally, 1 patient who underwent radiotherapy developed a late infected seroma, which was managed successfully with drainage and antibiotics. Overall, there was good lower pole projection even with the dual-coverage modification.
Skin-reducing mastectomy can be tailored according to individual patient anatomy, and the high reported complication rate associated with this technique can be minimized using certain surgical modifications, tissue expanders with progressive inflation, and good patient selection.
Formulating an Easy, Affordable, and Reproducible Method for Virtual Planning and 3D Reconstruction
Authors: Gupta Samarth , Goil Pradeep 
Published: May 2021

Introduction
Free fibula flap is now regarded as the criterion standard for mandibular reconstruction after oncological resection. However, the results are often confounded due to inappropriate estimate of defect or inappropriate angulation of osteotomy. Three-dimensional (3D) printing and virtual planning can be an effective tool to help in planning osteotomies, therefore simplifying the process. Unfortunately, in developing countries, it is considered to be an expensive and a time-consuming affair, refraining the surgeons to use this technology. We have devised a cheap (less than $35), rapid, and reproducible method for this process that can be performed by residents with the help of the operating surgeon using a freely available software.

Materials and Methods
The study was conducted over a span of 5 years from 2016 to 2020. Forty patients were randomly categorized into 2 groups of 20 each, one of which underwent conventional free fibula flap and the other group consisted of those for whom 3D printing and virtual planning were used. Aesthetic outcome was measured by preoperative and postoperative CT scans with 3D reconstruction. Furthermore, the reconstruction time and total operative time were also measured in both these groups.

Results
Comparative study clearly demonstrated a significantly better aesthetic outcome in the 3D printing and virtual planning group. The use of this modality significantly reduced the reconstruction time, which was 83.9 minutes in the cases group and 124 minutes in the control group.

Conclusions
Three-dimensional printing and virtual planning help to improve the quality of mandibular reconstruction giving a better aesthetic outcome. Besides, it also reduces the operative time and gives us a chance to use prebent implants used for reconstruction. Our methodology is simple, quick, and cost-effective; therefore, we believe that this tool can be incorporated often in free fibula flaps for mandibular reconstruction in developing countries such as ours.
Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy
Authors: Chow Amanda L. , Levidy Michael F. , Luthringer Margaret , Vasoya Devin , Ignatiuk Ashley 
Published: May 2021

Background
Neurolysis techniques have been adapted for decompression of peripheral nerves in multiple locations, including the common peroneal nerve (CPN) at the fibular neck. The aim of this study was to conduct a systematic review and meta-analysis to summarize the clinical outcomes of neurolysis for the management of peroneal nerve palsy (PNP).

Methods
Preferred Reporting Systems for Systematic Reviews and Meta-Analyses guidelines were followed for this meta-analysis. Four databases were queried, and randomized clinical trials, cohort studies, case-control studies, and case series with n > 10 published in English that evaluated clinical outcomes of neurolysis for the treatment of PNP and foot drop were included. Two reviewers completed screening and data extraction. Methodological quality was evaluated using the Newcastle-Ottawa Scale.

Results
A total of 493 articles were identified through literature search. Title and abstract screening identified 39 studies for full-text screening. Ten articles met the inclusion criteria for qualitative analysis, and 8 had complete data for meta-analysis.
Overall, there were 368 patients (370 nerves) who had neurolysis of the CPN for PNP, of which 59.2% (n = 218) were men and 40.8% (n = 150) were women. The mean age of the patients was 47.1 years (SD, 10.0 years), mean time to surgery was 9.65 months (SD, 6.3 months), and mean follow-up time was 28 months (SD, 14.0 months). The median preoperative Medical Research Council (MRC) score was 1 (IQR 0, 3), with 42.2% (n = 156) having MRC score of 0. The median postoperative MRC score was 5 (IQR 4, 5), with 53.9% (n = 199) having MRC score of 5. Complications of neurolysis of the peroneal nerve for treatment of PNP included postoperative infection (0.54%, n = 2), wound dehiscence (0.27%, n = 1), hematoma (0.54%, n = 2), bleeding (0.27%, n = 1), relapse of PNP (0.27%, n = 1), and 1 case of mortality due to sepsis.

Conclusions
Our meta-analysis shows that neurolysis of the CPN is safe and improves ankle dorsiflexion strength in patients with PNP. Future studies should use a standardized method of measuring sensory outcomes, and studies of higher levels of evidence are needed to better assess the clinical outcomes of neurolysis for treatment of PNP.
Does Complexity Always Correlate With Compensation? An Analysis of Work Relative Value Units in 3 Common Nerve Decompression Syndromes
Authors: Doval Andres F. , Boochoon Kieran , Le Hung B. , Mehra Nikhilesh V. , Liberman Shari , Harris Joshua D. , Echo Anthony 
Published: May 2021

Background
Work relative value units (wRVUs) are part of Resource Based Relative Value Scale system. It is expected that a more difficult and time-consuming procedure would yield higher wRVUs. Brachial plexus nerve decompression surgery is a more time-consuming procedure compared with carpal and cubital tunnel procedures. The aim of this study was to analyze physician reimbursement in upper limb decompression procedures by comparing mean operative times, wRVUs per minute, and dollars per minute.

Methods
A retrospective cohort study was conducted from June 2016 to June 2019, including all patients who underwent carpal tunnel, cubital tunnel, and brachial plexus release procedures. Operating time was collected, and calculations of mean operative time, wRVUs per minute, and dollars per minute were performed and compared between groups.

Results
A total of 209 cases were included. Carpal tunnel accounted for 75.1% of the cases, followed by cubital tunnel and brachial plexus releases. Brachial plexus release had the highest median operative time (147 minutes), followed by cubital tunnel (57 minutes) and carpal tunnel release (16 minutes, P < 0.0001). Carpal tunnel release procedures had a significantly higher wRVUs per minute (0.310) when compared with cubital tunnel and brachial pleaxus release procedures, 0.127 and 0.077, respectively (P < 0.0001). Same was true for dollars per minute; carpal tunnel procedures yielded significantly more compensation than cubital tunnel and thoracic outlet procedures (P < 0.0001).

Conclusions
More complex and time-consuming procedures yielded a lower reimbursement for physicians. The current work relative unit system does not account adequately for the time spent in each procedure.
Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy
Authors: Highet Alexandra , Johnson Emily H. , Bonham Aaron J. , Hutton David W. , Zhou Shuhao , Thalji Ameen S. , Ghaferi Amir A. 
Published: May 2021

Objective:
To perform a cost-effectiveness analysis of staple-line reinforcement in laparoscopic sleeve gastrectomy.

Summary of Background Data:
Exponential increases in surgical costs have underscored the critical need for evidence-based methods to determine the relative value of surgical devices. One such device is staple-line reinforcement, thought to decrease bleeding rates in laparoscopic sleeve gastrectomy.

Methods:
Two intervention arms were modeled, staple-line reinforcement and standard nonreinforced stapling. Bleed and leak rates and 30-day treatment costs were obtained from national and state registries. Quality-adjusted life-year (QALY) values were drawn from previous literature. Device prices were drawn from institutional data. A final incremental cost-effectiveness ratio was calculated, and one-way and probabilistic sensitivity analyses were performed.

Results:
A total of 346,530 patient records from 2012 to 2018 were included. Complication rates for the reinforced and standard cohorts were 0.05% for major bleed in both cohorts (P = 0.8841); 0.45% compared with 0.59% for minor bleed (P < 0.0001); and 0.24% compared with 0.26% for leak (P = 0.4812). Median cost for a major bleed was $5552 ($3287, $16,817) and $2406 ($1861, $3484) for a minor bleed. Median leak cost was $9897 ($4589, $21,619) and median cost for patients who did not experience a bleed, leak, or other serious complication was $1908 ($1712, $2739). Mean incremental cost of reinforced stapling compared with standard was $819.60/surgery. Net QALY gain with reinforced stapling compared with standard was 0.00002. The resultant incremental cost-effectiveness ratio was $40,553,000/QALY. One-way and probabilistic sensitivity analyses failed to produce a value below $150,000/QALY.

Conclusions:
Compared with standard stapling, reinforced stapling reduces minor postoperative bleeding but not major bleeding or leaks and is not cost-effective if routinely used in laparoscopic sleeve gastrectomy.
Development of a Low-Fidelity Laparoscopic Sacrocolpopexy Simulation Model and Evaluation of Curriculum
Authors: Karaoğlan Tunahan , Aydin Serdar , Bilginer Umur 
Published: May 2021

Objectives
Minimally invasive sacrocolpopexy (SCP) is a compelling surgical procedure that requires advanced laparoscopic suturing and dissection skills and knowledge of pelvic retroperitoneal anatomy. The aim of this study was to develop a low-cost laparoscopic SCP model and educational curriculum to improve dissection and suturing skills along with anatomic knowledge to avoid complications.

Methods
The pelvic SCP model was developed with easily available material that was placed on the commercial pelvic bone model to construct a vagina, major vessels, ureter, peritoneum, and areolar tissue. A comprehensive curriculum encompassing didactic and technical skills components on the pelvic model was used to teach laparoscopic SCP. Participants completed precurriculum and postcurriculum multiple-choice questionnaires to evaluate the didactic component. A modified Objective Structured Assessment of Technical Skills (OSATS) tool was used to measure technical skills before and after technical skills curriculum.

Results
Among the 10 senior residents, 6 (60%) were studying at their fourth postgraduate year, and 3 (30%) were studying at their third postgraduate year. Postcurriculum test scores (14.5 vs 10.6) for assessment of cognitive knowledge were significantly improved (P < 0.001). The median postcurriculum OSATS scores (26.5; range, 18–30) were significantly improved (P = 0.005). Laparoscopic SCP OSATS scores increased from median 21 to median 26.5 after cognitive and technical curriculum, showing a 21.4% improvement. The majority (70%) of residents believed that the SCP model would be useful to enhance skills acquisition before performing the skill in the operating room.

Conclusions
A low-fidelity laparoscopic SCP curriculum showed improvement in cognitive knowledge and technical skills.
Stability of Anti-HLA Sensitization Profiles in Highly Sensitized Kidney Transplantation Candidates: Toward a Rational Serological Testing Strategy
Authors: Wojciechowski Elodie , Jambon Frédéric , Cargou Marine , Guidicelli Gwendaline , Merville Pierre , Couzi Lionel , Taupin Jean-Luc , Visentin Jonathan 
Published: May 2021

Background.
Highly sensitized (HS) anti-HLA patients awaiting kidney transplantation benefit from specific allocation programs. Serological monitoring at 3-mo intervals is recommended to prevent unexpected positive crossmatch (XM), but this strategy is not evidence-based. Therefore, we assessed its relevance when using single-antigen flow bead (SAFB) and screening flow bead (SFB) assays.

Methods.
We included 166 HS patients awaiting a transplant and assessed their SAFB profile during the year preceding their inclusion. Anti-HLA antibodies were evaluated by SAFB assay and compared within patients as serum pairs at 3, 6, and 9 mo. We assessed the performance of SFB for detecting changes in SAFB profiles with 35 serum pairs.

Results.
On comparing 354, 218, and 107 serum pairs at 3, 6, and 9 mo, respectively, only 0.6%, 0.7%, and 1% of all antigens tested exceeded for the first time the unacceptable antigen threshold (mean fluorescence intensity ≥2000) in the most recent sample. Irrespective of the follow-up period, the calculated panel-reactive antibodies increased by a mean of 1%, and there was no significant increase in the proportion of donors at risk for positivity of flow- or complement-dependent cytotoxicity XM. The SFB did not accurately detect the variations of SAFB profiles.

Conclusions.
Changes in HS patient profiles are anecdotal and show little association with transplant access or risk for positive XM. Less-frequent monitoring in HS patients should be considered to improve cost-effectiveness without affecting transplant safety.
Frailty Measures in Patients Listed for Lung Transplantation
Authors: Montgomery Elyn , Newton Phillip J. , Chang Sungwon , Peng Wenbo , Jha Sunita R. , Wilhelm Kay , Macdonald Peter S. , Malouf Monique 
Published: May 2021

Background.
The study aimed to determine whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty (PF) is associated with the risk of lung transplant (LTX) waitlist mortality.

Methods.
Since March 2013, all patients referred for LTX evaluation underwent PF assessment. Cognition was assessed using the Montreal Cognitive Assessment and depression assessed using the Depression in Medical Illness questionnaire. We assessed the association of 4 composite frailty measures: PF ≥3 of 5 = frail, cognitive frailty (CogF ≥3 of 6 = frail), depressive frailty (DepF ≥3 of 6 = frail), and combined frailty (ComF ≥3 of 7 = frail) with waitlist mortality.

Results.
The prevalence of PF was 78 (22%), CogF 100 (28%), DepF 105 (29%), and ComF 124 (34%). Waitlist survival in the non-PF group was 94% ± 2% versus 71% ± 7% in the PF group (P < 0.001). Cox proportional hazards regression analysis demonstrated that PF (adjusted hazard ratio [HR], 4.88; 95% confidence interval [CI], 2.06-11.56), mild cognitive impairment (adjusted HR, 3.03; 95% CI, 1.05-8.78), and hypoalbuminemia (adjusted HR, 0.89; 95% CI, 0.82-0.97) were independent predictors of waitlist mortality. There was no significant difference in the area under the curve of the 4 frailty measures.

Conclusions.
The addition of cognitive function and depression variables to the PF assessment increased the number of patients classified as frail. However, the addition of these variables does not strengthen the association with LTX waitlist mortality compared with the PF measure.
Exploration of Rapid Automatized Naming and Standard Visual Tests in Prodromal Alzheimer Disease Detection
Authors: Wu Shirley Z. , Nolan-Kenney Rachel , Moehringer Nicholas J. , Hasanaj Lisena F. , Joseph Binu M. , Clayton Ashley M. , Rucker Janet C. , Galetta Steven L. , Wisniewski Thomas M. , Masurkar Arjun V. , Balcer Laura J. 
Published: May 2021

Background:
Visual tests in Alzheimer disease (AD) have been examined over the last several decades to identify a sensitive and noninvasive marker of the disease. Rapid automatized naming (RAN) tasks have shown promise for detecting prodromal AD or mild cognitive impairment (MCI). The purpose of this investigation was to determine the capacity for new rapid image and number naming tests and other measures of visual pathway structure and function to distinguish individuals with MCI due to AD from those with normal aging and cognition. The relation of these tests to vision-specific quality of life scores was also examined in this pilot study.

Methods:
Participants with MCI due to AD and controls from well-characterized NYU research and clinical cohorts performed high and low-contrast letter acuity (LCLA) testing, as well as RAN using the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number test, and vision-specific quality of life scales, including the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement. Individuals also underwent optical coherence tomography scans to assess peripapillary retinal nerve fiber layer and ganglion cell/inner plexiform layer thicknesses. Hippocampal atrophy on brain MRI was also determined from the participants' Alzheimer disease research center or clinical data.

Results:
Participants with MCI (n = 14) had worse binocular LCLA at 1.25% contrast compared with controls (P = 0.009) and longer (worse) MULES test times (P = 0.006) with more errors in naming images (P = 0.009) compared with controls (n = 16). These were the only significantly different visual tests between groups. MULES test times (area under the receiver operating characteristic curve [AUC] = 0.79), MULES errors (AUC = 0.78), and binocular 1.25% LCLA (AUC = 0.78) showed good diagnostic accuracy for distinguishing MCI from controls. A combination of the MULES score and 1.25% LCLA demonstrated the greatest capacity to distinguish (AUC = 0.87). These visual measures were better predictors of MCI vs control status than the presence of hippocampal atrophy on brain MRI in this cohort. A greater number of MULES test errors (r
s = −0.50, P = 0.005) and worse 1.25% LCLA scores (r
s = 0.39, P = 0.03) were associated with lower (worse) NEI-VFQ-25 scores.

Conclusions:
Rapid image naming (MULES) and LCLA are able to distinguish MCI due to AD from normal aging and reflect vision-specific quality of life. Larger studies will determine how these easily administered tests may identify patients at risk for AD and serve as measures in disease-modifying therapy clinical trials.
Chromonic liquid crystals and packing configurations of bacteriophage viruses
Authors: Hiltner Lindsey , Carme Calderer M. , Arsuaga Javier , Vázquez Mariel 
Published: May 2021

We study equilibrium configurations of hexagonal columnar liquid crystals in the context of characterizing packing structures of bacteriophage viruses in a protein capsid. These are viruses that infect bacteria and are currently the focus of intense research efforts, with the goal of finding new therapies for bacteria-resistant antibiotics. The energy that we propose consists of the Oseen–Frank free energy of nematic liquid crystals that penalizes bending of the columnar directions, in addition to the cross-sectional elastic energy accounting for distortions of the transverse hexagonal structure; we also consider the isotropic contribution of the core and the energy of the unknown interface between the outer ordered region of the capsid and the inner disordered core. The problem becomes of free boundary type, with constraints. We show that the concentric, azimuthal, spool-like configuration is the absolute minimizer. Moreover, we present examples of toroidal structures formed by DNA in free solution and compare them with the analogous ones occurring in experiments with other types of lyotropic liquid crystals, such as food dyes and additives.This article is part of the theme issue ‘Topics in mathematical design of complex materials’.
Efficacy and safety of novel probiotic formulation in adult Covid19 outpatients: a randomized, placebo-controlled clinical trial
Authors: Gutiérrez-Castrellón Pedro , Gandara-Martí Tania , Abreu Ana Teresa , Nieto-Rufino Cesar D. , López-Orduña Eduardo , Jiménez-Escobar Irma , Jiménez-Gutiérrez Carlos , López-Velazquez Gabriel , Espadaler-Mazo Jordi 
Published: May 2021

ABSTRACTBackgroundProbiotics have been proposed as adjuvants for Coronavirus Disease 2019 (Covid19) but randomized controlled trials (RCT) are lacking.MethodsSingle-center, quadruple-blinded RCT. Symptomatic Covid 19 outpatients (aged 18 to 60 years) with positive SARS-CoV2 nucleic acids test were randomized to active (n=150; ≥2×109 colony-forming units (CFU) of probiotic strains Lactiplantibacillus plantarum KABP022, KABP023 and KAPB033, plus strain Pediococcus acidilactici KABP021) or placebo (n=150), take orally once daily for 30 days. Oral acetaminophen was allowed and controlled as co-intervention. Primary endpoint included: i) proportion of patients in complete remission (both symptoms and nucleic acids test) or progressing to moderate or severe disease with hospitalization; ii) death rate and duration on Intensive Care Unit (ICU). Safety was assessed in all patients. This study is registered at ClinicalTrials.gov (NCT04517422).Findings300 subjects were randomized (median age 37.0 years [range 18 to 60], 161 [53.7%] women, 126 [42.0%] having known metabolic risk factors), and 293 completed the study (97.7%). Remission was achieved by 78 of 147 (53.1%) in the active group compared to 41 of 146 (28.1%) in placebo (P<0.0001; ARR=25.0% [95%CI 14.1-35.9%]), still significant after multiplicity correction for the primary endpoint. No hospitalizations or deaths occurred during the study, precluding the assessment of efficacy on these endpoints. No serious adverse events occurred during the study. Replication studies with this probiotic formula are warranted.