bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autologous Micro-Fat Transplantation for Facial Sunken Treatment: Single-Center Experience
Authors: Jiang Mengyuan , Mao Xiyuan , Zhang Lu 
Published: November 2024

Background:
Facial sunken deformities, congenital or acquired, are common in clinical practice for the reduction of soft or hard tissues. In clinical practice, filler injection and tissue transplantation are often used to improve facial contour. Among these, autologous fat grafting for treating facial contour defects is most common in clinical practice. Micro-fat, with relatively intact fat lobules, presents outstanding subcutaneous volumetric restoration and improvement of skin quality in skin rejuvenation.

Objectives:
This study showed our technique and experience of autologous micro-fat transplantation and its clinical effect on facial depression. The advantages and disadvantages between micro-fat transplantation and ordinary fat grafting for facial depression were also discussed.

Methods:
This study reviewed 22 facial sunken patients with micro-fat transplantation from February 2018 to December 2020. Participants under evaluation included 4 males and 18 females, with an average age of 38 years old. Surgical outcomes (defect augmentation, skin improvement), satisfaction (subjective and objective), and complication evaluations were performed for all participants.

Results:
During the follow-up (9.3±2.0 mo), the autologous micro-fat grafting led to prominent morphological adjustment with a low complication rate (1/22). Fourteen of the 22 patients (63.6%) achieved both objective and subjective satisfaction after a single treatment.

Conclusion:
This autologous micro-fat filling technology is a safe and ideal method for facial sunken correction, with persistent and stable postoperative outcomes.
Target Artery Outcomes Following Endovascular versus Open Surgical Repair of Thoracoabdominal Aortic Aneurysms – A Single Center Comparative Study
Authors: Huang Ying , Colglazier Jill , Mendes Bernardo C. , Pochettino Alberto , Kalra Manju , Greason Kevin L. , Tenorio Emanuel R. , Harmsen William S. , Oderich Gustavo S. 
Published: November 2024

Objective:
To compare target artery (TA) outcomes after fenestrated or branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAAs).

Background:
Few studies have compared TA outcomes after endovascular incorporation and open reconstruction.

Methods:
Among consecutive patients who underwent elective OSR or FB-EVAR of TAAAs (2008-2020), we reviewed those who had postoperative imaging studies evaluating TA. Data of FB-EVAR patients were obtained from a prospectively maintained institutional database. TAs included celiac, superior mesenteric, right and left renal arteries treated during TAAA repairs. Primary endpoint was TA patency (primary and secondary).

Results:
There were 131 patients (487 TAs) treated by OSR and 350 (1,300 TAs) by FB-EVAR. In the OSR group, 440 TAs (90.3%) were reconstructed by bypasses, and 47 (9.7%) by reimplantation. In the FB-EVAR group, 841 TAs (64.7%) were incorporated by fenestrations, and 459 (35.3%) by DBs. Thirty-day TA primary patency rates were not significantly different between FB-EVAR and OSR (99.4%% vs. 99.0%, P=0.36), but secondary patency rate was higher after FB-EVAR (99.8% vs. 99.0%, P=0.02). Three-year primary patency rates were 95.9% (95% confidence interval [CI], 94.7-97.2%) and 94.7% (95% CI, 92.2-97.2%), respectively; secondary patency rates were 98.5% (95% CI, 97.7-99.2%) and 94.7% (95% CI, 95.7-99.2%), respectively. There were no significant differences in late primary patency and secondary patency between groups (each P<0.05).

Conclusion:
Target artery primary and secondary patency rates following elective OSR or FB-EVAR were high. Endovascular repair was not associated with loss of primary patency and late secondary patency.
Too Big to Fail
Authors: Fuchs Juri , Rabaux-Eygasier Lucas , Husson Thomas , Fouquet Virginie , Guerin Florent , Hery Geraldine , Branchereau Sophie 
Published: November 2024

Objective:
To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy

Background:
Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remains undefined.

Methods:
All pediatric patients undergoing major hepatectomy at a tertiary care center over a 10-year study period were analyzed. Preoperative imaging was used for volumetry. The incidence of PHLF was assessed by applying predefined definitions, and the prognostic impact of the FLR on PHLF and complications was evaluated.

Results:
A total of 125 children underwent major hepatectomy, including 35 trisectionectomies. There was a strong correlation between imaging-based measured total liver volume (TLV) and calculated standard liver volume (r = 0.728, P < 0.001). The median TLV-to-body weight (BW) ratio was 3.4%, and the median FLR/BW ratio was 1.5%. The median FLR-to-TLV ratio was 44% (range: 18%–97%). No clinically relevant PHLF occurred. FLR/TLV and FLR/BW ratios had low predictive value for postoperative liver dysfunction and morbidity.

Conclusions:
This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-BW ratio is higher in children compared with adults, and the FLR is sufficient even in extreme resections with <20% of the liver remnant. These findings strongly question the use of asociating liver partition and portal vein ligation for staged hepatectomy, portal vein embolization, or transplantation based on suspected insufficient liver remnants in children.
Brain MRI Lesions in Alexia Without Agraphia: A Case–Control Study
Authors: Shapiro Jeremy N. , Sharma Aseem , Trobe Jonathan D. , Walsh Ryan D. , Khanna Sangeeta 
Published: November 2024

Background:
Alexia without agraphia (AWA) is an acquired reading disturbance associated with left posterior cerebral artery (PCA) infarction. Based on autopsy and neuroimaging, there are two explanations for its pathogenesis: a visual cortex–language cortex disconnection and a visual word-form agnosia. Our goal was to discover if more refined brain imaging in a case–control study would provide further imaging support for either of these hypotheses.

Methods:
A neuroradiologist masked to the presence of AWA reviewed diffusion-weighted and fluid-attenuated inversion recovery brain MRIs in patients who had left PCA infarctions with AWA (9 patients) or without AWA (18 patients) to characterize lesions in the splenium, left forceps major, and left fusiform gyrus.

Results:
Patients with AWA had various combinations of lesions in the splenium, left forceps major, and left fusiform gyrus. One of these regions was involved in 3 patients, 2 were involved in 3 patients, and 3 were involved in 3 patients. Most (89%) patients without AWA lacked involvement of any of these 3 regions.

Conclusions:
Our data provide imaging evidence for the two existing hypotheses of AWA. Involvement of any of these lesions on MRI imaging should encourage clinicians to obtain further neuropsychological testing.
Individual on Death Row Receiving Electroconvulsive Therapy (ECT) for Catatonia
Authors: Basden Brian J. , Surya Sandarsh , Rosenquist Peter B. , McCall William V. 
Published: November 2024

Abstract
Electroconvulsive therapy (ECT) is underused, logistically challenging for those who are justice-involved, and laced with ethical problems for those on death row. Herein we describe a case of a man without history of long-standing psychiatric illness who, after more than 15 years on death row, was hospitalized for altered mental status. After medical stabilization, the altered mental status persisted. On exam, he displayed signs of catatonic stupor with repetitive non–goal-directed motor activity, repetition of words, rigidity, and negativism, among others. The Bush-Francis Catatonia Rating Scale was found to be 23. Lorazepam was nontherapeutic. Hospital psychiatry considered ECT. Hospital medicine, medical prison staff, and the hospital ethics committee were consulted. Consent to treat catatonia with ECT was obtained from next of kin. Before treatment, the ECT psychiatrist spoke with prison staff regarding the presence of plastic restraints. To balance the competing demands of carceral policies and musculoskeletal protection, we implemented the practice of removing plastic restraints after the patient was sedated by anesthetic, with restraints being reapplied after the motor convulsion ended. Five days after 7 ECT treatments given thrice weekly, the catatonic symptoms remitted. Ethically, psychiatrists are not to restore competency for the purpose of execution. In this case, ECT was used by psychiatrists unaffiliated with the criminal legal system to reduce suffering and improve quality of life given the potentially fatal consequences of catatonia.
Elevated Blood Glucose in COVID-19 Patients: An explorative Study
Authors: Bisher Maryam , Thamer Ahlam , Shahata Shaheen , Atia Ahmed 
Published: November 2024

ABSTRACTBackgroundSince the emergence of the coronavirus pandemic in 2019, scientific studies have not stopped to understand the mechanism of several disorders that occurred in patients who were infected with the COVID-19 virus, among these disorders, the most important of which is high blood glucose because of its impact on human health. This study aimed to identify the association between blood glucose concentration and some biochemical variables that lead to high blood glucose in people infected with Covid-19 virus.MethodsThis study was conducted on 100 samples of serum of people who were confirmed to be infected with the COVID-19 virus using polymerase chain reaction (PCR) technology. Samples were collected from the Broccoli Isolation Center, the Respiratory Clinic, and the Sebha Medical Center in Sebha city, Libya. The concentration of glucose, insulin, cortisol, triglycerides, cholesterol, CRP and liver enzyme’s activity was measured.FindingsThe results showed that 60% of the patients had an increase in blood glucose concentration, and 40% of the patients had a normal glucose concentration. The levels of insulin, cortisol, CRP, triglycerides, and liver enzyme’s activity were compared between the two groups, and the results showed an increase in the mean concentration of cortisol, triglycerides, CRP and liver enzymes in the group of patients with high glucose concentration compared to the group of patients with a normal concentration of glucose, and the statistical analysis using the t-test showed that there were significant differences between the means (P = 0.000), while the mean insulin concentration was lower in the group of patients with elevated glucose level. The results also showed positive correlation between glucose and cortisol, triglycerides, CRP concentration and GPT, GOT activity.InterpretationPatients infected with the COVID-19 virus had elevated blood glucose concentration associated with decrease in their insulin hormone concentration. In addition, high concentration of biochemical variables that contribute to high blood glucose in patients infected with the COVID-19 virus were noticed.
Detection of human IgG antibodies againstMycoplasma genitaliumusing a recombinant MG075 antigen
Authors: Kildemoes Anna Overgaard , Rai Olivia Sureya Seierø , Westermann Elisabeth Probst Lyng , Johansen Henrik Frederik Bekkevold , Bjørnelius Eva , Anagrius Carin , Ma Liang , Rosenkrands Ida , Jensen Jørgen Skov 
Published: November 2024

AbstractMycoplasma genitaliumis a sexually transmitted pathogen, which can cause a range of reproductive tract diseases in both men and women. To disentangle the relationship betweenM. genitaliuminfection(s) and subsequent reproductive health complications at the population level, accurate serological tools are needed. The major challenge in developing specificM. genitaliumserological tests is the extensive cross-reactivity with the closely related ubiquitous respiratory tract pathogen,M. pneumoniae. In this report, we describe the development of an immunoblot assay based on a recombinant fragment of theM. genitaliumMG075 protein present in lipid-associated membrane extracts. A sensitivity of 87.1% was achieved based on testing antibody responses in sera from 101 adults with PCR-confirmedM. genitaliuminfection. A specificity of 95.2% was obtained through evaluation of sera from 166 children under 15 years of age with and withoutM. pneumoniaeinfection, who were unlikely to have been exposed to sexually transmittedM. genitalium. The development of a serological assay capable of accurately distinguishingM. genitaliumandM. pneumoniae, will enable a better understanding of associations betweenM. genitaliumand adverse reproductive sequelae.
Assessing the Limitations of Large Language Models in Clinical Practice Guideline-concordant Treatment Decision-making on Real-world Data
Authors: Roeschl Tobias , Hoffmann Marie , Hashemi Djawid , Rarreck Felix , Hinrichs Nils , Trippel Tobias D. , Gröschel Matthias I , Unbehaun Axel , Klein Christoph , Kempfert Jörg , Dreger Henryk , O’Brien Benjamin , Hindricks Gerhard , Balzer Felix , Falk Volkmar , Meyer Alexander 
Published: November 2024

AbstractAimsLarge Language Models (LLMs) have shown promise in therapeutic decision-making comparable to medical experts, but these studies have used highly curated patient data. The aim of this study was to determine whether LLMs can make guideline-concordant treatment decisions based on patient data as it typically presents in clinical practice.Methods and ResultsWe conducted a retrospective study of 80 patients with severe aortic stenosis who were scheduled for either surgical (SAVR, n=24) or transcatheter aortic valve replacement (TAVR, n=56) by our institutional heart team in 2022. Various LLMs (BioGPT, GPT-3.5, GPT-4, GPT-4 Turbo, GPT-4o, Llama-2, Mistral, PaLM 2, and DeepSeek-R1) were queried using either anonymized original medical reports or manually generated case summaries to determine the most guideline-concordant treatment. Agreement with the Heart Team was measured using Cohen’s kappa coefficients, reliability using intraclass correlation coefficients (ICCs), and fairness using frequency bias indices (FBIs) with FBIs >1 indicating bias towards TAVR. When presented with original medical reports, LLMs showed poor performance (kappa: −0.47–0.22, ICC: 0.0–1.0, FBI: 0.95–1.51). The LLMs’ performance improved substantially when case summaries were used as input and additional guideline knowledge was added to the prompt (kappa: −0.02–0.63, ICC: 0.01–1.0, FBI: 0.46–1.23). Qualitative analysis revealed instances of hallucinations in all LLMs tested.ConclusionEven advanced LLMs require extensively curated input for informed treatment decisions. Unreliable responses, bias and hallucinations pose significant health risks and highlight the need for caution in applying LLMs to real-world clinical decision-making.
Post-stroke changes in the ipsilesional motor area after contralesional continuous theta-burst stimulation
Authors: Vink Jord JT , Biemans Camille FM , van Lieshout Eline CC , van Eijk Ruben PA , Neggers Sebastiaan FW , Visser-Meily Johanna MA , van der Worp H Bart , Dijkhuizen Rick M 
Published: November 2024

AbstractBackgroundInhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) can promote upper limb recovery after stroke. However, its working mechanism remains unclear. We hypothesised that contralesional inhibitory rTMS increases ipsilesional M1 excitability and promotes ipsilesional motor-eloquent area (MEA) remapping.MethodsSixty patients who participated in a trial on contralesional continuous theta-burst stimulation (cTBS), an inhibitory form of rTMS, for the promotion of upper limb recovery after stroke, were included. M1 excitability and upper limb function were measured from TMS-based resting motor thresholds (RMTs) and the Fugl-Meyer Assessment (FMA) arm score, respectively, before cTBS treatment and at six follow-up visits up to one year after stroke. Forty-four patients additionally underwent longitudinal navigated TMS-based motor mapping. Remapping of the MEA was assessed from longitudinal changes in MEA overlap. Outcomes were analysed using mixed models for repeated measures.ResultsThe ipsilesional RMT was 11% lower after active cTBS compared to sham cTBS (95% CI −18.7 to −2.6; p 0.0099) within twelve hours after the series of treatments. Compared to the sham cTBS group, MEA overlap was 27% (95% CI −44 to −11; p 0.0030), 25% (95% CI −45 to −5; p 0.0224) and 29% (95% CI −48 to −11; p 0.0038) less in the active cTBS group within twelve hours and at one week post-treatment, and three months post-stroke, respectively. Ipsilesional M1 excitability (i.e., RMT) within twelve hours post-cTBS correlated with FMA arm score at 3 months post-stroke (Spearman’s rho 0.59; p < 0.0001).ConclusionsUpper limb recovery after cTBS treatment of the contralesional M1 after stroke may be caused by increased ipsilesional M1 excitability and MEA remapping.Trial registrationhttps://trialsearch.who.int/; Unique identifier: NTR6133.
Validation of Segmental Bioelectrical Impedance Analysis Compared with Dual Energy X-Ray Absorptiometry to Measure Body Composition in Patients with Obesity-related Heart Failure with Preserved Ejection Fraction
Authors: Salmons Hannah , Ahmed Syed Imran , Billingsley Hayley , Reavey-Cantwell Alexander , Markley Roshanak , Golino Michele , Del Buono Marco Giuseppe , Damonte Juan Ignacio , Pinel Sebastian , Franco R. Lee , Abbate Antonio , Earthman Carrie P. , Carbone Salvatore 
Published: November 2024

ABSTRACTBackgroundAppendicular lean mass index (ALMI), a term used to describe appendicular lean soft tissue measured by dual-energy X-ray absorptiometry (DXA), is a major determinant of cardiorespiratory fitness in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Moreover, ALMI can be used to diagnose sarcopenia and sarcopenic obesity in this population. DXA is a reference standard for assessing body composition, however, segmental single-frequency bioelectrical impedance analysis (SF-BIA) could offer a more accessible, portable, cost-effective, and radiation-free alternative. To validate segmental SF-BIA for body composition analysis in patients with HFpEF and obesity, with a focus on ALMI.MethodsWe analyzed 62 consecutive euvolemic patients with persistent obesity-related HFpEF (83.8% female, 60.8± 2.8 years of age). We used both DXA and segmental SF-BIA to measure ALMI and appendicular fat mass index (AFMI), fat mass (FM), fat-free mass (FFM) in kg and as % of body weight, FM index, and FFM index. Correlations were assessed using Pearson’s coefficients and Bland-Altman plots, while linear regression was performed to evaluate proportional bias.ResultsStrong, statistically significant correlations were found between BIA and DXA for ALMI (r=0.897), AFMI (r=0.864), FM (r=0.968), FM% (r=0.867), FFM (r=0.954), and FFM% (r=0.852), FM index (r=0.97), and FFM index (r=0.88) (all p<0.001). The Bland-Altman analysis demonstrated agreement between methods and linear regression indicated no significant proportional bias for all parameters, except for AFMI.ConclusionsSegmental SF-BIA-measured body composition shows strong correlations, appropriate agreements, and no proportional bias compared to DXA. Considering the central role of body composition and particularly of ALMI in patients with obesity-related HFpEF, when DXA is not readily available or contraindicated, segmental SF-BIA should be considered in this population.
Interventions for improving antibiotic prescribing in the community: systematic review and meta-analysis
Authors: Andrews Rebecca A J , Santiago Virginia Hernandez , Guthrie Bruce , Marwick Charis A 
Published: November 2024

AbstractBackgroundAntibiotic resistance is a public health priority and antibiotic use in humans is a major contributing factor to its development. Interventions to improve antibiotic prescribing in the community, where most antibiotics are prescribed, are widely implemented with varying effect. The aim was to systematically review and meta-analyse evidence on effectiveness of different types of antibiotic prescribing interventions in the community.Methods and FindingsMedline, Embase, and the Cochrane Central Register of Controlled Trials, were searched from database inception to 16 August 2021 to identify randomised controlled trials comparing antibiotic stewardship interventions versus usual care in community settings. Two reviewers screened studies, extracted data, and assessed risk of bias. Studies were grouped according to type of intervention. Meta-analyses employed random effects models. The outcome for meta-analyses was change in total antibiotic prescribing rates attributable to the intervention, compared to usual care, calculated as percentage differences. Other measures of change in antibiotic prescribing were included in narrative description.Of 26,130 studies screened, 74 were included, with 53 comparisons from 45 studies meta- analysed. 50% of included studies had high risk of bias. Single interventions with statistically significant reductions in total antibiotic prescribing were point of care tests for antigen detection (−28.0% reduction, 95%CI−38.2 to−17.8); educational materials (−17.0%, −31.0 to - 3.0); printed decision-support systems (−10.8%,−15.7 to -6.0), educational workshops (− 8.7%,−12.8 to -4.7), and; educational outreach (−6.0%,−10.6 to−1.4). Multifaceted interventions were not more effective than single interventions (education + audit and feedback –9.9%, −12.8 to -7.0; other multifaceted -9.4%, −17.2 to −1.6). Effect sizes in sensitivity analyses excluding trials at high risk of bias were similar or larger.ConclusionsCommunity antibiotic stewardship interventions were effective but with considerable variation in effect size. The most effective trial interventions may be more difficult to implement in practice, a key challenge for antibiotic stewardship.Systematic review registrationPROSPERO CRD42014010160