bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of carnitine supplementation on energy utilization in patients with type 2 diabetes and long-term tube feeding: A CARE-compliant case report
Authors: Asai Shingo , Tai Yuki , Fujimura Masaki , Yamamoto Masakazu , Makabu Yasuhiro , Shimizu Yuki , Kido Yasuhiro , Hara Hiroto , Kokubo Eri , Chen Wun-Bill 
Published: June 2024

Introduction:
Carnitine is essential for the energy utilization of long-chain fatty acids. However, the effects of carnitine supplementation on patients undergoing tube feeding remain unclear, and some enteral formula products do not contain carnitine. In order to gain insights into the role of carnitine supplementation on energy utilization in patients with long-term tube feeding, we observed the changes in respiratory quotient (RQ) of patients before and after the addition of carnitine due to the renewal of an enteral formula product.

Case presentation:
We observed 6 patients who continued tube feeding with the same enteral formula product scheduled for renewal. All 6 participants had diabetes, and indirect calorimetry data were available for 4 patients. Participants were observed for 3 months after switching to the new formulation. After the switching, a carnitine supplementation of 120 to 180 mg/day was provided, depending on the intake amount. One month after switching, blood free carnitine and total carnitine levels in all 6 patients increased from below the lower limit to within the range of the Japanese reference standard. In 3 of the 4 patients for whom indirect calorimetry was possible, the fasting RQ at baseline was >0.90, suggesting impaired lipid utilization. The mean fasting RQ significantly decreased 2 months after the switch. The 1- and 2-hour postprandial RQ also showed a significant decrease after switching.

Conclusion:
Carnitine supplementation of enteral formulas may be important for normal energy utilization of lipids in patients receiving long-term tube feeding. An evaluation using randomized controlled trials with a larger number of patients is required.
Canakinumab is effective for refractory Entero-Behçet’s disease with compound heterozygous variants of the MEFV gene: A case report
Authors: Umeda Masataka , Tsukamoto Yutaka , Sugimoto Takashi , Ozasa Souichiroh , Akabame Shogo , Fukui Shoichi , Mohamed Lamiaa Yaser Helmy , Tsuji Yoshika , Koga Tomohiro , Matsuoka Yuki , Kato Takeharu , Tominaga Tetsuro , Furuse Yuki , Maeda Takahiro , Ariyoshi Koya , Kawakami Atsushi 
Published: June 2024

Rationale:
Behçet’s disease (BD) is characterized by recurrent oral ulcers, skin lesions, genital ulcers, and ocular inflammation, with uncontrolled gastrointestinal manifestations potentially leading to fatal complications. Human leukocyte antigen (HLA) class I alleles such as HLA-B51 and HLA-A26 are genetic risk factors for BD, and interleukin-1β activation plays a key role in BD pathogenesis. Familial Mediterranean fever, another autoinflammatory disease caused by MEFV gene mutations, shares similarities with BD, including enhanced interleukin-1β production.

Patient concerns:
We present a case of BD with severe gastrointestinal ulcers and MEFV variants treated with canakinumab.

Diagnoses:
A 69-year-old Japanese woman with a history of malignant lymphomas and nontuberculous mycobacterial arthritis developed BD symptoms, including oral and gastrointestinal ulcers.

Interventions:
Despite after treatments with 2 tumor necrosis factor inhibitors, her oral and gastrointestinal ulcers persisted. Genetic analysis revealed L110P/E148Q MEFV variants, prompting the administration of canakinumab and granulocyte and monocyte adsorption apheresis.

Outcomes:
Continuous treatment with canakinumab improved the oral and gastrointestinal ulcers.

Lessons:
This case highlights the potential efficacy of canakinumab in treating severe gastrointestinal ulcers in BD patients with MEFV variants.
Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps
Authors: Tanna Neil , Sultan Darren L. , Minasian Raquel A. , Clappier Mona , Haddock Nicholas T. , Chrysopoulo Minas T. , Nahabedian Maurice Y. , Serletti Joseph M. , Allen Robert J. 
Published: June 2024

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand the types of abdominally based flaps, their anatomy, and their drawbacks. 2. Understand important aspects of the history and physical examination of patients wishing to undergo these procedures. 3. Understand the benefits of preoperative planning and its role in avoiding complication. 4. Understand the operative steps of the procedures and tips to increase efficiency. 5. Understand the postoperative care of these patients and the role of enhanced recovery pathways.

Summary:
In this article, the authors review the history, current state, and future directions related to abdominally based microsurgical breast reconstruction. This article covers preoperative, intraoperative, and postoperative considerations intended to improve patient outcomes and prevent complications. Evidence-based findings are reported when available to comprehensively review important aspects of these procedures.
The Role of Local Flaps in Foot and Ankle Reconstruction: An Assessment of Outcomes across 206 Patients with Chronic Wounds
Authors: Berger Lauren E. , Spoer Daisy L. , Huffman Samuel S. , Garrett Richard W. , Khayat Elias , DiBello John R. , Zolper Elizabeth G. , Akbari Cameron M. , Evans Karen K. , Attinger Christopher E. 
Published: June 2024

Background:
Reconstructive surgery has experienced a paradigm shift in favor of free flaps. Yet local flaps may be of particular use in foot and ankle reconstruction among comorbid patient populations. Thus, the authors sought to better characterize long-term outcomes in this setting.

Methods:
A single-center, retrospective cohort study of patients undergoing local muscle and fasciocutaneous flaps of the foot and ankle from January of 2010 through November of 2022 was performed. Flaps were performed on wounds measuring 3 × 6 cm or smaller; flap selection depended on preoperative vascular assessment, Doppler findings, comorbidity profile, and wound location, depth, and geometry.

Results:
A total of 206 patients met inclusion criteria. Their median age was 61.0 years (interquartile range, 16.8), and comorbidities included diabetes mellitus (n = 149 [72.3%]) and peripheral arterial disease (n = 105 [51.0%]). Presentations included chronic, nonhealing wounds (n = 77 [39.1%]) or osteomyelitis (n = 45 [22.8%]) and most frequently extended to the bone (n = 128 [62.1%]). Eighty-seven patients (42.2%) received muscle flaps; 119 (57.8%) received fasciocutaneous flaps. Six patients (2.9%) needed return to the operating room, with thrombosis occurring in 2 cases (1.0%). The flap success rate was 98.1%. By a median follow-up duration of 21.7 months (interquartile range, 39.0), 21.8% of patients (n = 45) required ipsilateral amputation, 73% (n = 145 of 199) were ambulatory, and 2 deaths related to the surgical wound occurred (2 of 49 [4.1%]). Multivariate analysis revealed that positive predictors of complications included diabetes mellitus, end-stage renal disease, and history of venous thromboembolism or smoking.

Conclusion:
Local flaps remain a reliable option to reconstruct smaller defects of the foot and ankle in a highly comorbid population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Antithrombotic Questionnaire Tool for Evaluation of Combined Antithrombotic Therapy in Community Pharmacies
Authors: van Uden Renate C.A.E. , Sulaiman Barzo , Pols Patricia A.M. , Meijer Karina , van den Bemt Patricia M.L.A. , Becker Matthijs L. 
Published: June 2024

Objective
The objective of this paper is to assess the diagnostic value of an antithrombotic questionnaire tool compared with the hospital’s medical record information tool. The hypothesis of this study was that the antithrombotic questionnaire tool could identify patients with potentially incorrect antithrombotic therapy.

Methods
This cross-sectional study was conducted in eight community pharmacies in the Netherlands. A standardized questionnaire was developed as antithrombotic questionnaire tool. The pharmacist assessed whether the antithrombotic therapy was correct or potentially incorrect based on answers given by patients and based on the medical record. The primary outcome of the study was the sensitivity and specificity of the antithrombotic questionnaire tool to identify patients with potentially incorrect antithrombotic therapy.

Results
For 95 patients, the pharmacist assessed that in 81 (85%) the antithrombotic therapy was correct and in 14 (15%) potentially incorrect. Based on the medical record, 86 patients (91%) were assessed as correct and 9 (9%) as potentially incorrect. The sensitivity of the tool was 100% and the specificity 94%.

Conclusions
This study demonstrated that the antithrombotic questionnaire tool is a suitable tool to assess whether the patient’s antithrombotic therapy is potentially incorrect. It can be applied to identify patients with potentially incorrect antithrombotic therapy.
Cost-effectiveness of different intervention strategies of HIV in Zhejiang, China
Authors: Wu Chensi , Xu Xiaolan , Peng Chunting , Dong Yin , Lou Zhuoqi , Pan Liya , Chen Lin , Zeng Yifan , Ruan Bing 
Published: June 2024

Objective:
Mass screening for HIV and preexposure prophylaxis (PrEP) may be effective measures for reducing the probability of HIV transmission. Our study aimed to determine the cost-effectiveness of preliminary screening in the general population, PrEP for HIV-negative spouses in serodiscordant couples, or both approaches in Zhejiang Province.

Design:
From a policy-maker's perspective, a Markov model was constructed to compare four strategies over a 30-year horizon.

Methods:
In the Markov model, the implementation intensities of the strategies varied from 50 to 100%. Different strategies were evaluated by the reduction of unfavorable clinical outcomes, saved life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs).

Results:
The PrEP-screening strategy reduced the most unfavorable clinical outcomes and saved the most life-years and QALYs from 2023 to 2052. It always gained the maximum QALYs and NMB, while its ICER was always lower than the willingness-to-pay (WTP). The NMB of the PrEP-screening strategy gradually increased as the implementation intensity increased.

Conclusion:
With adequate manpower and policies, we suggest implementing the PrEP-screening strategy in Zhejiang Province, suggesting that the broader the population coverage of the strategy, the better. In addition, the PrEP strategy is an alternative.
Dedicated Photon-Counting CT for Detection and Classification of Microcalcifications
Authors: Huck Luisa Charlotte , Bode Maike , Zanderigo Eloisa , Wilpert Caroline , Raaff Vanessa , Dethlefsen Ebba , Wenkel Evelyn , Kuhl Christiane Katharina 
Published: June 2024

Objectives
Clinical experience regarding the use of dedicated photon-counting breast CT (PC-BCT) for diagnosis of breast microcalcifications is scarce. This study systematically compares the detection and classification of breast microcalcifications using a dedicated breast photon-counting CT, especially designed for examining the breast, in comparison with digital breast tomosynthesis (DBT).

Materials and Methods
This is a prospective intraindividual study on women with DBT screening–detected BI-RADS-4/-5 microcalcifications who underwent PC-BCT before biopsy. PC-BCT images were reconstructed with a noninterpolated spatial resolution of 0.15 × 0.15 × 0.15 mm (reconstruction mode 1 [RM-1]) and with 0.3 × 0.3 × 0.3 mm (reconstruction mode 2 [RM-2]), plus thin-slab maximum intensity projection (MIP) reconstructions. Two radiologists independently rated the detection of microcalcifications in direct comparison with DBT on a 5-point scale. The distribution and morphology of microcalcifications were then rated according to BI-RADS. The size of the smallest discernible microcalcification particle was measured. For PC-BCT, the average glandular dose was determined by Monte Carlo simulations; for DBT, the information provided by the DBT system was used.

Results
Between September 2022 and July 2023, 22 participants (mean age, 61; range, 42–85 years) with microcalcifications (16 malignant; 6 benign) were included. In 2/22 with microcalcifications in the posterior region, microcalcifications were not detectable on PC-BCT, likely because they were not included in the PC-BCT volume. In the remaining 20 participants, microcalcifications were detectable. With high between-reader agreement (κ > 0.8), conspicuity of microcalcifications was rated similar for DBT and MIPs of RM-1 (mean, 4.83 ± 0.38 vs 4.86 ± 0.35) (P = 0.66), but was significantly lower (P < 0.05) for the remaining PC-BCT reconstructions: 2.11 ± 0.92 (RM-2), 2.64 ± 0.80 (MIPs of RM-2), and 3.50 ± 1.23 (RM-1). Identical distribution qualifiers were assigned for PC-BCT and DBT in 18/20 participants, with excellent agreement (κ = 0.91), whereas identical morphologic qualifiers were assigned in only 5/20, with poor agreement (κ = 0.44). The median size of smallest discernible microcalcification particle was 0.2 versus 0.6 versus 1.1 mm in DBT versus RM-1 versus RM-2 (P < 0.001), likely due to blooming effects. Average glandular dose was 7.04 mGy (PC-BCT) versus 6.88 mGy (DBT) (P = 0.67).

Conclusions
PC-BCT allows reliable detection of in-breast microcalcifications as long as they are not located in the posterior part of the breast and allows assessment of their distribution, but not of their individual morphology.
Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema
Authors: Uyulmaz Semra , Grünherz Lisanne , Giovanoli Pietro , Fuchs Bruno , Lindenblatt Nicole 
Published: June 2024

Introduction
Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection.

Methods
We performed immediate lymphatic reconstruction in 11 patients after soft tissue sarcoma resection in the upper medial thigh. The postoperative course was followed up closely, and postoperative occurrence of lymphocele and lymphedema was clinically assessed. A literature search outlining the latest clinical data, current treatment strategy landscape, and their application into clinical practice was added to the investigation.

Results
A total of 19 LVA and 2 lympho-lymphatic anastomoses were performed in 11 patients immediately after tumor resection in an end-to-end manner. We found a postoperative lymphedema rate of 36% and a postoperative lymphocele rate of 27%. Mean follow-up time was 17 months. Average tumor volume was 749 cc. Our literature search yielded 27 articles reporting on immediate LVA in cancer patients. Incidences of secondary lymphedema after LVA for lymphedema prevention vary between 0% and 31.1%. Lymphocele prevention with LVA is poorly studied in sarcoma patients.

Conclusion
Immediate lymphatic reconstruction improved the overall postoperative course of our patients. The current literature does not serve with high-quality studies about primary LVA preventing lymphedema and lymphocele formation. We conclude that this technique should be seen as an additional concept to achieve overall better postoperative outcomes in these challenging surgical settings. We strongly recommend to either anastomose or ligate severed lymphatics under the microscope primarily after sarcoma resection in the upper medial thigh area.
Individualized Digital Nasoalveolar Molding: A Proof of Concept
Authors: Parakarn Hathaichanok , Pisek Poonsak , Wangsrimongkol Buddhathida 
Published: June 2024

Nasoalveolar molding (NAM) is a recognized adjunctive therapy to primary cheiloplasty in patients with complete cleft lip and palate (CLP). The conventional technique can be time-consuming, costly, and requires experienced clinicians. Over the past decade, CAD/CAM technology has been employed to facilitate NAM therapy, showing promising results. This study introduces an individualized Digital NAM (iDNAM), a digital approach revolutionizing NAM treatment using CAD/CAM technology, and evaluates treatment outcomes. A 57-day-old infant with complete UCLP underwent intraoral and nasolabial scans, along with 3D photogrammetry. Open-source software was utilized for virtual alveolar segmentation and NAM plate design. iDNAM incorporates a nasal molding extension, introducing an innovative nasal stent activation protocol. Changes in alveolar and nasal morphology were compared between the initial and presurgery stages. After treatment with iDNAM, the alveolar cleft gap was reduced to 4.22 mm. Nostril height on the cleft side, columellar length, and nose projection increased by 0.98, 2.40, and 1.90 mm, respectively. The nasal base-columellar angle improved by 29.50 degrees. The results demonstrate a significant reduction in the alveolar cleft gap and improved nasal morphology, making iDNAM as an alternative to NAM therapy.
TRAUMA-INDUCED COAGULOPATHY: PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER
Authors: Teeter William , Neal Matthew D. , Brown Joshua B. , MacLeod Jana B. A. , Vesselinov Roumen , Kozar Rosemary A. 
Published: June 2024

ABSTRACT

Introduction: A 2003 landmark study identified the prevalence of early trauma-induced coagulopathy (eTIC) at 28% with a strong association with mortality of 8.9%. Over the last 20 years, there have been significant advances in both the fundamental understanding of eTIC and therapeutic interventions. Methods: A retrospective cohort study was performed from 2018 to 2022 on patients ≥18 using prospectively collected data from two level 1 trauma centers and compared to data from 2003. Demographics, laboratory data, and clinical outcomes were obtained. Results: There were 20,107 patients meeting criteria: 65% male, 85% blunt, mean age 54 ± 21 years, median Injury Severity Score 10 (10, 18), 8% of patients were hypotensive on arrival, with an all-cause mortality 6.0%. The prevalence of eTIC remained high at 32% in patients with an abnormal prothrombin time and 10% with an abnormal partial thromboplastin time, for an overall combined prevalence of 33.4%. Coagulopathy had a major impact on mortality over all injury severity ranges, with the greatest impact with lower Injury Severity Score. In a hybrid logistic regression/Classification and Regression Trees analysis, coagulopathy was independently associated with a 2.1-fold increased risk of mortality (95% confidence interval 1.5–2.9); the predictive quality of the model was excellent [area under the receiver operating characteristic curve (AUROC) 0.932]. Conclusion: The presence of eTIC conferred a higher risk of death across all disease severities and was independently associated with a greater risk of death. Biomarkers of coagulopathy associated with eTIC remain strongly predictive of poor outcome despite advances in trauma care.
Advanced Preoperative Clinical Stage Is Associated With More Lymph Node Harvest in Patients With Right Colon Cancer
Authors: Kim Hyeon Kyeong , Oh Bo-Young , Noh Gyoung Tae , Chung Soon Sup , Lee Ryung-Ah , Kim Ho Seung 
Published: June 2024

Purpose:
The adequacy of lymph node (LN) harvest is important in oncological colon cancer resections. While several studies have suggested factors influencing LN yield in colon cancer, limited data are available only regarding right hemicolectomies with complete mesocolic excision (CME) and central vessel ligation (CVL).

Methods:
A retrospective analysis was conducted on 169 patients who underwent right hemicolectomies with CME and CVL for right-sided colon cancer between February 2019 and March 2023. The patients were divided into 2 groups: groups with ≤24 LN yield and >24 LN yield, and the patient, surgical, and pathologic factors, which could potentially influence the LN yield, were analyzed.

Results:
Younger age, lower American Society of Anesthesiologists (ASA) classification, and advanced clinical TNM (cTNM) stage among patient factors, the presence of obstructions regarding the surgical factors, and the presence of desmoplastic tumor reaction in the pathologic factors were more likely to harvest >24 LNs. In a multivariate analysis, younger age, lower ASA classification, advanced cTNM stage, and an ileocolic artery (ICA) crossing pattern posterior to the superior mesenteric vein (SMV) were independently associated with a >24 LN harvest. Patients with cTNM 3,4 showed the tendency of > 24 LN yield consistently within each subgroup, irrespective of the age, ASA classification, and ileocolic artery crossing pattern.

Conclusions:
Our investigation revealed a significant correlation between the advanced preoperative clinical stage and an increased number of harvested lymph nodes (LNs) in patients undergoing right hemicolectomies with CME a CVL. The observed association is potentially influenced by tumor aggressiveness and the extent of surgical resection performed by the surgeon. To elucidate the intricate relationship between surgical outcomes and the quantity of LN harvest in patients subjected to standardized CME and CVL for right-sided colon cancer, further dedicated research is warranted.
The Risk of Microbial Transmission in Recipients of Donor Livers That Underwent Hypothermic or Normothermic Machine Perfusion
Authors: Endo Chikako , Lascaris Bianca , Brüggenwirth Isabel M. A. , Roggeveld Jan , Blokzijl Hans , de Meijer Vincent E. , Doting M. H. Edwina , Porte Robert J. 
Published: June 2024

Background.
Ex situ machine perfusion is increasingly used to preserve and assess donor livers before transplantation. Compared with traditional static cold storage (SCS), machine perfusion exposes livers to an additional risk of microbial contamination. However, information on the risk of microbial transmission during machine perfusion is lacking.

Methods.
All livers that underwent either hypothermic oxygenated machine perfusion (HOPE) or normothermic machine perfusion (NMP) in our center between September 2021 and September 2023, and during which samples were taken from SCS fluid and/or machine perfusion solution for microbiological examination, were included in this retrospective, observational clinical study. Microbial transmission was examined from SCS fluid to machine perfusion solution fluid and, subsequently, to recipients of these livers.

Results.
A total of 90 cases of liver machine perfusion were included: 59 HOPE and 31 NMP. SCS preservation fluid cultures before HOPE or NMP were positive for at least 1 microorganism in 52% of the cases. After HOPE, there were no cases of positive machine perfusion fluid or evidence of microbial transmission to the recipients. After NMP, in 1 (3%) patient Escherichia coli was grown from abdominal drain fluid, the same bacterial strain that was also grown from the SCS preservation fluid before NMP. This E coli was resistant to the antibiotics that are routinely added to the NMP perfusion fluid.

Conclusions.
The risk of microbial transmission after machine perfusion is very low but not absent. We recommend routine sampling of machine perfusion fluid at the end of the procedure for microbiological analysis.