bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol
Authors: Peters Blair R. , Annen Alvin A. , Berli Jens U. , Gallagher Sandra , Smigelski Caitlin , Kahn Lorna H. , Skelton Hales E. 
Published: February 2023

Background:
Sensory nerve transfers are performed as part of phalloplasty surgery. Despite this, sensory re-education to rehabilitate these nerve transfers has not been employed. Additionally, little attention has been paid to the role of the central nervous system in experienced sensation following phalloplasty. The purpose of this article is to report on the development of a targeted rehabilitation protocol to integrate and optimize peripheral and central contributions to sensation following phalloplasty.

Methods:
This neurosensory re-education protocol was constructed over four phases by a multi-disciplinary team (phalloplasty/peripheral nerve surgeon, reconstructive urologist, pelvic floor physiotherapists, nerve therapist, sex therapist, sexual medicine physician) and individuals with lived phalloplasty experience. The final protocol was approved by all team members and is supported here by qualitative narratives from people with lived phalloplasty experience.

Results:
The protocol is built to follow each stage of phalloplasty surgery. In each stage, exercises are grouped into three core themes: visualization, tactile stimulation, and sexual/erogenous stimulation. Visualization exercises progress from static to dynamic. Tactile exercises start at simple touch and progress toward targeted sensory stimulation. Sexual stimulation focuses on developing erogenous sensation in the phallus that is separate from erogenous sensation in the natal clitoral tissue. By recommendation of individuals with phalloplasty, the protocol is now integrated into our center’s phalloplasty care pathway for all individuals undergoing phalloplasty surgery.

Conclusion:
We introduce a novel protocol targeting peripheral and central contributions to sensation to provide a tool to help optimize experienced sensation for transmasculine individuals undergoing phalloplasty.
Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes
Authors: Clark Robert C. , Swanson Marco A. , Cai Yida , Sarode Anuja L. , Lineberry Kyle D. , Kumar Anand R. 
Published: February 2023

Background:
Infected Ventricular Assist Device (VAD)–associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized that patients treated with flaps and/or NPWT would have higher hardware salvage rates compared with other surgical management strategies.

Methods:
A meta-analysis study evaluating VAD-associated wounds was performed following PRISMA guidelines. Primary predictor variables were flap-reconstruction (FR), NPWT, no FR, and infection location (mediastinum versus driveline). Primary outcomes were hardware retention (salvage) versus explantation, infection recurrence, or death. Twenty-nine studies were included. Standard statistical methods included logistic regression analysis.

Results:
Seventy-four subjects with nonsignificant demographic differences between cohorts were identified. Overall salvage was 59.5% in both driveline and mediastinum cohorts. Overall, NPWT significantly improved salvage compared with no NPWT [77.4% versus 46.5% respectively (P = 0.009)], and FR significantly improved salvage compared with no FR [68.6% versus 39.1% respectively (P = 0.022)]. Logistic regression analysis predicting odds of salvage by FR (area under curve = 0.631) was significantly three times higher (95% CI: 1.2–9.5) and predicting the odds for salvage by NPWT (area under curve = 0.656) was significantly four times higher (95% CI: 1.4–11.1) compared with other treatment.

Conclusions:
NPWT or flap reconstruction for treatment of threatened VAD hardware was associated with a significantly improved device salvage compared with other surgical strategies. Further study should focus on subgroup analysis of flaps utilized and synergistic treatment benefits.
κ-Opioid Receptor Plasma Levels Are Associated With Sex and Diagnosis of Major Depressive Disorder But Not Response to Ketamine
Authors: Quintanilla Brandi , Medeiros Gustavo C. , Greenstein Dede , Yuan Peixiong , Johnston Jenessa N. , Park Lawrence T. , Goes Fernando S. , Gould Todd D. , Zarate Carlos A. 
Published: February 2023

Abstract

Background
Preclinical evidence indicates that the κ-opioid receptor (KOR)/dynorphin pathway is implicated in depressive-like behaviors. Ketamine is believed to partly exert its antidepressant effects by modulating the opioid system. This post hoc study examined the following research questions: (1) at baseline, were there differences in KOR or dynorphin plasma levels between individuals with major depressive disorder (MDD) and healthy volunteers (HVs) or between men and women? (2) in individuals with MDD, did KOR or dynorphin baseline plasma levels moderate ketamine's therapeutic effects or adverse effects? and (3) in individuals with MDD, were KOR or dynorphin plasma levels affected after treatment with ketamine compared with placebo?

Methods
Thirty-nine unmedicated individuals with MDD (23 women) and 25 HVs (16 women) received intravenous ketamine (0.5 mg/kg) and placebo in a randomized, crossover, double-blind trial. Blood was obtained from all participants at baseline and at 3 postinfusion time points (230 minutes, day 1, day 3). Linear mixed model regressions were used.

Results
At baseline, participants with MDD had lower KOR plasma levels than HVs (F
1,60 = 13.16, P < 0.001), and women (MDD and HVs) had higher KOR plasma levels than men (F
1,60 = 4.98, P = 0.03). Diagnosis and sex had no significant effects on baseline dynorphin levels. Baseline KOR and dynorphin levels did not moderate ketamine's therapeutic or adverse effects. Compared with placebo, ketamine was not associated with postinfusion changes in KOR or dynorphin levels.

Conclusions
In humans, diagnosis of MDD and biological sex are involved with changes in components of the KOR/dynorphin pathway. Neither KOR nor dynorphin levels consistently moderated ketamine's therapeutic effects or adverse effects, nor were levels altered after ketamine infusion.

Trial Registration
NCT00088699 (ClinicalTrials.gov).
Impact of COVID-19 Pandemic on Human Papillomavirus Vaccine Uptake in Israel
Authors: Lavie Michael , Lavie Inbar , Laskov Ido , Cohen Aviad , Grisaru Dan , Grisaru-Soen Galia , Michaan Nadav 
Published: February 2023

Objective
Isolation and school closure during the COVID-19 pandemic could decrease human papillomavirus (HPV) vaccination uptake and potentially increase future HPV-related morbidity among unvaccinated populations. The aim of our study was to investigate HPV vaccination rates in Israel during the pandemic.

Methods
The HPV vaccination rates were compared before and during the COVID-19 pandemic years (2020–2021). Data regarding HPV vaccination between 2015 and 2021 were extracted from the Israeli Ministry of Health online reports. Vaccination rates were compared with other childhood vaccines, given at similar ages. Israeli HPV vaccination rates were further compared with England and Australia, which have an established vaccination infrastructure.

Results
The average Israeli coverage of first-dose HPV vaccine was 60.2%, with significant variations from 2015 to 2021. During the pandemic years, first-dose vaccine coverage increased compared with the 3 previous years. The pandemic had also no apparent influence on other childhood vaccine uptake, even though adolescents in Israel missed many school days during this time. Average vaccine uptake in England and Australia was significantly higher than Israel (p = .009); however, first-dose vaccination rates decreased considerably in England during 2020, to a nadir of 59%. The pandemic had little effect on HPV vaccination rates in Australia.

Conclusions
Despite many school days missed, the COVID-19 pandemic did not result in a decrease in HPV vaccine uptake in Israel. The pandemic could prove a good opportunity to further educate the public regarding the importance of whole-population vaccination programs. Implementing catch-up vaccination programs may bridge “vaccination gaps” that may be caused by future pandemics.
Nutrition and diet in inflammatory bowel disease
Authors: Yamamoto Takayuki , Shimoyama Takahiro 
Published: February 2023

Purpose of review
This study was to review the current evidence for dietary risk factors for developing inflammatory bowel disease (IBD), and therapeutic benefit of dietary and enteral interventions in IBD.

Recent findings
A Westernized diet rich in protein, fats and refined carbohydrates and low in fibre, fruits and vegetables may increase risk of developing IBD. Nevertheless, there are methodological limitations in case–control studies, which can affect the accuracy of the outcomes. Currently, various dietary interventions and supplements have been attempted to control the disease activity of IBD, but none of them showed striking efficacy. Exclusive enteral nutrition (EEN) is recommended as the first-line therapy in paediatric patients with active Crohn's disease. EEN is recommended in adults with good adherence to enteral formula and with intolerance to corticosteroids. Partial enteral nutrition is not recommended as primary therapy for the maintenance of remission, but it is used when undernutrition cannot be treated sufficiently with diets.

Summary
Dietary risk factors for IBD, and the efficacies of dietary and enteral interventions need to be confirmed by large, well designed studies.
Carnitine derivatives beyond fatigue: an update
Authors: Malaguarnera Michele , Catania Vito Emanuele , Malaguarnera Mariano 
Published: February 2023

Purpose of review
Carnitine is an essential micronutrient that transfer long-chain fatty acids from the cytoplasm into the mitochondrial matrix for the β-oxidation. Carnitine is also needed for the mitochondrial efflux of acyl groups in the cases wherein substrate oxidation exceeds energy demands.

Recent findings
Carnitine deficiency can affect the oxidation of free fatty acids in the mitochondria resulting in the aggregation of lipids in the cytoplasm instead of entering the citric acid cycle. The aggregation leads a lack of energy, acetyl coenzyme A accumulation in the mitochondria and cytotoxic production.

Summary
Carnitine and its derivatives show great clinical therapeutic effect without significant side effects.
Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?
Authors: Dike Chinenye R. , Huang Pacheco Andrew , Lyden Elizabeth , Freestone David , Choudhry Ojasvini , Bishop Warren P. , Shukry Mohanad 
Published: February 2023

Background:
Inflation of the gastrointestinal lumen is vital for proper visualization during endoscopy. Air, insufflated via the endoscope, is gradually being replaced with carbon dioxide (CO2) in many centers, with the intention of minimizing post-procedural discomfort due to retained gas. Recent studies suggest that the use of CO2 during pediatric esophagogastroduodenoscopy (EGD) with an unprotected airway is associated with transient elevations in exhaled CO2 (end-tidal CO2, EtCO2), raising safety concerns. One possible explanation for these events is eructation of insufflation gas from the stomach.

Objectives:
To distinguish eructated versus absorbed CO2 by sampling EtCO2 from a protected airway with either laryngeal mask airway (LMA) or endotracheal tube (ETT), and to observe for changes in minute ventilation (MV) to exclude hypoventilation events.

Methods:
Double-blinded, randomized clinical trial of CO2 versus air insufflation for EGD with airway protection by either LMA or ETT. Tidal volume, respiratory rate, MV, and EtCO2 were automatically recorded every minute. Cohort demographics were described with descriptive characteristics. Variables including the percent of children with peak, transient EtCO2 ≥ 60 mmHg were compared between groups.

Results:
One hundred ninety-five patients were enrolled for 200 procedures. Transient elevations in EtCO2 of ≥60 mmHg were more common in the CO2 group, compared to the air group (16% vs 5%, P = 0.02), but were mostly observed with LMA and less with ETT. Post-procedure pain was not different between groups, but flatulence was reported more with air insufflation (P = 0.004).

Conclusion:
Transient elevations in EtCO2 occur more often with CO2 than with air insufflation during pediatric EGD despite protecting the airway with an LMA or, to a lesser degree, with ETT. These elevations were not associated with changes in MV. Although no adverse clinical effects from CO2 absorption were observed, these findings suggest that caution should be exercised when considering the use of CO2 insufflation, especially since the observed benefits of using this gas were minimal.
Adverse Events During Apnea Testing for the Determination of Death by Neurologic Criteria: A Single-Center, Retrospective Pediatric Cohort*
Authors: Sveen William N. , Antommaria Armand H. Matheny , Gilene Stephen J. , Stalets Erika L. 
Published: February 2023

OBJECTIVES:
To report the prevalence of adverse events in children undergoing apnea testing as part of the determination of death by neurologic criteria (DNC).

DESIGN:
Single-center, retrospective study.

SETTING:
Academic children’s hospital that is a Level I Trauma Center.

PATIENTS:
All children who underwent apnea testing to determine DNC from July 2013 to June 2020.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We abstracted the medical history, blood gases, ventilator settings, blood pressures, vasoactive infusions, intracranial pressures, chest radiographs, and echocardiograms for all apnea tests as well as any ancillary test. Adverse events were defined as hypotension, hypoxia, pneumothorax, arrhythmia, intracranial hypertension, and cardiac arrest. Fifty-eight patients had 105 apnea tests. Adverse events occurred in 21 of 105 apnea tests (20%), the most common being hypotension (15/105 [14%]) and hypoxia (4/105 [4%]). Five of 21 apnea tests (24%) with adverse events were terminated prematurely (three for hypoxia, one for hypotension, and one for both hypoxia and hypotension) but the patients did not require persistent escalation in care. In the other 16 of 21 apnea tests (76%) with adverse events, clinical changes were transient and managed by titrating vasoactive infusions or completing the apnea test.

CONCLUSIONS:
In our center, 20% of all apnea tests were associated with adverse events. Only 5% of all apnea tests required premature termination and the remaining 15% were completed and the adverse events resolved with medical care.
HEMIN ATTENUATED LPS-INDUCED ACUTE LUNG INJURY IN MICE VIA PROTECTING PULMONARY EPITHELIAL BARRIER AND REGULATING HO-1/NLRP3-MEDIATED PYROPTOSIS
Authors: Cheng Xue , Yin Mingzhu , Sun Xiongjie , Zhang Zhigang , Yao Xiaowei , Liu Hongtao , Xia Hui 
Published: February 2023

ABSTRACT
Pulmonary epithelial barrier injury contributes to acute lung injury, accelerating exudate formation, and resulting alveolar edema. Heme oxygenase-1 (HO-1) plays an important role in ameliorating the pathological symptoms of acute lung injury (ALI). Using an ALI mouse model induced by LPS inhalation, the present study explored the potential molecular regulatory effect of hemin (a potent HO-1 inducer) against ALI epithelial damage. Lipopolysaccharide challenge triggered dysfunction of the alveolar epithelial barrier, impaired tight junctions, and disrupted alveoli fluid clearance, while these pathological changes were effectively reversed by hemin treatment. Furthermore, HO-1 elevation inhibited the activation of the nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome and oxidative stress in alveolar epithelia, leading to the suppression of inflammatory responses and epithelial pyroptosis, as indicated by the decreased levels of NLRP3 and apoptosis-associated speck-like protein containing a CARD domain (ASC), repressed cleavage of caspase-1 and gasdermin D, and reduced expression levels of inflammatory cytokine IL-1β. In contrast, protoporphyrin IX zinc (II) (ZnPP, an HO-1 inhibitor) treatment had no protective effect on LPS inhalation-induced ALI in mice. In summary, HO-1 induction serves a critical role in maintaining airway epithelium homeostasis through the inhibition of NLRP3/ASC/caspase-1–mediated pyroptosis and inflammation in the occurrence of ALI.
Fully Covered Metal Stents Safely Facilitate Extraction of Difficult Bile Duct Stones
Authors: Koksal Aydin Seref , Eminler Ahmet Tarik , Parlak Erkan 
Published: February 2023

Background:
Ten to 15% of the common bile duct (CBD) stones require advanced endoscopic extraction techniques during endoscopic retrograde cholangiopancreatography. The study aimed to evaluate the efficacy and safety of fully covered self-expandable metal stents (FC-SEMS) for facilitating the extraction of difficult bile duct stones.

Methods:
Patients who received FC-SEMS for the extraction of difficult CBD stones were retrospectively reviewed. Group 1 included patients with extrahepatic stones above a distal CBD stricture, Group 2 included patients with intrahepatic stones above a hilar stricture, and Group 3 included patients with complex stone(s) and no biliary stricture. Complete stone clearance rate and complications of FC-SEMS treatment were evaluated.

Results:
The study group included 33 procedures on 32 patients (mean age: 55±17, 56.3% male). FC-SEMS was placed as a primary treatment in 15 (45.5%) procedures. Complete stone clearance was achieved in 84.6% of the procedures in Group 1, 100% in Group 2, and 87.5% in Group 3 (P=0.23). Overall, complete stone clearance was achieved in 30 of the 33 procedures (90.9%). None of the patients developed pancreatitis, cholecystitis, or cholangitis. Stent migration occurred in 4 procedures (12.1%), and all were clinically insignificant.

Conclusion:
FC-SEMS is effective and safe for facilitating treatment of difficult bile duct stones.
Efficacy of Reinforced Stapler Versus Hand-sewn Closure of the Pancreatic Stump During Pure Laparoscopic Distal Pancreatectomy to Reduce Pancreatic Fistula
Authors: Murata Yasuhiro , Maeda Koki , Ito Takahiro , Gyoten Kazuyuki , Hayasaki Aoi , Iizawa Yusuke , Fujii Takehiro , Tanemura Akihiro , Kuriyama Naohisa , Kishiwada Masashi , Mizuno Shugo 
Published: February 2023

Background:
Laparoscopic distal pancreatectomy (L-DP) is the standard procedure for treating left-sided pancreatic tumors. Stapler closure of the pancreas is the preferred method for L-DP; however, postoperative pancreatic fistula (POPF) remains a challenging problem. The present study aimed to compare the surgical outcomes of staple closure using a reinforcing stapler (RS) and transection using an ultrasonic dissector followed by hand-sewn (HS) closure in a fish-mouth manner in pure L-DP and to determine independent perioperative risk factors for clinically relevant postoperative pancreatic fistula (CR-POPF).

Patients and Methods:
Among the 85 patients who underwent pure L-DP between February 2011 and August 2021, 80 of whom the pancreatic stump was closed with RS (n = 59) or HS (n = 21) were retrospectively investigated. Associations between potential risk factors and POPF were assessed using univariate analysis. The factors, of which the P value was determined to be <0.1 by univariate analysis, were entered into a multivariate regression analysis to ascertain independent predictive factors.

Results:
The surgery time and estimated blood loss were not significantly different between the two groups. Overall, 13 patients (16.3%) developed CR-POPF (B = 12 and C = 1). The rate of CR-POPF was lower in RS than in HS; however, the difference was not statistically significant (RS vs HS: 11.9% vs 28.9%, P = 0.092). Consistent with the results for CR-POPF, the rate of Clavien-Dindo IIIa or more postoperative complications and the length of hospital stay were also not significantly different between the two groups (RS vs HS: 10.2, 12% vs 14.3%, 14 d). In the univariate analysis of risk factors for CR-POPF, the pancreatic thickness at the transection site, procedure for stump closure, and estimated blood loss were associated with a significantly higher rate of CR-POPF. The multivariate analysis revealed that the pancreatic thickness at the transection site (cutoff: 12 mm) was the only independent risk factor for CR-POPF (odds ratio: 6.5l, 95% CI: 1.4-30.4, P = 0.018). The rate of CR-POPF was much lower in RS than in HS for pancreatic thickness <12 mm (RS vs HS: 4.1% vs 28.6%), whereas that was rather higher in RS than in HS for pancreatic thickness ≥12 mm (RS vs HS: 50% vs 28.6%).

Conclusions:
RS closure was superior to HS closure for pancreatic thickness <12 mm and for prevention of CR-POPF after pure L-DP. It is necessary to seek more reliable procedures for pancreatic stump closure in patients with a pancreatic thickness of ≥12 mm.
Timing of Bariatric Surgery and COVID-19 Vaccination: Experience From a High-volume Single Center
Authors: Vitiello Antonio , Berardi Giovanna , Velotti Nunzio , Schiavone Vincenzo , Abu-Abeid Adam , Musella Mario 
Published: February 2023

Background:
During the last year, there was a large COVID-19 vaccination campaign in Italy. Concurrently, metabolic bariatric surgery (MBS) restarted after a long period of discontinuity. No data are currently available on the best timing of COVID-19 vaccination for MBS candidates. The aim of this study was to report MBS outcomes in relation to the timing of COVID-19 vaccine administration.

Materials and Methods:
A prospectively maintained database was utilized to locate patients undergoing MBS between January 1 and December 31, 2021. Patients were divided into 2 groups: patients receiving a vaccine dose within 30 days before or after surgery (Group±30); and patients with a longer time interval of vaccine dose before or after surgery (Group>±30). Postoperative outcomes were recorded and compared.

Results:
A total of 108 patients were included: 33 (30.6%) of whom were in Group±30 and 74(69.4%) in Group>30. Baseline characteristics were comparable between the 2 groups. Findings revealed that postoperative outcomes (ie, 30-d complications and length of stay postoperatively) were comparable between groups. Two patients in the ±30 group had mesenteric vein thrombosis after sleeve gastrectomy (SG); however, the rate of thrombosis events was comparable between groups (P=0.09). Thrombosis between SG patients were not significantly different between the 2 groups.

Conclusions:
COVID-19 vaccination within 30 days of MBS does not impact complication rates and length of stay. COVID-19 vaccination may have a negative impact on venous thrombosis after SG, but this study is underpowered to draw this conclusion. Larger studies should be conducted to replicate current study findings.