bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in Unilateral Do Not Resuscitate Order Use During the COVID-19 Pandemic*
Authors: Piscitello Gina M. , Tyker Albina , Schenker Yael , Arnold Robert M. , Siegler Mark , Parker William F. 
Published: March 2023

OBJECTIVES:
A unilateral do-not-resuscitate (UDNR) order is a do-not-resuscitate order placed using clinician judgment which does not require consent from a patient or surrogate. This study assessed how UDNR orders were used during the COVID-19 pandemic.

DESIGN:
We analyzed a retrospective cross-sectional study of UDNR use at two academic medical centers between April 2020 and April 2021.

SETTING:
Two academic medical centers in the Chicago metropolitan area.

PATIENTS:
Patients admitted to an ICU between April 2020 and April 2021 who received vasopressor or inotropic medications to select for patients with high severity of illness.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The 1,473 patients meeting inclusion criteria were 53% male, median age 64 (interquartile range, 54–73), and 38% died during admission or were discharged to hospice. Clinicians placed do not resuscitate orders for 41% of patients (n = 604/1,473) and UDNR orders for 3% of patients (n = 51/1,473). The absolute rate of UDNR orders was higher for patients who were primary Spanish speaking (10% Spanish vs 3% English; p ≤ 0.0001), were Hispanic or Latinx (7% Hispanic/Latinx vs 3% Black vs 2% White; p = 0.003), positive for COVID-19 (9% vs 3%; p ≤ 0.0001), or were intubated (5% vs 1%; p = 0.001). In the base multivariable logistic regression model including age, race/ethnicity, primary language spoken, and hospital location, Black race (adjusted odds ratio [aOR], 2.5; 95% CI, 1.3–4.9) and primary Spanish language (aOR, 4.4; 95% CI, 2.1–9.4) had higher odds of UDNR. After adjusting the base model for severity of illness, primary Spanish language remained associated with higher odds of UDNR order (aOR, 2.8; 95% CI, 1.7–4.7).

CONCLUSIONS:
In this multihospital study, UDNR orders were used more often for primary Spanish-speaking patients during the COVID-19 pandemic, which may be related to communication barriers Spanish-speaking patients and families experience. Further study is needed to assess UDNR use across hospitals and enact interventions to improve potential disparities.
Electron Transport Chain Inhibition to Decrease Injury in Transplanted Donation After Circulatory Death Rat Hearts
Authors: Quader Mohammed , Chen Qun , Akande Oluwatoyin , Cholyway Renee , Mezzaroma Eleonora , Lesnefsky Edward J. , Toldo Stefano 
Published: March 2023

Abstract
Donation after circulatory death (DCD) donor hearts sustain ischemic damage and are not routinely used for heart transplantation. DCD heart injury, particularly reperfusion injury, is primarily mediated by releasing reactive oxygen species from the damaged mitochondria (complex I of the electron transport chain). Amobarbital (AMO) is a transient inhibitor of complex I and is known to reduce releasing reactive oxygen species generation. We studied the beneficial effects of AMO in transplanted DCD hearts. Sprague-Dawley rats were assigned to 4 groups—DCD or DCD + AMO donors and control beating-heart donors (CBD) or CBD + AMO donors (n = 6–8 each). Anesthetized rats were connected to a ventilator. The right carotid artery was cannulated, heparin and vecuronium were administered. The DCD process started by disconnecting the ventilator. DCD hearts were procured after 25 minutes of in-vivoischemia, whereas CBD hearts were procured without ischemia. At procurement, all donor hearts received 10 mL of University of Wisconsin cardioplegia solution. The CBD + AMO and DCD + AMO groups received AMO (2 mM) dissolved in cardioplegia. Heterotopic heart transplantation was performed by anastomosing the donor aorta and pulmonary artery to the recipient's abdominal aorta and inferior vena cava. After 14 days, transplanted heart function was measured with a balloon tip catheter placed in the left ventricle. Compared with CBD hearts, DCD hearts had significantly lower developed pressure. AMO treatment significantly improved cardiac function in DCD hearts. Treatment of DCD hearts at the time of reperfusion with AMO resulted in an improvement of transplanted heart function that was comparable with the CBD hearts.
Complement Inhibition for Geographic Atrophy: Review of Salient Functional Outcomes and Perspective
Authors: Spaide Richard F. , Vavvas Demetrios G. 
Published: March 2023

Abstract

Purpose:
To evaluate available rationale and outcomes of randomized trial results for complement inhibition for geographic atrophy.

Methods:
Data from recently completed randomized trials of complement inhibition, particularly for pegcetacoplan and avacincaptad pegol, were evaluated for both the outcome, area of autofluorescence loss, and functional vision tests.

Results:
Pegcetacoplan 2 mg showed statistically significant reduction in expansion of area of autofluorescence loss with monthly, but not every-other-month dosing, in a 12-month phase 2 trial. Nearly 40% of patients recruited for the monthly arm did not complete the trial. In two parallel phase 3 studies there was a statistically significant reduction in the area of atrophy in one but not both studies. Data released at 24 months follow-up showed statistically significant reduction in area of autofluorescence detected atrophy in both studies compared with sham. Patients did not show functional difference in best corrected visual acuity, maximum reading speed, Functional Reading Independence Index, and mean microperimetry threshold sensitivities in the treatment versus sham arms. Avacincaptad pegol was evaluated in 2 randomized pivotal studies and showed a statistically significant reduction in expansion of autofluorescence loss at 12 months. Patients in the treatment arms did not show any difference as compared with sham in best corrected visual acuity or low luminance visual acuity, the only functional outcomes mentioned. Both drugs increased the risk of macular neovascularization.

Conclusions:
Both avacincaptad pegol and pegcetacoplan show significant differences compared with sham in autofluorescence imaging but no benefit in visual function at 12 and 24 months, respectively.
EXTENSIVE SUBRETINAL FIBROSIS ASSOCIATED WITH PSEUDOXANTHOMA ELASTICUM
Authors: Oyeniran Enny , Wiley Henry , Bellur Sunil , Sen H. Nida , Ferreira Carlos R. , Chew Emily Y. , Kodati Shilpa 
Published: March 2023

Purpose:
The purpose of this study was to report an unusual case of pseudoxanthoma elasticum presenting with an inflammatory phenotype associated with atypical and rapidly progressive subretinal fibrosis.

Methods:
This was an observational case report.

Results:
A patient with a history of pseudoxanthoma elasticum presented with rapidly progressive subretinal fibrosis, particularly in the left eye, over the course of one year. The patient was noted at presentation to have intraocular inflammation, outer retinal attenuation, multifocal choroiditis–like lesions, and intraretinal fluid (in the absence of obvious clinical or angiographic signs of exudative choroidal neovascular membranes). An ocular inflammatory phenotype was diagnosed, and the patient was treated with a combination of local steroids and systemic corticosteroids/immunomodulatory agents. After initiation of these agents, the patient demonstrated functional and structural improvement, with partial outer retinal reconstitution, decreased intraretinal fluid, and lack of further progression of subretinal fibrosis.

Conclusion:
This report describes an inflammatory phenotype of pseudoxanthoma elasticum associated with severe and atypical subretinal fibrosis. This case expands upon the currently known spectrum of inflammatory phenotypes associated with pseudoxanthoma elasticum. Treatment with corticosteroids or immunomodulatory treatment should be considered in similar cases.
Desperate Times Call for Desperate Measures: Bridging to Transplant in the Face of Central Device Infection
Authors: Jenkins Haley , Starling Randall C. , Soltesz Edward G. , Tong Michael Z.Y. , Weiss Aaron J. 
Published: March 2023

Patients with durable left ventricular assist devices (LVAD) that develop central device infections can prove prohibitively challenging to treat and may require device explant for source control. In bridge to transplant (BTT) LVAD patients, the management of mediastinal infection is further complicated by changes in the 2018 United Network of Organ Sharing (UNOS) allocation system, which resulted in a comparatively lower listing status than in its previous iteration.
We present the case of a 36-year-old male with nonischemic cardiomyopathy status post Heartmate 3 (HM3) implantation as BTT who after a year of stable HM3 support, developed a severe bacterial infection along the outflow graft. Despite attempts at finding a suitable donor at his current listing, his clinical status continued to deteriorate. To obtain infection source control, he underwent LVAD explant and insertion of a left axillary artery Impella 5.5 ventricular assist device for necessary hemodynamic support. The patient’s listing was upgraded to Status 2, and following the identification of a suitable donor, underwent successful heart transplantation. This case highlights the limitation of the updated UNOS heart allocation system for patients with central device infections and describes the successful use of salvage temporary mechanical circulatory support to bridge to transplantation.
Secondary breast reconstruction in small to medium-sized irradiated breasts: could Fat-Augmented LD (FALD) flap be a reliable alternative?
Authors: Longo Benedetto , D’Orsi Gennaro , Vanni Gianluca , Gagliano Elettra , Buonomo Claudio Oreste , Cervelli Valerio 
Published: March 2023

Background:
Secondary breast reconstruction (BR) is recognized as challenging procedure particularly when radiotherapy (RT) has previously been performed. The aim of the study was to compare operative data and aesthetic outcomes between secondary irradiated and immediate BR using Fat-Augmented Latissimus Dorsi (FALD) flap.

Methods:
We conducted a prospective clinical study between September 2020 and September 2021. Patients were divided into 2 groups: Group A included secondary BR using FALD flap in previously irradiated breasts, while Group B immediate BR with FALD flap. Demographics and surgical data were compared and an aesthetic analysis was performed. Chi-square and t-test were performed for categorical and continuous variables respectively.

Results:
20 FALD flap-based BR for each group were included. The two groups were found to be homogeneous for the demographic’s variables. The difference in mean operative time (263.1 vs 265.1 min; p=0.467) and complications (p=0.633) among the two groups were not significant. There was statistically significant difference in term of immediate fat grafting volume in favor of group A (218.2 cc vs 133.0 cc; p<0.0001). Regarding aesthetic outcomes, the mean global score evaluation showed no statistically significant differences between groups (17.86 vs 18.21; p=0.209).

Conclusion:
Our study states that the FALD flap can be considered a reliable procedure for secondary reconstruction in previously irradiated breasts, although it is not indicated for patients with larger breasts. This surgical technique allowed us to achieve a totally autologous BR with good aesthetic results and low complication rates, even in secondary irradiated cases.
Level of Evidence III
Late Presenting Sagittal Craniosynostosis: An Update to a Standardized Treatment Protocol
Authors: Beiriger Justin W. , Bruce Madeleine K. , Mak Allison , Zhang Casey , Kueper Janina , Irgebay Zhazira , Smetona John , Pfaff Miles , Bykowski Michael , Losee Joseph E. , Goldstein Jesse A. 
Published: March 2023

Background:
We previously published our protocol to treat patients who present with sagittal craniosynostosis after the age of one year. The purpose of this study is to present a follow-up and update of this cohort to evaluate outcomes of our treatment protocol.

Methods
Patients with isolated sagittal craniosynostosis who presented after the age of one year between July 2013 and April 2021 were included.

Results
108 patients met inclusion criteria. The average age at presentation was 5.2 ± 3.4 years and 79 (73.1%) were male. The indications for imaging were head shape (54.6%), headache (14.8%), trauma (9.3%), seizure (4.6%), papilledema (2.8%), and other (13.9%). Of the 108 patients, 12 (11.1%) underwent surgery following their initial consultation: 5 for papilledema, 4 for elevated ICP, 2 for severely scaphocephalic head shapes, and 1 for abnormal fundoscopic findings. Two of these patients underwent additional reconstructive surgery, one for the recurrence of papilledema and headache and the other for progressive scaphocephaly. The average length of time between surgeries was 4.9 years. Of the 96 patients who were conservatively managed, 4 (4.2%) underwent surgery at an average of 1.2 ± 0.5 years later (average age 4.4 ± 1.5 years) for brain growth restriction (n=2), aesthetic concerns (n=1), and refractory headaches (n=1). The average follow-up of all patients with craniofacial surgery was 2.7 ± 2.3 years (median 2.1 years, IQR 3.7 years).

Conclusions
Patients with late-presenting sagittal craniosynostosis require surgical correction less often than younger patients, likely due to milder phenotype. Few patients in the conservative treatment arm ultimately required surgery (4%).
Editorial: A Tribute to Mediterranean Pioneers in Facial Plastic and Craniomaxillofacial Surgery
Authors: Hallak Hana , Sharaf Basel A. 
Published: March 2023

Background:
Physicians from the Mediterranean civilization were profoundly instrumental in the early development and contemporary advancement of the craniomaxillofacial field. These feats are scarcely studied or acclaimed. In this editorial, the authors explore the contributions of these major Mediterranean pioneers.

Methods:
A literature review on the subject was performed using PubMed, Scopus, Embase, and Mayo Clinic Libraries.

Results:
Mediterranean medicine has recognized and managed craniomaxillofacial pathologies from as early as the 10th century. The first inscriptions were authored by Abu Alkasem al-Zahrawi and Serefeddin Sabuncuoglu. Starting in the 15th century, Leonardo da Vinci shed light on anatomy and esthetics at a time where Gasparo Tagliacozzi spearheaded maxillofacial techniques. The field during the Renaissance was dominated by Hippocrates Asclepiades. Varaztad Kazanjian revolutionized the armamentarium necessitated by mass emergencies during the World War. In the 20th century, Paul Tessier redefined the limits of craniomaxillofacial treatment by using facial osteotomies and developing refined surgical instruments. Modern day Sam Hamra, Enrico Robotti, and Daniel Labbé continue to lead educational and innovative fronts of the field.

Conclusions:
This essay highlights some important historical contributions to the fields of craniomaxillofacial and facial plastic surgery by pioneer surgeons from around the Mediterranean.
Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery
Authors: Kirkham Aidan M. , Candeliere Jasmine , McIsaac Daniel I. , Stelfox Henry T. , Dubois Luc , Gill Heather L. , Brandys Timothy , Nagpal Sudhir K. , Roberts Derek J. 
Published: March 2023

Objective:
The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery.

Background:
SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality.

Methods:
We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty.

Results:
Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11–0.57; n=4 studies; I
2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38–0.78; n=5 studies; I
2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26–0.73; n=2 studies; I
2=0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33–1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097–1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44–1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42–1.03; n=1 study) (low certainty for all).

Conclusions:
Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.
Variation of Liver Transplant Practice and Outcomes During Public Holidays in the United States: Analysis of United Network for Organ Sharing Registry
Authors: Shamaa Tayseer M. , Kitajima Toshihiro , Ivanics Tommy , Shimada Shingo , Mohamed Adhnan , Yeddula Sirisha , Rizzari Michael , Collins Kelly , Yoshida Atsushi , Abouljoud Marwan , Nagai Shunji 
Published: March 2023

Background:
It has been reported that patients hospitalized outside regular working hours have worse outcomes. This study aims to compare outcomes following liver transplantation (LT) performed during public holidays and nonholidays.

Methods:
We analyzed the United Network for Organ Sharing registry data for 55 200 adult patients who underwent an LT between 2010 and 2019. Patients were grouped according to LT receipt during public holidays ±3 d (n = 7350) and nonholiday periods (n = 47 850). The overall post-LT mortality hazard was analyzed using multivariable Cox regression models.

Results:
LT recipient characteristics were similar between public holidays and nonholidays. Compared with nonholidays, deceased donors during public holidays had a lower donor risk index (median [interquartile range]: holidays 1.52 [1.29–1.83] versus nonholidays 1.54 [1.31–1.85]; P = 0.001) and shorter cold ischemia time (median [interquartile range]: holidays 5.82 h [4.52–7.22] versus nonholidays 5.91 h [4.62–7.38]; P < 0.001). Propensity score matching 4-to-1 was done to adjust for donor and recipient confounders (n = 33 505); LT receipt during public holidays (n = 6701) was associated with a lower risk of overall mortality (hazard ratio 0.94 [95% confidence interval, 0.86-0.99]; P = 0.046). The number of livers that were not recovered for transplant was higher during public holidays compared with nonholidays (15.4% versus 14.5%, respectively; P = 0.03).

Conclusions:
Although LT performed during public holidays was associated with improved overall patient survival, liver discard rates were higher during public holidays compared with nonholidays.
Admixture Mapping of Peripheral Artery Disease in a Dominican Population Reveals a Novel Risk Locus on 2q35
Authors: Cullina Sinead , Wojcik Genevieve L. , Shemirani Ruhollah , Klarin Derek , Gorman Bryan R. , Sorokin Elena P. , Gignoux Christopher R. , Belbin Gillian M. , Pyarajan Saiju , Asgari Samira , Tsao Phil S. , Damrauer Scott M. , Abul-Husn Noura S. , Kenny Eimear E. 
Published: March 2023

AbstractPeripheral artery disease (PAD) is a form of atherosclerotic cardiovascular disease, affecting ∼8 million Americans, and is known to have racial and ethnic disparities. PAD has been reported to have significantly higher prevalence in African Americans (AAs) compared to non-Hispanic European Americans (EAs). Hispanic/Latinos (HLs) have been reported to have lower or similar rates of PAD compared to EAs, despite having a paradoxically high burden of PAD risk factors, however recent work suggests prevalence may differ between sub-groups. Here we examined a large cohort of diverse adults in the BioMebiobank in New York City (NYC). We observed the prevalence of PAD at 1.7% in EAs vs 8.5% and 9.4% in AAs and HLs, respectively; and among HL sub-groups, at 11.4% and 11.5% in Puerto Rican and Dominican populations, respectively. Follow-up analysis that adjusted for common risk factors demonstrated that Dominicans had the highest increased risk for PAD relative to EAs (OR=3.15 (95% CI 2.33-4.25),P<6.44×10-14). To investigate whether genetic factors may explain this increased risk, we performed admixture mapping by testing the association between local ancestry (LA) and PAD in Dominican BioMeparticipants (N=1,940) separately for European (EUR), African (AFR) and Native American (NAT) continental ancestry tracts. We identified a NAT ancestry tract at chromosome 2q35 that was significantly associated with PAD (OR=2.05 (95% CI 1.51-2.78),P<4.06×10-6) with 22.5% vs 12.5% PAD prevalence in heterozygous NAT tract carriers versus non-carriers, respectively. Fine-mapping at this locus implicated tag SNP rs78529201 located within a long intergenic non-coding RNA (lincRNA)LINC00607, a gene expression regulator of key genes related to thrombosis and extracellular remodeling of endothelial cells, suggesting a putative link of the 2q35 locus to PAD etiology. In summary, we showed how leveraging health systems data helped understand nuances of PAD risk across HL sub-groups and admixture mapping approaches elucidated a novel risk locus in a Dominican population.