bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrophysiological monitoring of neurological functions at the acute phase of brain injury
Authors: Gobert Florent , Dailler Frédéric , Rheims Sylvain , André-Obadia Nathalie , Balança Baptiste 
Published: February 2024

The continuous monitoring of physiological parameters is now considered as a standard of care in intensive care units (ICU). While multiple techniques are available to guide hemodynamic or respiratory management, the monitoring of neurological function in unconscious patients is usually limited to discontinuous bedside neurological examination or morphological brain imaging. However, cortical activity is accessible at the bedside with electroencephalography (EEG), electrocorticography (ECoG) or evoked potentials. The analysis of the unprocessed signal requires a trained neurophysiologist and could be time consuming. During the past decades, advances in neurophysiological signal acquisition make it possible to calculate quantified EEG parameters in real-time. New monitors also provide ICU friendly display for a dynamic and live assessment of neurological function changes.
In this review, we will describe the technical aspects of EEG, ECoG and evoked potentials required for a good signal quality before interpretation. We will discuss how to use those electrophysiological techniques in the ICU to assess neurological function in comatose patients at the acute phase of brain injuries such as traumatic brain injuries, haemorrhagic or ischemic stroke. We will discuss, which quantitative EEG or evoked potentials monitoring parameters can be used at the bedside to guide sedation, evaluate neurological function during awaking and look for new neurological (encephalic or brainstem) injuries. We will present the state of the art and discuss some analyses, which may develop shortly.
Immediate Symmetrization of the Contralateral Breast in Breast Reconstruction–Revision, Complications, and Satisfaction: A Systematic Review
Authors: AlQhtani Abdullh 
Published: February 2024

Background:
It is desirable to achieve breast symmetry after unilateral surgery for breast tumors. Thus, contralateral balancing is often required, but it is still debated whether symmetrization surgery should be performed alongside reconstruction or as a delayed procedure. Therefore, we aimed to compare revision rates, complication rates, and satisfaction levels between those who underwent immediate versus delayed symmetrization.

Methods:
A systematic review was designed to summarize the revision surgery rates, complication rates, and satisfaction levels of patients who underwent contralateral breast symmetrization at the same time as breast reconstruction. We included articles published between 2010 and 2022 in databases such as PubMed, MEDLINE, and Embase.

Results:
Most studies showed no difference or lower revision rates for immediate symmetrization, except for one study where immediate symmetrization had a revision rate twice that of delayed symmetrization. There were no significant differences in complication rates between the two groups. Regarding satisfaction levels, most studies showed that the immediate group had higher scores regardless of statistical significance; however, breast-related satisfaction was significantly higher in the immediate group than in the delayed group.

Conclusion:
This systematic review demonstrates that immediate symmetrization surgery does not increase revision surgery and complication rates or decrease satisfaction levels.
Shortage of Plastic Surgeons in Lebanon: Impact of the 2019 Economic Crisis
Authors: Bakhach Joseph Y. , Saba Salim C. , Doghman Jana H. 
Published: February 2024

Background:
Lebanon’s ongoing economic crisis since 2019 has seen an unprecedented migration of professional healthcare workers. This article analyzes the adequacy of registered plastic surgeons in Lebanon in 2023.

Methods:
A list of registered plastic surgeons was obtained from the Lebanese Order of Physicians. Registered plastic surgeons were contacted via email or phone and were asked to fill in a survey questionnaire addressing their work status. Additionally, the number of plastic surgeon graduates, between 2018 and 2022, was obtained from Lebanese medical schools.

Results:
Of the 162 plastic surgeons registered with the Lebanese Order of Physicians in 2023, 158 responded to the survey (97.5%). The work settings of the active plastic surgeons fell into three categories: working in Lebanon full time, splitting work between Lebanon and abroad, and exclusively working abroad. The ratio of plastic surgeons practicing full time in Lebanon is 1.11 per 100,000 inhabitants, which is significantly below the recommended ratio of 2.01. Twenty eight percent of the plastic surgeons working in Lebanon are aged between 65 and 75 years. Meanwhile, an average of only three graduates (2018–2022) enter the workforce annually after completing training in plastic and reconstructive surgery residency. Among the various subspecialties within plastic and reconstructive surgery, aesthetic surgery was the most commonly practiced by those surveyed.

Conclusions:
There is a relative shortage of plastic surgeons in Lebanon that is compounded by a significant focus on aesthetic procedures. Implementation of strategies is needed to bridge this gap and meet the needs of the underserved people of Lebanon.
Machine Learning to Predict the Need for Postmastectomy Radiotherapy after Immediate Breast Reconstruction
Authors: Chen Yi-Fu , Chawla Sahil , Mousa-Doust Dorsa , Nichol Alan , Ng Raymond , Isaac Kathryn V. 
Published: February 2024

Background:
Post mastectomy radiotherapy (PMRT) is an independent predictor of reconstructive complications. PMRT may alter the timing and type of reconstruction recommended. This study aimed to create a machine learning model to predict the probability of requiring PMRT after immediate breast reconstruction (IBR).

Methods:
In this retrospective study, breast cancer patients who underwent IBR from January 2017 to December 2020 were reviewed and data were collected on 81 preoperative characteristics. Primary outcome was recommendation for PMRT. Four algorithms were compared to maximize performance and clinical utility: logistic regression, elastic net (EN), logistic lasso, and random forest (RF). The cohort was split into a development dataset (75% of cohort for training-validation) and 25% used for the test set. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), precision-recall curves, and calibration plots.

Results:
In a total of 800 patients, 325 (40.6%) patients were recommended to undergo PMRT. With the training-validation dataset (n = 600), model performance was logistic regression 0.73 AUC [95% confidence interval (CI) 0.65–0.80]; RF 0.77 AUC (95% CI, 0.74–0.81); EN 0.77 AUC (95% CI, 0.73–0.81); logistic lasso 0.76 AUC (95% CI, 0.72–0.80). Without significantly sacrificing performance, 81 predictive factors were reduced to 12 for prediction with the EN method. With the test dataset (n = 200), performance of the EN prediction model was confirmed [0.794 AUC (95% CI, 0.730–0.858)].

Conclusion:
A parsimonious accurate machine learning model for predicting PMRT after IBR was developed, tested, and translated into a clinically applicable online calculator for providers and patients.
Utility of Thermal Imaging in Predicting Superficial Infections in Transfemoral Osseointegrated Implants
Authors: Harrington Colin J. , Nelson Benjamin A. , Lansford Jefferson L. , Rivera Julio A. , Souza Jason M. , Forsberg Jonathan A. , Potter Benjamin K. 
Published: February 2024

Background:
Superficial infection is a common minor complication of transcutaneous implants that can be challenging to predict or diagnose. Although it remains unclear whether superficial infections progress to deep infections (which may require implant removal), predicting and treating any infection in these patients is important. Given that flap thinning during stage II surgery requires compromising vascularity for stability of the skin penetration aperture, we hypothesized that early skin temperature changes predict long-term superficial infection risk.

Methods:
We obtained standardized thermal imaging and recorded surface temperatures of the aperture and overlying flaps 2 weeks postoperatively for the first 34 patients (46 limbs) treated with the Osseointegrated Prosthesis for the Rehabilitation of Amputees transfemoral implant system. We used two-sided t tests to compare temperatures surrounding the aperture and adjacent soft tissues in patients with and without subsequent infection.

Results:
During median follow-up of 3 years, 14 limbs (30.4%) developed 23 superficial infections. At patients’ initial 2-week visit, mean skin temperature surrounding the aperture was 36.3ºC in limbs that later developed superficial infections and 36.7ºC in uninfected limbs (P = 0.35). In four patients with bilateral implants who later developed superficial infection in one limb, average temperature was 1.5ºC colder in the infected limb (P = 0.12).

Conclusions:
Superficial infections remain a frequent complication of transfemoral osseointegration surgery. We did not find differences in early heat signatures between limbs subsequently complicated and those not complicated by superficial infection. Further research should explore more objective measures to predict, diagnose, and prevent infections after osseointegration surgery.
Integrated analysis of metabolomic and gut microbiota reveals idiosyncratic drug-induced liver injury resulting from the combined administration of bavachin and icariside II
Authors: Cao Bo , Li Yingying , Lin Mengmeng , Xu Jing , Li Taifeng , Fei Xiaofei , Xiao Xiaohe , Li Guohui , Li Chunyu 
Published: February 2024

Objective:
Xianling gubao (XLGB), a widely used Chinese patent medicine for osteoporosis, has garnered significant attention due to its potential to cause liver injury. The constituents Psoraleae Fructus (PF, the dried ripe seeds of Psoralea corylifolia L.) and Epimedii Folium (EF, the dried leaves of various Epimedium species) present in XLGB have been implicated in causing idiosyncratic drug-induced liver injury (IDILI). However, the specific components and mechanisms underlying liver injury related to these tonics remain elusive. This study aims to establish that the combination of bavachin (the primary active compound in PF, and icariside II, the main active compound in EF) induces IDILI in a tumor necrosis factor-α (TNF-α)-mediated mouse model.

Methods:
To assess the impact of bavachin and icariside II on the liver in the presence of TNF-α immune stress, an animal model was developed. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics technology was employed to identify biomarkers associated with TNF-α-induced IDILI and the combination of bavachin and icariside II. Additionally, 16S rRNA high-throughput sequencing technology was utilized to explore changes in the species composition and relative abundance of gut microbiota. Spearman correlation analysis was conducted to unveil the relationship between gut microbiota and in vivo metabolites.

Results:
The study observed that the combined administration of bavachin and icariside II induced liver injury in the TNF-α mediated susceptibility mouse model of IDILI. Under TNF-α stimulation, there was an elevation in levels in mouse livers following bavachin and icariside II administration, while Gly-Tyr, Leu-Gly, and Trp-Ser levels decreased. These differentially expressed metabolites associated with liver injury were predominantly enriched in metabolic pathways such as sphingolipid metabolism, sphingolipid signaling pathway, and necroptosis. it is noteworthy that the gut of mice with liver injury induced by the bavachin and icariside II combination exhibited a significant increase in Bacteroides and Desulfovibrionaceae abundance. Correlation analysis revealed a positive association between Bacteroidaceae and Desulfovibrionaceae with methylcarbamoyl PAF and methyl Indole-3-acetate, while a negative correlation was observed with Gly-Tyr, Leu-Gly, and Trp-Ser.

Conclusions:
These findings demonstrated that the combination of bavachin and icariside II increased the risk of IDILI in vivo, providing a promising scientific basis for understanding the component basis of IDILI resulting from the compatibility of EF and PF.
The Diagnostic Value of Multispectral Fundus Imaging in Hypertensive Retinopathy
Authors: Bai Guitao , Wei Hao , Li Shuangle 
Published: February 2024

Purpose:
To observe the diagnostic value of multispectral fundus imaging (MSI) in hypertensive retinopathy (HR).

Methods:
A total of 100 patients with HR were enrolled in this cross-sectional study, and all participants received fundus photography (FP) and MSI. Participants with severe HR received fundus fluorescein angiography (FFA). The diagnostic consistency between FP and MSI in the diagnosis of HR was calculated. The sensitivity of MSI in the diagnosis of severe HR was calculated by comparison with FFA. Choroidal vascular index (CVI) was calculated in HR patients using MSI at 780 nm.

Results:
MSI and FP were highly concordant in the diagnosis of HR with a Kappa value = 0.883. MSI had a sensitivity of 96% in diagnosing retinal hemorrhage (RH), a sensitivity of 89.47% in diagnosing retinal exudation (RE), a sensitivity of 100% in diagnosing vascular compression indentation (VCI), and a sensitivity of 96.15% in diagnosing retinal arteriosclerosis (RA). The CVI of the patients in the HR group was significantly lower than that of the control group, whereas there was no significant difference between the affected and fellow eyes.

Conclusion:
As a noninvasive modality of observation, MSI may be a new tool for the diagnosis and assessment of HR.
The Potential of Huangqi Decoction for Treating Diabetic Kidney Disease
Authors: Chen Ying , Liu Yang , Cao Aili 
Published: February 2024

ABSTRACT
Diabetic kidney disease (DKD) is a prevalent complication of diabetes mellitus that primarily affects the kidney microvasculature. According to the Traditional Chinese Medicine (TCM) theory, early-stage DKD is characterized by deficiencies in essence and Qi and is often accompanied by spleen and kidney deficiencies. Huangqi decoction (HQD), a classic Chinese herbal formula with historical use in treating thirst-related ailments, is described in Shiyin Yang's Renzhai Zhizhi Fang Lun. This review aimed to investigate the potential molecular mechanisms, pharmacological effects, and key targets of HQD to establish a theoretical and scientific foundation for further research and clinical applications. The bioactive compounds and targets of HQD were retrieved from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, and compound-target and protein-protein interaction networks were constructed using Cytoscape and BisoGent, respectively. A total of 172 bioactive compounds were identified in HQD. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of the hub targets indicated associations between diverse biological processes, cellular components, and molecular functions. These findings signify a promising avenue for the development of evidence-based treatments for DKD by leveraging the potential of TCM to enhance patient outcomes.
Patterns of Perioperative Hormone Therapy for Gender-Affirming Surgery
Authors: Hung Ya-Ching , Assi Patrick E. , Park Benjamin C. , Nemani Sriya V. , Chaker Sara C. , Williams Teja D. , Drolet Brian C. , Kassis Salam A. 
Published: February 2024

IntroductionThere is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Common concerns for continuing perioperative HRT included risk of deep vein thrombosis (DVT) or hematoma. However, discontinuing HRT is not risk free and may cause mood swing or increased anxiety. Our study aimed to investigate current patterns of HRT before GAS worldwide.MethodsThe first stage of Delphi technique was implemented by sending a 27-item survey to all surgeons (total n = 150; 94 plastic surgeon, 35 urologist, and 21 gynecologists) of the World Professional Association for Transgender Health who perform GAS. Survey themes included the hormone type, duration, and usage of DVT prophylaxis.ResultsOverall survey response rate was 34% (total n = 51; 8 urologists, 35 plastic surgeons, and 8 gynecologists). The majority of surgeons are US-based (n = 39, 76%). The most common HRTs are in injection form (n = 28, 55%). The majority of surgeons do not stop HRT before GAS and do provide DVT prophylaxis to all patients <1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (43%). For surgeons who discontinue HRT before GAS, there is a wide variation on discontinuation schedule.ConclusionsThere is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and nonbinary patients.
THE PROTECTIVE EFFECT OF DEXMEDETOMIDINE ON THE LIVER INJURY IN SEPSIS THROUGH INHIBITION OF NECROPTOSIS
Authors: Meng Yu , Meng Shuqi , Zhang Yu , Song Yu , Wang Enquan , Wang Guolin , Xie Keliang , Cui Yan 
Published: February 2024

ABSTRACT

Background: Sepsis-induced liver injury leads to extensive necroptosis in hepatocytes, which is the main factor of liver dysfunction. This study aims to investigate the protective effect of dexmedetomidine (DEX) on septic liver and to explore whether its molecular mechanism is related to the modulation of necroptosis. Methods: The model of septic liver injury was induced by cecal ligation and puncture (CLP) in rats. DEX and necrostatin-1(Nec-1), a specific antagonist of necroptosis, were administered 1 h before CLP. The levels of arterial blood gas, serum aspartate aminotransferase, and alanine aminotransferase were measured at 6, 12 and 24 h after CLP. The survival rate was observed 24 h after CLP. Liver pathological changes and apoptosis, the contents of IL-6 and TNF-α in liver tissue homogenates, the ROS content in liver tissue, and the expression levels of RIP1, RIP3, MLKL, and HMGB1 were detected. Results: At 6, 12, and 24 h after CLP, the levels of aspartate aminotransferase, and alanine aminotransferase levels increased, and liver enzyme levels gradually increased with the progression of sepsis. In arterial blood gas analysis, PaO2 gradually decreased and lactic acid concentration gradually increased during these three periods. The morphological impairment of liver tissues, increased apoptosis, elevated inflammatory factors (IL-6 and TNF-α), increased ROS level, and necroptosis components (RIP1, RIP3, MLKL, and HMGB1) were all observed in sepsis rats. However, these injuries can be ameliorated by pretreatment with DEX. Meanwhile, Nec-1 pretreatment also reduced the expression of RIP1, RIP3, MLKL, HMGB1, and ROS level. Conclusion: Our study suggests that DEX alleviates septic liver injury, and the mechanism is associated with the inhibition of necroptosis.
Postoperative Outcomes Associated with the Timing of Surgery After SARS-CoV-2 Infection
Authors: Leeds Ira L. , Park Lesley S. , Akgun Kathleen , Weintrob Amy , Justice Amy C. , King Joseph T. 
Published: February 2024

Objective:
Examine the association between prior SARS-CoV-2 infection, interval from infection to surgery, and adverse surgical outcomes.

Summary Background Data:
Earlier series have reported worse outcomes for surgery after COVID-19 illness, and these findings have led to routinely deferring surgery seven weeks after infection.

Methods:
We created a retrospective cohort of patients from the US Veterans Health Administration facilities nationwide, April 2020 to September 2022, undergoing surgical procedures. Primary outcomes were 90-day all-cause mortality and 30-day complications. Within surgical procedure groupings, SARS-CoV-2 infected and uninfected patients were matched in a 1:4 ratio. We categorized patients by 2-week intervals from SARS-CoV-2 positive test to surgery. Hierarchical multilevel multivariable logistic regression models were used to estimate the association between infection to surgery interval versus no infection and primary end points.

Results:
We identified 82,815 veterans undergoing eligible operations (33% general, 27% orthopedic, 13% urologic, 9% vascular), of whom 16,563 (20%) had laboratory-confirmed SARS-CoV-2 infection before surgery. The multivariable models demonstrated an association between prior SARS-CoV-2 infection and increased 90-day mortality (odds ratio (OR) 1.42, 95% CI: 1.08, 1.86) and complications (OR 1.32, 95% CI: 1.11, 1.57) only for patients having surgery within 14 days of infection. ASA-stratified multivariable models showed that the associations between increased 90-day mortality (OR 1.40, 95% CI: 1.12, 1.75) and complications (OR 1.73, 95% CI: 1.34, 2.24) for patients having surgery within 14 days of infection were confined to those with ASA 4-5.

Conclusions:
In a contemporary surgical cohort, patients with prior SARS-CoV-2 infection only had increased postoperative mortality or complications when they had surgery within 14 days after the positive test. These findings support revising timing recommendations between surgery and prior SARS-CoV-2 infection.
Endovascular Repair of 100 Urgent and Emergent Free or Contained Thoracoabdominal Aortic Aneurysms Ruptures. An International Multicenter Trans-Atlantic Experience
Authors: Spath Paolo , Tsilimparis Nikolaos , Gallitto Enrico , Becker Daniel , Vacirca Andrea , Berekoven Bärbel , Panuccio Giuseppe , Karelis Angelos , Kahlberg Andrea , Melissano Germano , Dias Nuno , Kölbel Tilo , Austermann Martin , Faggioli Gianluca , Oderich Gustavo , Gargiulo Mauro ,   On behalf of International Collaborators writing committee on TAAA ruptures’ study group
Published: February 2024

Objective:
To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA).

Background:
Endovascular repair of rTAAA has been scarcely described in emergent setting.

Methods:
An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January 2015 to January 2023 in 6 European and 1 US Vascular Surgery Centers. Primary end points were technical success, 30-day and/or in-hospital mortality, and follow-up survival.

Results:
A total of 100 rTAAA patients were included (75 male; mean age 73 years). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24 hours from diagnosis: multibranched off-the-shelf devices (Zenith t-branch, Cook Medical Inc., Bjaeverskov, Denmark) in 88 patients, physician-modified endografts in 8, patient-specific device or parallel grafts in 2 patients each. Primary technical success was achieved in 89 patients, and 30-day and/or in-hospital mortality was 24%. Major adverse events occurred in 34% of patients (permanent dialysis and paraplegia in 4 and 8 patients, respectively). No statistical differences were detected in mortality rates between free and contained ruptured patients (43% vs 21%; P=0.075). Multivariate analysis revealed contained rupture favoring technical success [odds ratio (OR): 10.1; 95% CI: 3.0–33.6; P<0.001]. Major adverse events (OR: 9.4; 95% CI: 2.8–30.5; P<0.001) and pulmonary complications (OR: 11.3; 95% CI: 3.0–41.5; P<0.001) were independent risk factors for 30-day and/or in-hospital mortality. The median follow-up time was 13 months (interquartile range 5–24); 1-year survival rate was 65%. Aneurysm diameter >80 mm (hazard ratio: 2.0; 95% CI: 1.0–30.5; P=0.037), technical failure (hazard ratio: 2.6; 95% CI: 1.1–6.5; P=0.045) and pulmonary complications (hazard ratio: 3.0; 95% CI: 1.2–7.9; P=0.021) were independent risk factors for follow-up mortality.

Conclusions:
Endovascular repair of rTAAA shows high technical success; the presence of free rupture alone appear not to correlate with early mortality. Effective prevention/management of postoperative complications is crucial for survival.