bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimizing Nipple-Areolar Complex Complications in Prepectoral Breast Reconstruction After Nipple-Sparing Mastectomy
Authors: Perez-Otero Sofia , Hemal Kshipra , Boyd Carter J. , Kabir Raeesa , Sorenson Thomas J. , Jacobson Alexis , Thanik Vishal D. , Levine Jamie P. , Cohen Oriana D. , Karp Nolan S. , Choi Mihye 
Published: April 2024

Purpose
Nipple-areolar complex (NAC) viability remains a significant concern following prepectoral tissue expander (TE) reconstruction after nipple-sparing mastectomy (NSM). This study assesses the impact of intraoperative TE fill on NAC necrosis and identifies strategies for mitigating this risk.

Methods
A chart review of all consecutive, prepectoral TEs placed immediately after NSM was performed between March 2017 and December 2022 at a single center. Demographics, mastectomy weight, intraoperative TE fill, and complications were extracted for all patients. Partial NAC necrosis was defined as any thickness of skin loss including part of the NAC, whereas total NAC necrosis was defined as full-thickness skin loss involving the entirety of the NAC. P < 0.05 was considered statistically significant.

Results
Forty-six patients (83 breasts) with an average follow-up of 22 months were included. Women were on average 46 years old, nonsmoker (98%), and nondiabetic (100%) and had a body mass index of 23 kg/m2. All reconstructions were performed immediately following prophylactic mastectomies in 49% and therapeutic mastectomies in 51% of cases. Three breasts (4%) were radiated, and 15 patients (33%) received chemotherapy. Mean mastectomy weight was 346 ± 274 g, median intraoperative TE fill was 150 ± 225 mL, and median final TE fill was 350 ± 170 mL. Partial NAC necrosis occurred in 7 breasts (8%), and there were zero instances of complete NAC necrosis. On univariate analysis, partial NAC necrosis was not associated with any patient demographic or operative characteristics, including intraoperative TE fill. In multivariable models controlling for age, body mass index, mastectomy weight, prior breast surgery, and intraoperative TE fill, partial NAC necrosis was associated with lower body mass index (odds ratio, 0.53; confidence interval [CI], 0.29–0.98; P < 0.05) and higher mastectomy weight (odds ratio, 1.1; CI, 1.01–1.20; P < 0.05). Prior breast surgery approached significance, as those breasts had a 19.4 times higher odds of partial NAC necrosis (95% CI, 0.88–427.6; P = 0.06).

Conclusions
Nipple-areolar complex necrosis following prepectoral TE reconstruction is a rare but serious complication. In this study of 83 breasts, 7 (8%) developed partial NAC necrosis, and all but one were able to be salvaged.
Is Tourniquet Pain the Result of Increased Compartment Pressure in the Forearm?
Authors: Manstein Carl Howard , Manstein Samuel Max , Manstein Ely 
Published: April 2024

Abstract
The pneumatic tourniquet has been a mainstay in upper extremity surgery by allowing the surgeon to operate in a blood-free field. Many upper extremity surgical procedures are done under local anesthesia or minimal sedation, and the problem of tourniquet pain is a vexing one. The question is posed: Is tourniquet pain the result of increased compartment pressure in the forearm? This study measured compartment pressures of the volar forearm in 10 healthy normotensive volunteers before inflation of a pneumatic tourniquet and compared it with pressure measurements taken while the tourniquet was still inflated after 15 minutes. Compartment pressures were measured using a Stryker needle manometer; all measurements were taken in the volar forearm by the senior author (C.H.M.). There was no increase in the volar/flexor compartment pressure of the forearm after 15 minutes of tourniquet inflation. All subjects complained of pain of the forearm, characteristically what is commonly called “tourniquet pain.” We therefore conclude that in the upper extremity, at least for relatively short operating times, appropriate inflation of a tourniquet does not induce the early onset of increased compartment pressure in the forearm.
Long-term Survival and Functional Outcomes of Laparoscopic Surgery for Clinical Stage I Ultra-low Rectal Cancers Located Within 5 cm of the Anal Verge
Authors: Ito Masaaki , Tsukada Yuichiro , Watanabe Jun , Fukunaga Yosuke , Hirano Yasumitsu , Sakamoto Kazuhiro , Hamamoto Hiroki , Yoshimitsu Masanori , Horie Hisanaga , Matsuhashi Nobuhisa , Kuriu Yoshiaki , Nagai Shuntaro , Hamada Madoka , Yoshioka Shinichi , Ohnuma Shinobu , Hayama Tamuro , Otsuka Koki , Inoue Yusuke , Ueda Kazuki , Toiyama Yuji , Maruyama Satoshi , Yamaguchi Shigeki , Tanaka Keitaro , Suzuki Motoko , Naitoh Takeshi , Ando Koji , Watanabe Masahiko ,   for the Ultimate Trial Group
Published: April 2024

Objective:
To clarify the long-term oncological outcomes and postoperative anal, urinary, and sexual functions after laparoscopic surgery for clinical stage I very low rectal carcinoma located near the anal canal.

Background:
Laparoscopic surgery is widely applied for rectal cancer; however, concerns remain, with some studies showing poorer outcomes compared with open surgery.

Methods:
This single-arm, phase II trial included patients registered preoperatively from 47 institutions in Japan. The planned sample size was 300. The primary end point was the 3-year local recurrence rate. Anal, urinary, and sexual functions were evaluated using a prospective questionnaire.

Results:
Three hundred patients were registered between January 2014 and March 2017. Anus-preserving surgery was performed in 278 (93%), including 172 who underwent intersphincteric resection (58%) and 106 (36%) who underwent low anterior resection. The 3-year cumulative local recurrence rate was 6.3%. At 3 years postoperatively, 87% of patients used their own anus, and the median incontinence score improved from 12 at 3 months to 8 at 3 years. Only 5% of patients had severe incontinence (incontinence score of 16 points). Postoperative urinary function evaluation showed that the International Prostate Symptom Score and Overactive Bladder Symptom Score decreased 1 week after surgery but recovered to preoperative level 1 month after surgery. International Consultation on Incontinence Questionnaire-Sort Form remained almost stable after surgery. Sexual function evaluation using the International Index of Erectile Function-5 and International Index of Erectile Function-15 revealed that the patients had deteriorated 3 months after surgery but had recovered only slightly by 6 months.

Conclusions:
Laparoscopic surgery achieves feasible long-term oncological outcomes and a high rate of anus preservation with moderate anal function and an acceptable incontinence score. While urinary function recovered rapidly, sexual function showed poor recovery.
A Primary Report 166 Cases of Abdominal or Pelvic Neuroblastoma Surgery Utilizing the International Neuroblastoma Surgical Report Form (INSRF)
Authors: Chang Saishuo , Yang Shen , Yu Tong , Zhang Qi , Lin Yu , Ren Qinghua , Cheng Haiyan , Chang Xiaofeng , Zhu Zhiyun , Cai Siyu , Feng Jun , Han Jianyu , Yang Wei , Qin Hong , Wang Huanmin 
Published: April 2024

Background and aims:
Surgery is pivotal in the management of neuroblastoma (NB), particularly in patients with Image-Defined Risk Factors (IDRFs). The International Neuroblastoma Surgical Report Form (INSRF) was introduced to enhance surgical reporting quality and analyze the defining role of extensive surgery in NB. This study reports our experience with INSRF and explores new criteria for evaluating the extent of surgical resection.

Methods:
INSRF was deployed to critically analyze 166 patients with abdominal or pelvic NB who underwent surgery at our department between October 2021 and June 2023. Patient demographics, clinical characteristics, surgical datasets, and postoperative complications were described in detail. Receiver operating characteristic (ROC) curves were used to explore a new method to evaluate the extent of resection. A questionnaire was formulated to obtain attitudes/feedback and commentary from surgical oncologists with INSRF.

Results:
166 neuroblastoma patients with a median disease age 36.50 months. This study collated 320 INSRF reports. Among the 166 index cases, 137 were documented by two surgeons, with a concordance rate of 16.78%. Items with high inconsistency were (i) the extent of tumor resection (29.20%), (ii) renal vein involvement (25.55%), (iii) abdominal aorta encasement (16.79%), and (iv) mesenteric infiltration (17.52%). According to INSRF, the extent of resection was complete excision in 86 (51.81%) patients, minimal residual tumor < 5 cm3 in 67 (40.36%) patients, and incomplete excision > 5 cm3 in 13 (7.83%) patients. In ROC curve analysis, the number of vessels encased by tumors > 3 had a high predictive value in determining that a tumor could not be completely resected (AUC 0.916, sensitivity 0.838, specificity 0.826) using INSRF as the gold standard reference. The questionnaires showed that surgeons agreed that the extent of resection and tumor involvement of organ/vascular structures were important, while the definition and intervention(s) of intraoperative complications were less operational and understandable.

Conclusions:
INSRF has significant clinical application in neuroblastoma surgery. The extent of resection can be predicted based on the number of tumor-encased blood vessels. Supplementary information should be considered with the INSRF to aid practitioner reporting. Multicenter studies are needed to explore the defining role of INSRF in NB surgical management.
Tissue-resident Lymphocytes Are Released During Hypothermic and Normothermic Machine Perfusion of Human Donor Kidneys
Authors: Hullegie-Peelen Daphne M. , Hesselink Dennis A. , Dieterich Marjolein , Minnee Robert C. , Peeters Annemiek , Hoogduijn Martin J. , Baan Carla C. 
Published: April 2024

Background.
Machine perfusion is the preferred preservation method for deceased donor kidneys. Perfusate fluid, which contains a complex mixture of components, offers potential insight into the organ’s viability and function. This study explored immune cell release, particularly tissue-resident lymphocytes (TRLs), during donor kidney machine perfusion and its correlation with injury markers.

Methods.
Perfusate samples from hypothermic machine perfusion (HMP; n = 26) and normothermic machine perfusion (NMP; n = 16) of human donor kidneys were analyzed for TRLs using flow cytometry. Residency was defined by expressions of CD69, CD103, and CD49as. TRL release was quantified exclusively in NMP. Additionally, levels of cell-free DNA, neutrophil gelatinase-associated lipocalin, and soluble E-cadherin (sE-cadherin) were measured in NMP supernatants with quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.

Results.
Both HMP and NMP samples contained a heterogeneous population of TRLs, including CD4+ tissue-resident memory T cells, CD8+ tissue-resident memory T cells, tissue-resident natural killer cells, tissue-resident natural killer T cells, and helper-like innate lymphoid cells. Median TRL proportions among total CD45+ lymphocytes were 0.89% (NMP) and 0.84% (HMP). TRL quantities in NMP did not correlate with donor characteristics, perfusion parameters, posttransplant outcomes, or cell-free DNA and neutrophil gelatinase-associated lipocalin concentrations. However, CD103+ TRL release positively correlated with the release of sE-cadherin, the ligand for the CD103 integrin.

Conclusions.
Human donor kidneys release TRLs during both HMP and NMP. The release of CD103+ TRLs was associated with the loss of their ligand sE-cadherin but not with general transplant injury biomarkers.
Exception Policy Change Increased the Simultaneous Kidney-liver Transplant Probability of Polycystic Disease in the Centers With High Median MELD at Transplantation
Authors: Miyake Katsunori , Kim Dean Y. , Chau Lucy C. , Trudeau Sheri , Kitajima Toshihiro , Wickramaratne Niluka , Shimada Shingo , Nassar Ahmed , Yoshida Atsushi , Abouljoud Marwan S. , Nagai Shunji 
Published: March 2024

Background.
In 2019, Organ Procurement and Transplantation Network/United Network for Organ Sharing changed the exception policy for liver allocation to the median model for end-stage liver disease at transplantation (MMaT). This study evaluated the effects of this change on-waitlist outcomes of simultaneous liver-kidney transplantation (SLKT) for patients with polycystic liver-kidney disease (PLKD).

Methods.
Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing registry, 317 patients with PLKD listed for SLKT between January 2016 and December 2021 were evaluated. Waitlist outcomes were compared between prepolicy (Era 1) and postpolicy (Era 2) eras.

Results.
One-year transplant probability was significantly higher in Era 2 than in Era 1 (55.7% versus 37.9%; P = 0.001), and the positive effect on transplant probability of Era 2 was significant after risk adjustment (adjusted hazard ratio, 1.76; 95% confidence interval, 1.22-2.54; P = 0.002 [ref. Era 1]), whereas waitlist mortality was comparable. Transplant centers were separated into the high and low MMaT groups with a score of 29 (median MMaT) and transplant probability in each group between eras was compared. In the high MMaT transplant centers, the 1-y transplant probability was significantly higher in Era 2 (27.5% versus 52.4%; P = 0.003). The positive effect remained significant in the high MMaT center group (adjusted hazard ratio, 2.79; 95% confidence interval, 1.43-5.46; P = 0.003 [ref. Era 1]) but not in the low MMaT center group. Although there was a difference between center groups in Era 1 (P = 0.006), it became comparable in Era 2 (P = 0.54).

Conclusions.
The new policy increased 1-y SLKT probability in patients with PKLD and successfully reduced the disparities based on center location.
Normothermic Liver Machine Perfusion and Successful Transplantation of Split Liver Grafts: From Proof of Concept to Clinical Implementation
Authors: Krendl Felix J. , Cardini Benno , Laimer Gregor , Singh Jessica , Resch Thomas , Oberhuber Rupert , Schneeberger Stefan 
Published: March 2024

Background.
Normothermic liver machine perfusion (NLMP) is advancing the field of liver transplantation (LT). Beyond improved preservation and organ assessment, NLMP helps to increase organ utilization. We herein address the feasibility and merit of NLMP in split liver transplantation (SLT) to postpone the transplantation of the second split graft to the following day.

Methods.
We analyzed the perfusion characteristics and outcomes of all consecutive adult recipients who underwent SLT following NLMP from February 1, 2018, to June 30, 2023. The primary endpoint was 90-d graft and patient survival. Secondary endpoints were posttransplant complications and 90-d morbidity.

Results.
Three right and 3 extended right SLT following NLMP have been performed. NLMP was uneventful in all cases. Perfusion characteristics differed according to graft volume. Mean perfusion time was 17:00 h (±05:13) and bile production ranged between 8 and 21 mL/h. All split grafts fulfilled predefined center viability criteria during NLMP and were transplanted on the following day. The 90-d graft and patient survival rate was 100%. Three patients (50%) required an early relaparotomy, and 2 patients (33.3%) developed biliary complications. The 90-d morbidity as recorded by the comprehensive complication index was 62.7 (±24.7).

Conclusion.
NLMP of split liver grafts is technically feasible and safe. Through prolongation of preservation time, NLMP allows to safely postpone transplantation of the second split liver graft to the next day.
Metatranscriptomics-based metabolic modeling of patient-specific urinary microbiome during infection
Authors: Josephs-Spaulding Jonathan , Rettig Hannah Clara , Zimmermann Johannes , Chkonia Mariam , Mischnik Alexander , Franzenburg Sören , Graspeuntner Simon , Rupp Jan , Kaleta Christoph 
Published: March 2024

AbstractUrinary tract infections (UTIs) are a major health concern which incur significant socioeconomic costs in addition to substantial antibiotic prescriptions, thereby accelerating the emergence of antibiotic resistance. To address the challenge of antibiotic-resistant UTIs, our systems biology approach uncovers patient-specific uromicrobiome insights that are focused on community utilization of metabolites. By leveraging the distinct metabolic traits of patient-specific pathogens, we aim to identify metabolic dependencies of pathogens and provide suggestions for targeted interventions for future studies. Combining patient-specific metatranscriptomic data with genome-scale metabolic modeling and data from the Human Urine Metabolome, this study explores UTIs from a systems biology perspective through the reconstruction of tailored microbial community models to mirror the metabolic profiles of individual UTI patients’ urinary microbiomes. Delving into patient-specific bacterial gene expressions and microbial interactions, we identify metabolic signatures and propose mechanisms for UTI pathology. Our research underscores the potential of integrating metatranscriptomic data using systems biological approaches, providing insights into disease metabolic mechanisms and potential phenotypic manifestations. This contribution introduces a new method that could guide treatment options for antibiotic-resistant UTIs, aiming to lessen antibiotic use by combining the pathogens’ unique metabolic traits.Abstract FigureGraphical AbstractMetatranscriptome sequencing was used to investigate the functional uromicrobiome across a cohort of 19 individuals; patient-specific microbiome community models were reconstructed and simulated in a virtual urine environment. Total RNA was extracted from patients’ urine and sequenced to assess the metatranscriptome, providing insights into patient-specific uromicrobiome microbial taxa and their associated gene expression during urinary tract infections (UTIs). These combinatory datasets derived from metatranscriptomics data were further expanded first to reconstruct species specific metabolic models that were conditioned with gene expression. Gene expression conditioned metabolic models were combined in an in silico environment with a defined urine media to construct patient-specific context-specific uromicrobiome models, enabling an understanding of each patient’s unique microbiome. Using this approach, we aimed to identify patient-specific microbiome dynamics and provide insight towards various metabolic features that can be utilized or validated in future studies for individualized intervention strategies. Created withwww.biorender.com.
IT IS NOT A SMALL WORLD FOR PSYCHIATRIC PATIENTS: Small-world of psychiatric patients
Authors: Akın Ata , Yorgancıgil Emre , Öztürk Ozan Cem , Sütçübaşı Bernis , Kırımlı Ceyhun , Kırımlı Elçim , Dumlu Seda Nilgün , Yükselen Gülnaz , Erdoğan S. Burcu 
Published: March 2024

ABSTRACTIndividuals suffering from Obsessive Compulsive Disorder (OCD) and Schizophrenia (SCZ) frequently exhibit symptoms of cognitive disassociations, which are linked to poor functional integration among brain regions. The loss of integration can be assessed using graph metrics computed from functional connectivity matrices (FCMs) derived from neuroimaging data. A healthy brain with an effective connectivity pattern exhibits small-world features with high clustering coefficients and shorter path lengths in contrast to random networks. We analyzed neuroimaging data from 60 subjects (13healthy controls, 21 OCD and 26 SCZ) using functional near-infrared spectroscopy (fNIRS) during a color word matching Stroop Task and computed FCMs. Small-world features were evaluated using the Global Efficiency (GE), Clustering Coefficient (CC), Modularity (Q), and small-world parameter (σ). The proposed pipeline in this study for fNIRS data processing demonstrates that patients with OCD and SCZ exhibit small-world features resembling random networks, as indicated by higherGEand lowerCCvalues compared to healthy controls, implying a higher operational cost for these patients.AUTHOR SUMMARYIndividuals suffering from Obsessive Compulsive Disorder (OCD) and Schizophrenia (SCZ) frequently exhibit symptoms of cognitive disassociations, which are linked to poor functional integration among brain regions. The loss of integration can be assessed using graph metrics computed from functional connectivity matrices (FCMs) derived from neuroimaging data. A healthy brain with an effective connectivity pattern exhibits small-world features with high clustering coefficients and shorter path lengths in contrast to random networks. We analyzed neuroimaging data from 60 subjects (13healthy controls, 21 OCD and 26 SCZ) using functional near-infrared spectroscopy (fNIRS) during a color word matching Stroop Task and computed FCMs. Small-world features were evaluated using the Global Efficiency (GE), Clustering Coefficient (CC), Modularity (Q), and small-world parameter (σ). The proposed pipeline in this study for fNIRS data processing demonstrates that patients with OCD and SCZ exhibit small-world features resembling random networks, as indicated by higherGEand lowerCCvalues compared to healthy controls, implying a higher operational cost for these patients.
Simple shell measurements do not consistently predict habitat in turtles: a reply to Lichtig and Lucas (2017)
Authors: Evers Serjoscha W. , Foth Christian , Joyce Walter G. , Hermanson Guilherme 
Published: March 2024

AbstractInferring palaeoecology for fossils is a key interest of palaeobiology. For groups with extant representatives, correlations of aspects of body shape with ecology can provide important insights to understanding extinct members of lineages. The origin and ancestral ecology of turtles is debated and various shell or limb pro-portions have been reported to correlate with habitat ecology among extant turtles, such that they may be informative for inferring the ecology of fossil turtles, including early shelled stem turtles. One recently described method proposes that simple shell measurements that effectively quantify shell doming and plastron width can differentiate habitat classes among extant turtles in linear discriminant analysis, whereby aquatic turtles have low domed shells with narrow plastra. The respective study proposes unorthodox habitat predictions for key fossil turtles, including aquatic lifestyles for the early turtleProganochelys quenstedtiiand the meiolaniformMeiolania platyceps, and terrestrial habits for the early turtleProterochersis robusta. Here, we show that these published results are the consequence of questionable methodological choices such as omission of species data which do not conform to a preconceived shell shape-ecology association. When these choices are reversed, species measurements for fossils are corrected, and phylogenetic flexible discriminant analysis applied, habitat cannot be correctly predicted for extant turtles based on these simple shell measurements. This invalidates the method as well as the proposed palaeohabitats for fossils.