bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multivariate Analysis of Risk Factors for Complications in Pediatric Tissue Expansion
Authors: Katsushima Chihiro , Sowa Yoshihiro , Sakamoto Michiharu , Abe Hiroyasu , Yamanaka Hiroki , Tsuge Itaru , Katsube Motoki , Saito Susumu , Morimoto Naoki 
Published: April 2024

Background
Tissue expanders represent one of the main surgical options for skin reconstruction in cases of tumors, traumalike burn injury, scar contracture, and alopecia. However, the tissue expander device is also associated with complications such as infection and extrusion. The aim of this study was to analyze risk factors for major complications of use of tissue expanders in pediatric patients using multivariate analysis.

Methods
A retrospective, single-center observational study was performed over 10 years in pediatric patients who were treated with tissue expanders for tumors, nevus, scars, burn reconstruction, and alopecia from April 2012 to March 2022. The primary outcome was overall complications per operation and expander, including infection and extrusion. Ten predictor variables were included as risk factors based on previous studies and as new factors considered important from clinical experience. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications such as expander infection or extrusion.

Results
The study included 44 patients who underwent 92 operations using 238 tissue expanders. The overall complication rate per expander was 14.3%. Univariate logistic regression analysis identified associations of younger age, number of expanders used per operation, history of infection, and tissue expander locations with a higher complication rate. In multivariate logistic regression analysis, younger age (odds ratio, 1.14; P = 0.043) was associated with a high likelihood of expander complications.

Conclusions
Younger age is an independent risk factor for tissue expander complications in pediatric patients. This factor should be considered in preoperative planning and discussions with the patient's family.
Report on Pseudoaneurysm Caused by Injury of Internal Carotid Artery During Endoscopic Pituitary Surgery and Rebleeding After Treatment With Willis Covered Stent
Authors: Xiao Kai , Chen Yu Jing , Xu Hao , Zhang Shao Jie , Chen Lang , Hu Fei , Li Pan , Chen Yang , Shao Qiang 
Published: April 2024

Objective:
Report on a case of pseudoaneurysm which was caused by injury of the internal carotid artery (ICA) during endoscopic endonasal surgery (EES), which was followed by rebleeding after treatment with a Willis covered stent.

Methods:
A woman, aged 68, underwent EES for the treatment of a pituitary adenoma. During the surgery, the right ICA was injured, and successfully hemostasis by packed with cottonoid and gelatin sponge. Besides, cerebral angiography was performed in the interventional operating room for the purpose of discovering the formation of a pseudoaneurysm in the cavernous sinus segment of ICA, which was treated with a covered stent. After successfully placing the covered stent, the patient was promptly transferred to the general operating room for the removal of the cottonoid and to address the bleeding once again. The authors employ crushed muscles and cottonoid to locally compress and stop bleeding. Owing to concerns about the risk of rebleeding in the patient, after stent implantation, the patient did not utilize antiplatelet drugs. After the surgery, the patient developed occlusion of the right ICA and massive cerebral infarction in the right hemisphere. Dehydration, anti-infection, rehabilitation, hyperbaric oxygen, as well as related treatments, were given. The cottonoid was removed in EES 2 months postsurgery, and no instances of bleeding were observed. Six months after surgery, the patient had clear consciousness and hemiplegia in the left limb, with a Glasgow Outcome Scale score of 4.

Results:
The ICA was injured during EES, which resulted in the formation of a pseudoaneurysm, the Willis stent was adopted for treatment, and there was a risk of rebleeding after the nasal packing (cottonoid, crushed muscles) was removed immediately.

Conclusions:
The ICA was injured during EES after bleeding was controlled by packing with cottonoid, crushed muscles, etc, subsequently, the patient was given intravascular treatment, it is advised to make thorough preparations and, after a suitable period, remove nasal packing in the hybrid operating room to address unexpected situations and unforeseen circumstances.
Four-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study
Authors: Estroff Jordan M. , Devlin Joseph , Hoteit Lara , Hassoune Adnan , Neal Matthew D. , Brown Joshua B. , Lu Liling , Kotch Shannon , Hazelton Joshua P. , Christian Ashton B. , Yeates Eric O. , Nahmias Jeffry , Jacobson Lewis E. , Williams Jamie , Schuster Kevin M. , O’Connor Rick , Semon Gregory R. , Straughn Angela D. , Cullinane Daniel , Egodage Tanya , Kincaid Michelle , Rollins Allison , Amdur Richard , Sarani Babak 
Published: April 2024

BACKGROUND
Andexanet alfa (AA) is the only FDA-approved reversal agent for apixaban and rivaroxaban (DOAC). There are no studies comparing its efficacy with four-factor prothrombin complex concentrate (PCC). This study aimed to compare PCC to AA for DOAC reversal, hypothesizing noninferiority of PCC.

METHODS
We performed a retrospective, noninferiority multicenter study of adult patients admitted from July 1, 2018, to December 31, 2019, who had taken a DOAC within 12 hours of injury, were transfused red blood cells (RBCs) or had traumatic brain injury, and received AA or PCC. Primary outcome was PRBC unit transfusion. Secondary outcome with intensive care unit length of stay. MICE imputation was used to account for missing data and zero-inflated Poisson regression was used to account for an excess of zero units of RBC transfused. Two units difference in RBC transfusion was selected as noninferior.

RESULTS
Results: From 263 patients at 10 centers, 77 (29%) received PCC and 186 (71%) AA. Patients had similar transfusion rates across reversal treatment groups (23.7% AA vs. 19.5% PCC) with median transfusion in both groups of 0 RBC. According to the Poisson component, PCC increases the amount of RBC transfusion by 1.02 times (95% confidence interval, 0.79–1.33) compared with AA after adjusting for other covariates. The average amount of RBC transfusion (nonzero group) is 6.13. Multiplying this number by the estimated rate ratio, PCC is estimated to have an increase RBC transfusion by 0.123 (95% confidence interval, 0.53–2.02) units compared with AA.

CONCLUSION
PCC appears noninferior to AA for reversal of DOACs for RBC transfusion in traumatically injured patients. Additional prospective, randomized trials are necessary to compare PCC and AA for the treatment of hemorrhage in injured patients on DOACs.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Characterizing trauma patients with delays in orthopedic process measures
Authors: Gohel Nishant , Khambete Pranav , Gerhardinger Laura J. , Miller Anna N. , Wolinsky Philip R. , Jarman Molly P. , Scott John W. , Vaidya Rahul , Hemmila Mark R. , Oliphant Bryant W. 
Published: April 2024

INTRODUCTION
Early operative intervention in orthopedic injuries is associated with decreased morbidity and mortality. Relevant process measures (e.g., femoral shaft fixation <24 hours) are used in trauma quality improvement programs to evaluate performance. Currently, there is no mechanism to account for patients who are unable to undergo surgical intervention (i.e., physiologically unstable). We characterized the factors associated with patients who did not meet these orthopedic process measures.

METHODS
A retrospective cohort study of patients from 35 American College of Surgeons Committee on Trauma–verified level 1 and level 2 trauma centers was performed using quality collaborative data (2017–2022). Inclusion criteria were adult patients (18 years or older), Injury Severity Score ≥5, and a closed femoral shaft or open tibial shaft fracture classified via the Abbreviated Injury Scale version 2005. Relevant factors (e.g., physiologic) associated with a procedural delay >24 hours were identified through a multivariable logistic regression, and the effect of delay on inpatient outcomes was assessed. A subanalysis characterized the rate of delay in “healthy patients.”

RESULTS
We identified 5,199 patients with a femoral shaft fracture, and 87.5% had a fixation procedure, of which 31.8% had a delay, and 47.1% of those delayed were “healthy.” There were 1,291 patients with an open tibial shaft fracture, 92.2% had fixation, 50.5% had an irrigation and debridement, and 11.2% and 18.7% were delayed, respectively. High Injury Severity Score, older age, and multiple medical comorbidities were associated with a delay in femur fixation, and those delayed had a higher incidence of complications.

CONCLUSION
There is a substantial incidence of surgical delays in some orthopedic trauma process measures that are predicted by certain patient characteristics, and this is associated with an increased rate of complications. Understanding these factors associated with a surgical delay, as well as effectively accounting for them, is key if these process measures are to be used appropriately in quality improvement programs.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Favorable Outcome After Single-kidney Transplantation From Small Donors in Children: A Match-controlled CERTAIN Registry Study
Authors: Schild Raphael , Carvajal Abreu Karla , Büscher Anja , Kanzelmeyer Nele , Lezius Susanne , Krupka Kai , Weitz Marcus , Prytula Agnieszka , Printza Nikoleta , Berta László , Saygili Seha Kamil , Sellier-Leclerc Anne-Laure , Spartà Giuseppina , Marks Stephen D. , Kemper Markus J. , König Sabine , Topaloglu Rezan , Müller Dominik , Klaus Günter , Weber Stefanie , Oh Jun , Herden Uta , Carraro Andrea , Dello Strologo Luca , Ariceta Gema , Hoyer Peter , Tönshoff Burkhard , Pape Lars 
Published: April 2024

Background.
Kidney transplantation (KTx) from small donors is associated with inferior graft survival in registry studies, whereas single-center studies show favorable results.

Methods.
We compared 175 pediatric KTx from small donors ≤20 kg (SDKTx) with 170 age-matched recipients from adult donors (ADKTx) from 20 centers within the Cooperative European Paediatric Renal Transplant Initiative registry. Graft survival and estimated glomerular filtration rate (eGFR) were analyzed by Cox regression and mixed models. Detailed data on surgical and medical management were tested for association with graft survival.

Results.
One-year graft survival was lower after SDKTx compared with ADKTx (90.9% versus 96.5%; odds ratio of graft loss, 2.92; 95% confidence interval [CI], 1.10-7.80; P = 0.032), but 5-y graft survival was comparable (90.9% versus 92.7%; adjusted hazard ratio of graft loss 1.9; 95% CI, 0.85-4.25; P = 0.119). SDKTx recipients had an annual eGFR increase of 8.7 ± 6.2 mL/min/1.73 m² compared with a decrease of 6.9 ± 5.7 mL/min/1.73 m² in ADKTx recipients resulting in a superior 5-y eGFR (80.5 ± 25.5 in SDKTx versus 65.7 ± 23.1 mL/min/1.73 m² in ADKTx; P = 0.008). At 3 y posttransplant, eGFR after single SDKTx was lower than after en bloc SDKTx (86.6 ± 20.4 versus 104.6 ± 35.9; P = 0.043) but superior to ADKTx (68.1 ± 23.9 mL/min/1.73 m²). Single-kidney SDKTx recipients had a lower rate of hypertension at 3 y than ADKTx recipients (40.0% versus 64.7%; P = 0.008).

Conclusions.
Compared with ADKTx, 5-y graft function is superior in SDKTx and graft survival is similar, even when performed as single KTx. Utilizing small donor organs, preferably as single kidneys in experienced centers, is a viable option to increase the donor pool for pediatric recipients.
Organ Donation and Transplantation Registries Across the Globe: A Review of the Current State
Authors: Rampersad Christie , Ahn Curie , Callaghan Chris , Dominguez-Gil Beatriz , Ferreira Gustavo F. , Kute Vivek , Rahmel Axel O. , Sarwal Minnie , Snyder Jon , Wang Haibo , Wong Germaine , Kim S. Joseph ,   on behalf of the Global Data Harmonization Committee of the Transplantation Society
Published: April 2024

Background.
The current landscape of organ donation and transplantation (ODT) registries is not well established. This narrative review sought to identify and characterize the coverage, structure, and data capture of ODT registries globally.

Methods.
We conducted a literature search using Ovid Medline and web searches to identify ODT registries from 2000 to 2023. A list of ODT registries was compiled based on publications of registry design, studies, and reports. Extracted data elements included operational features of registries and the types of donor and recipient data captured.

Results.
We identified 129 registries encompassing patients from all continents except Antarctica. Most registries were active, received funding from government or professional societies, were national in scope, included both adult and pediatric patients, and reported patient-level data. Registries included kidney (n = 99), pancreas (n = 32), liver (n = 44), heart (n = 35), lung (n = 30), intestine (n = 15), and islet cell (n = 5) transplants. Most registries captured donor data (including living versus deceased) and recipient features (including demographics, cause of organ failure, and posttransplant outcomes) but there was underreporting of other domains (eg, donor comorbidities, deceased donor referral rates, waitlist statistics).

Conclusions.
This review highlights existing ODT registries globally and serves as a call for increased visibility and transparency in data management and reporting practices. We propose that standards for ODT registries, a common data model, and technical platforms for collaboration, will enable a high-functioning global ODT system responsive to the needs of transplant candidates, recipients, and donors.
Antibiotic Use and Antimicrobial Resistance: KAP survey of medical students to evaluate undergraduate training curriculum
Authors: Saksena Rushika , Parida Annapurna , Jain Madhura , Gaind Rajni 
Published: April 2024

Introduction: A better understanding of knowledge, attitude and practices of undergraduate medical students towards antimicrobial resistance (AMR) is necessary to identify gaps in current training curriculum.
Methods: A 20-point Likert scale-based questionnaire divided three parts on knowledge, attitude and practices relating to antibiotic use and resistance was devised. Students attending each year of undergraduate medical program were approached to participate in the study over a one-week-period. KAP scores of each year were compared through logistic ordinal regression and Kruskal-Wallis (KW) test.
Results: Two hundred and eight students participated in the study. Overall, knowledge of about intended use of antibiotics, fixed drug combinations and awareness about AMR was good (average score of 73.75%). Steady improvement in knowledge scores was observed from first year (-0.441) to final year (0.00). The medical students had favorable attitude towards rational antimicrobial use (Likert score ³4) including the need to spread awareness about AMR amongst students and public and following doctor’s prescription. Self-medication was reported by 28.4% of students and hoarding of leftover doses by 49.1%. Attitude score had a direct correlation with the knowledge score on KW test (χ2 =29.6, p≤0.5) but had no significant correlation with antimicrobial practices (χ2 =3.9, p≥0.5). The gaps identified in students’ practices included self-medication, skipping of dosing, hoarding of leftover medication.
Conclusion: As improvement in knowledge did not correlate with better personal behaviours regarding antibiotics, current curriculum needs to include AMR as a focus area to ensure good antibiotic prescribing practices in future practitioners.
Characterization of Collaborative Cross mouse founder strain CAST/EiJ as a novel model for lethal COVID-19
Authors: Baker Candice N. , Duso Debra , Kothapalli Nagarama , Hart Tricia , Casey Sean , Cookenham Tres , Kummer Larry , Hvizdos Janine , Lanzer Kathleen , Vats Purva , Shanbhag Priya , Bell Isaac , Tighe Mike , Travis Kelsey , Szaba Frank , Bedard Olivia , Oberding Natalie , Ward Jerrold M. , Adams Mark D. , Lutz Cathleen , Bradrick Shelton S. , Reiley William W. , Rosenthal Nadia 
Published: April 2024

AbstractMutations in SARS-CoV-2 variants of concern (VOCs) have expanded the viral host range beyond primates, and a limited range of other mammals, to mice, affording the opportunity to exploit genetically diverse mouse panels to model the broad range of responses to infection in patient populations. Here we surveyed responses to VOC infection in genetically diverse Collaborative Cross (CC) founder strains. Infection of wild-derived CC founder strains produced a broad range of viral burden, disease susceptibility and survival, whereas most other strains were resistant to disease despite measurable lung viral titers. In particular, CAST/EiJ, a wild-derived strain, developed high lung viral burdens, more severe lung pathology than seen in other CC strains, and a dysregulated cytokine profile resulting in morbidity and mortality. These inbred mouse strains may serve as a valuable platform to evaluate therapeutic countermeasures against severe COVID-19 and other coronavirus pandemics in the future.
A Novel Association Between Human Papillomavirus and Thyroid Eye Disease
Authors: Garg Ishita , Meyer Benjamin I. , Gallo Ryan A. , Wester Sara T. , Pelaez Daniel 
Published: April 2024

ABSTRACTContextThyroid eye disease (TED) is an autoimmune disease characterized by orbital inflammation and tissue remodeling. TED pathogenesis is poorly understood but is linked to autoantibodies to thyroid-stimulating hormone receptor (TSHR) and insulin-like growth factor 1 receptor (IGF-1R).ObjectiveTo explore the potential involvement of viral infections in TED pathogenesis.MethodsUsing NCBI BLAST, we compared human TSHR and IGF-1R proteins to various viral proteomes, includingPapillomaviridae,Paramyxoviridae,Herpesviridae,Enterovirus,Polyomaviridae, andRhabdoviridae. Enzyme-linked immunoassays (ELISAs) were performed on orbital adipose tissue samples from 22 TED patients and controls to quantify antiviral antibody titers. Demographics and clinical data were reviewed.ResultsHomology analysis revealed conserved motifs between TSHR and IGF-1R with several viral proteins, particularly the human papillomavirus 18 (HPV18) L1 capsid protein. Basic demographic and clinical information between the cohorts were comparable. ELISAs showed statistically significant differences in the average HPV18 L1 IgG normalized optical density levels among tissues of control (M= 0.9387,SD= 0.3548), chronic TED (M= 2.305,SD= 1.064), and active acute TED (M= 4.087,SD= 2.034) patients. These elevated HPV18 L1 IgG titers did not statistically correlate with TSH, T4, or TSI levels, and were elevated in TED patients irrespective of treatment with teprotumumab, indicating a direct immunological response to HPV.ConclusionsThis study presents the first molecular evidence linking HPV and TED, highlighting molecular mimicry between HPV capsid protein and key autoimmunity targets in TED. This suggests an immunological link contributing to TED’s pathogenesis, opening new avenues for understanding and managing the disease.
Common and Specific Intrinsic Functional Network Related to Episode Dynamics during Treatment in Bipolar Spectrum
Authors: Liu Xiaobo , Liu Zhen-Qi , Wan Bin , Liu Lang , Xiao Jinming , Meng Yao , Weng Chao , Gao Yujun 
Published: April 2024

ABSTRACTA significant challenge in bipolar disorder (BD) is to understand the neural substrates of emotional fluctuations (i.e., episode phases) along the spectrum including manic (BipM), depressive (BipD), and remission states (rBD). Here, We constructed intrinsic functional connectome for 117 subjects with BD (BipM: 38, BipD: 42, and rBD: 37) and 35 healthy controls, then associated connectivities with emotional fluctuations to identify the common and specific patterns, and finally probed their biological underpinnings. We uncovered the common altered pattern in the salience-attention network and the specific pattern in the default mode-salience network specific for BipM and sensory-prefrontal network specific for BipD and rBD. These pathological patterns can accurately delineate the various episodes episodes types of bipolar disorder and forecast the corresponding clinical symptoms associated with each episodes type. Both common and specific patterns exhibited significant genetic stability and centered regions were enriched in multiple receptors such as MOR, NMDA, and H3 for specific pathology while A4B2, 5HTT, and 5HT1a for common pathology. Gene expression was enriched in PLEKHO1, SCN2A, POU3F2, and ANK3. Our study provides new insights into possible neurobiological interpretation for episode phases in the bipolar spectrum and holds promise for advancing personalized precision medicine approaches targeting various episodes of the condition.
The potential impact of removing a ban on electronic nicotine delivery systems using the Mexico smoking and vaping model (SAVM)
Authors: Sánchez-Romero Luz María , Li Yameng , Zavala-Arciniega Luis , Gallegos-Carrillo Katia , Thrasher James F. , Meza Rafael , Levy David T. 
Published: April 2024

AbstractObjectiveTo develop the Mexico Smoking and Vaping Model (Mexico SAVM) to estimate cigarette and electronic nicotine delivery systems (ENDS) prevalence and the public health impact of legalizing ENDS use.MethodsSAVM, a cohort-based discrete-time simulation model, compares two scenarios. TheENDS-Restricted Scenarioestimates smoking prevalence and associated mortality outcomes under the current policy of an ENDS ban, using Mexico-specific population projections, death rates, life expectancy, and smoking and e-cigarette prevalence.The ENDS-Unrestricted Scenarioprojects smoking and vaping prevalence under a hypothetical scenario where ENDS use is allowed. The impact of legalizing ENDS use is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the ENDS-Restricted and Unrestricted scenarios.ResultsCompared to a national ENDS ban, The Mexico SAVM projects that legalizing ENDS use could decrease smoking prevalence by 40.1% in males and 30.9% in females by 2049 compared to continuing the national ENDS ban. This reduction in prevalence would save 2.9 (2.5 males and 0.4 females) million life-years and avert almost 106 (91.0 males and 15.5 females) thousand deaths between 2025 and 2049. Public health gains decline by 43% to 59,748 SVADs averted when the switching rate is reduced by half and by 24.3% (92,806 SVADs averted) with a 25% ENDS risk level from that of cigarettes but increased by 24.3% (121,375 SVADs averted) with the 5% ENDS risk.ConclusionsMexico SAVM suggests that greater access to ENDS and a more permissive ENDS regulation, simultaneous with strong cigarette policies, would reduce smoking prevalence and decrease smoking-related mortality. The unanticipated effects of an ENDS ban merit closer scrutiny, with further consideration of how specific ENDS restrictions may maximize public health benefits.