bluuebunny/crossref_metadata_2025_split huggingface dataset:
Average Causal Effect Estimation Via Instrumental Variables: the No Simultaneous Heterogeneity Assumption
Authors: Hartwig Fernando Pires , Wang Linbo , Davey Smith George , Davies Neil Martin 
Published: January 2023

Background:
Instrumental variables (IVs) can be used to provide evidence as to whether a treatment

has a causal effect on an outcome

. Even if the instrument

satisfies the three core IV assumptions of relevance, independence, and exclusion restriction, further assumptions are required to identify the average causal effect (ACE) of

on

. Sufficient assumptions for this include homogeneity in the causal effect of

on

; homogeneity in the association of

with

; and no effect modification.

Methods:
We describe the no simultaneous heterogeneity assumption, which requires the heterogeneity in the

-

causal effect to be mean independent of (i.e., uncorrelated with) both

and heterogeneity in the

-

association. This happens, for example, if there are no common modifiers of the

-

effect and the

-

association, and the

-

effect is additive linear. We illustrate the assumption of no simultaneous heterogeneity using simulations and by re-examining selected published studies.

Results:
Under no simultaneous heterogeneity, the Wald estimand equals the ACE even if both homogeneity assumptions and no effect modification (which we demonstrate to be special cases of—and therefore stronger than—no simultaneous heterogeneity) are violated.

Conclusions:
The assumption of no simultaneous heterogeneity is sufficient for identifying the ACE using IVs. Since this assumption is weaker than existing assumptions for ACE identification, doing so may be more plausible than previously anticipated.
Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps
Authors: Shuck John W. , Andejani Doaa F. , Garvey Patrick B. , Chang Edward I. 
Published: February 2023

Summary:
The free fibula flap is the gold standard in reconstruction of oncologic mandibular defects. When the mandibular condyle is resected, reconstruction of the temporomandibular joint (TMJ) continues to pose a unique challenge to the reconstructive surgeon. Several conventional methods have been described, including costochondral grafts, bone grafts, and alloplastic prostheses. These nonvascularized options are rarely employed in the oncologic patient receiving postoperative radiation therapy due to high rates of resorption, nonunion, and failure. The authors describe a novel technique for mandibular and TMJ reconstruction utilizing the fibula free flap as a flow through for a medial femoral trochlea flap for vascularized mandible and condylar reconstruction. This technique provides a vascularized cartilaginous surface to articulate with the glenoid fossa, making it an attractive option for the oncologic patient undergoing postoperative radiation therapy.
Successful Use of Delayed Reverse Sural Artery Flap in Single Vessel Legs with Severe Atherosclerotic Disease and Venous Insufficiency
Authors: Kareh Aurora M. , Felder John M. 
Published: February 2023

Summary:
Distal lower extremity wounds are a challenging problem for reconstructive surgeons and can lead to major lower extremity amputations in patients with comorbid conditions. The reverse sural artery flap (RSAF) is a local flap supplied by perforators of the peroneal artery that can cover defects of the distal lower extremity, ankle, and foot. There has been concern over performing the RSAF in patients with venous insufficiency, peripheral artery disease, and diabetes, and in older patients due to the increased risk of flap necrosis. In patients who are not microsurgical candidates, the RSAF may be the final option for reconstruction before undergoing major lower extremity amputation. We describe our experience with two patients with significant comorbidities and single vessel runoff from the peroneal artery due to atherosclerotic disease who successfully underwent RSAF reconstruction for distal lower extremity wounds.
A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures
Authors: Nelson Benjamin A. , Trentadue Taylor P. , Somasundaram Vivek , Patel Priya , Capo John T. , Rizzo Marco 
Published: February 2023

Background:
The aim of this study is to compare clinical and radiographic outcomes of open reduction and internal fixation versus closed reduction and percutaneous pinning of metacarpal fractures in relation to anatomic and surgical variables.

Methods:
Electronic medical records at two institutions were reviewed for patients who underwent surgical intervention for metacarpal fractures. Data were collected from those who underwent reduction and internal fixation with either plates or Kirschner wires (K-wires). Inclusion criteria included minimum postoperative follow-up of 60 days and age 18 years or older. Exclusion criteria included insufficient radiographic data, previously attempted closed reduction with immobilization, pathologic fracture mechanism, history of previous trauma or surgery to the affected bone, and fixation technique other than plate or K-wire.

Results:
We reviewed data for patients treated over a 22-year time period. Ultimately, 81 metacarpal shaft and neck fractures in 60 patients met inclusion criteria. Among all metacarpal fractures, complications were present in 39 (48.1%) cases. There were no significant associations between complication prevalence and hardware type. Revision surgery was required in 11 (13.6%) patients; there were no significant associations between revision procedures and hardware type. Postoperatively, all patients with imaging data had radiograph follow-up to assess union status. There was no significant association between time to union and hardware type.

Conclusions:
Outcomes showed no significant difference between plate and pin fixation for metacarpal shaft and neck fractures. These findings suggest that surgeons may have flexibility to decide on the type of operative intervention while considering patient-specific factors, such as the need for early mobilization.
Distally-based (Reverse) Medial Hemi-flexor Hallucis Brevis Muscle Flap in a Series of High-risk Patients: Retrospective Case Series
Authors: Masadeh Suhail , Liette Michael D. , Perry William , Bibbo Christopher 
Published: February 2023

Background:
The first ray provides an important biomechanical function in ambulation. Loss of this region due to ulceration and pursuant amputation poses significant morbidity to patients. Utilizing the distally based (reverse) medial hemi-flexor hallucis brevis (rmFHB) muscle flap to cover defects of this region may decrease patient morbidity, as it may provide needed bulk and durability for rapid coverage and preservation of the first ray.

Methods:
In this case series, an uncontrolled, retrospective review of the medical records was performed, identifying patients with diabetes who underwent an rmFHB muscle flap performed by a single surgeon. Outcomes measured included the need for secondary soft-tissue procedures at the index surgery; complications; percentage and time to wound healing, defined as epithelialization of wound site; and short-term survival rate (12 months).

Results:
Healing was demonstrated at a mean of 12 weeks, and the preservation of the distal first ray was achieved in 94% of those patients (12/13). One patient went on to first ray amputation and two were deceased before healing. All patients ambulated in shoes with custom molded inserts without complication postoperatively. No recurrence of ulceration was encountered at 12 months follow-up.

Conclusions:
This study demonstrates that the rmFHB muscle flap may serve as an option for distal first ray soft-tissue defects when local flap coverage is needed due to exposed deep or avascular structures not amenable to skin grafting or conservative wound care techniques. No cases of recurrence of ulceration occurred during this study.
Finite Element Analysis to Study Tensile Strength Differences between Free and Attached Ear Lobules
Authors: Vathulya Madhubari , Sarkar Subrato , Verma Vaishali , Singh Indra Vir , Kandwal Pankaj 
Published: February 2023

Summary
Recurrent ear lobule deformity is a chronic condition with aesthetic implications. The problem is normally addressed by certain improvisations of the traditional lobuloplasty technique. These include introduction of autologous tissue components like cartilage pieces to improve the structural integrity. Certain authors also advocate a different site for repiercing of the ear hole away from the lobuloplasty scar. Our study tries to understand the differences in the tensile strength between free and attached ear lobules, using finite element analysis. Eighteen healthy female volunteers with attached (eight subjects) and free ear lobules (10 subjects) were chosen, and the lobules were scanned using Artec 3D scanner. The model was then converted to free form or attached form (opposite to the form in which it was present originally) by decreasing or increasing the area of contact using geomagic software. Finite element analysis was then performed on both the models, and their yield max and, hence, the maximum load at the yield max at 0.7 strains according to previous studies were estimated and compared. The yield max and the corresponding load were found to be lesser in the free variety than in the attached variety. This experiment helps us to understand that when a structural difference in the ear lobule surgically may bring about a change in the tensile strength of the lobules. However, further clinical trials are required to clinically translate the same.
Successful Use of WALANT in Local and Regional Soft Tissue Flaps: A Case Series
Authors: Connors Katherine M. , Kurtzman Joey S. , Koehler Steven M. 
Published: February 2023

Background:
The wide awake local anesthesia no tourniquet (WALANT) technique has been proven to be safe and effective for upper extremity surgery. WALANT does not require extensive medical clearance and allows for intraoperative assessment of range of motion. Additionally, it is frequently associated with lower costs and less postoperative pain when compared with traditional methods of anesthesia. Despite its expanded use for hand procedures, there are sparse data to support the use of WALANT in local and regional soft tissue flaps.

Methods:
A retrospective review was performed. Twenty-one patients who underwent a local or regional soft tissue flap surgery using the WALANT technique from February 2, 2018 to February 25, 2022 were included in our analysis.

Results:
Overall, one Louvre flap, two posterior tibial artery perforator propeller flaps, two reverse radial forearm flaps, two Quaba flaps, six cross finger flaps, one reverse homodigital island flap, three first dorsal metacarpal artery flaps, two thenar flaps, and two Moberg flaps were performed. Patients were followed up for an average of 11.9 ± 8.1 weeks. During this time, no postoperative complications occurred. All patients demonstrated appropriate healing at donor and recipient sites. Full range of motion was regained for all patients.

Conclusions:
WALANT is safe and effective for use in local and regional soft tissue flap surgery. Surgeons should consider this technique for more involved procedures such as flap surgery, as preliminary results demonstrate positive outcomes and potentially superior recovery for patients.
Evaluating sleep in covert encephalopathy with wearable technology: results from the WATCHES study
Authors: Buckholz Adam , Clarke Lindsay , Paik Paul , Jesudian Arun , Schwartz Robert , Krieger Ana , Rosenblatt Russell , Brown Robert S. 
Published: February 2023

Background and Aims:
Covert HE (CHE) is a common early stage of HE associated with poor outcomes. Available neuropsychiatric diagnostic testing is underutilized and has significant clinical limitations. Sleep deterioration is consistently associated with CHE and HE; however, objective data is sparse and it has not been studied longitudinally. We longitudinally study and describe an association of sleep metrics with CHE as detected by a commercial wearable technology.

Methods:
We monitored sleep for 6 months using a commercial fitness tracker in 25 participants with cirrhosis, hypothesizing that CHE as diagnosed by psychometric testing would be associated with significant reductions in sleep quality, especially restorative sleep (deep sleep + rapid eye movement). Mixed-effects modeling was performed to evaluate sleep factors associated with CHE and developed and internally validated a score based on these sleep metrics for associated CHE.

Results:
Across 2862 nights with 66.3% study adherence, we found that those with CHE had consistently worse sleep, including an average of 1 hour less of nightly restorative sleep, driven primarily by reductions in rapid eye movement. A model including albumin, bilirubin, rapid eye movement, sleep disturbances, and sleep consistency showed good discrimination (area under the receiver operating curve=0.79) for CHE status with a sensitivity of 76% and specificity of 69%.

Conclusions:
Our large longitudinal study of sleep in cirrhosis suggests that sleep derangements in CHE can be detected using wearable technology. Given the known importance of sleep to overall health and CHE/HE to prognosis in cirrhosis, the ability to associate dynamic sleep metrics with CHE may in the future help with the detection and passive monitoring as factors that precipitate decompensation of cirrhosis become better understood and mobile health data validation and integration improves.
Can remnant cholesterol (triglyceride-rich lipoproteins) reclassify estimated risk of atherosclerotic cardiovascular disease?
Authors: Doi Takahito , Nordestgaard Børge G. , Langsted Anne 
Published: February 2023

Purpose of review
To summarize recent studies analyzing reclassification of estimated risk of myocardial infarction (MI) and ischemic heart disease (IHD) by inclusion of remnant cholesterol (= cholesterol content in triglyceride-rich lipoproteins) in primary and secondary prevention settings.

Recent findings
For individuals in a primary prevention setting with remnant cholesterol levels at least 95th percentile (≥1.6 mmol/l, 61 mg/dl), 23% of MI and 21% of IHD events developed later were reclassified correctly from below to above 5% for 10-year occurrence when remnant cholesterol levels were added to models based on conventional risk factors, whereas no events were reclassified incorrectly. Overall improved reclassification of MI was also observed for remnant cholesterol levels as low as at least 50th percentile (≥0.6 mmol/l, 25 mg/dl); however, the addition of remnant cholesterol over the entire concentration range yielded insignificant improvements of NRI for MI but slightly improved reclassification of NRI for IHD. In a secondary prevention setting, addition of remnant cholesterol over the entire concentration range to a conventional risk model improved reclassification.

Summary
Elevated remnant cholesterol levels considerably improves reclassification of individuals who later develop MI and IHD, in primary as well as in secondary prevention settings.
Fascia promotes adipose tissue regeneration by improving early macrophage infiltration following fat grafting in mice model
Authors: Bi Xin , Li Bin , Zou Jialiang , Zhao Jing , Chen Yunzi , Wang Xinhui , Lu Feng , Li Ye , Dong Ziqing , Gao Jianhua 
Published: February 2023

Background:
Low early macrophage fat graft infiltration (within a week of surgery) hinders tissue regeneration, suggesting that macrophages play a vital role in early angiogenesis and adipogenesis. However, the source of macrophages during this period is unclear.

Method:
C57BL/6 mice were split into fascial removal (FR) and control groups (CG). Mice had a piece of back fascia removed in the FR, which was immediately replaced in the CG, and inguinal fat injected into the transplantation site of both groups. Separately, fascia was harvested from green fluorescent protein-expressing mice and transplanted into C57BL/6 mice for tracing the macrophages infiltration after fat grafting.

Results:
The number of capillaries in the FR group was lower than that in the CG at days 3 (p<0.01) and 7 (p<0.05). Moreover, the number of small adipocytes in the FR group was lower than in the CG on days 3, 7 and 14(all p<0.05), and the relative expression of several adipogenic proteins was significantly lower in the FR group than in the CG on days 14 and 30. The timeline of macrophage infiltration was consistent with angiogenesis and adipogenesis. The number of macrophages in the FR group was significantly lower than in the CG at days 3 and 7(p<0.05), and there were more fascia-derived macrophages than circulation-derived macrophages infiltrated into fat grafts within 7 days. Finally, the graft retention was lower in the FR group than the CG at day 90 (p<0.05).

Conclusion:
In the early stage following fat grafting, fascial macrophages infiltration initiates tissue regeneration, thereby improving graft retention by promoting angiogenesis and adipogenesis.
SARS-CoV-2 Spike Protein Receptor Binding-ACE2 Interaction Increases Carbohydrate Sulfotransferases and Reduces N-Acetylgalactosamine-4-Sulfatase through Phospho-p38-MAPK and RB-E2F1
Authors: Bhattacharyya Sumit , Tobacman Joanne K. 
Published: January 2023

AbstractImmunohistochemistry of post-mortem lung tissue from patients with SARS-CoV2 infection showed marked decline in intensity and distribution of N-acetylgalactosamine-4-sulfatase (Arylsulfatase B; ARSB), increase of total chondroitin sulfate by immunohistochemistry, and increase of vascular-associated carbohydrate sulfotransferase (CHST)15 [1]. The mechanisms leading to these observations were not explained by signaling pathways known to be activated by exposure to coronaviruses. This report addresses the underlying reactions leading to these observations in a cell-based model, using normal, human, primary small airway epithelial cells, treated with the SARS-CoV-2 spike protein receptor binding domain protein.
Child and Adolescent Psychiatrists’ Use, Attitudes, and Understanding of Genetic Tests in Clinical Practice
Authors: Soda Takahiro , Merner Amanda R. , Small Brent J. , Torgerson Laura N. , Muñoz Katrina , Austin Jehannine , Storch Eric A. , Pereira Stacey , Lázaro-Muñoz Gabriel 
Published: January 2023

AbstractObjectiveTo report current practices and attitudes of child and adolescent psychiatrists (CAP) regarding diagnostic genetic and pharmacogenetic (PGx) testing.MethodsSurvey of 958 US-based practicing CAP.Results54.9% of respondents indicated that they had ordered/referred for a genetic test in the past 12 months. 87% of respondents agreed that it is their role to discuss genetic information regarding psychiatric conditions with their patients; however, 45% rated their knowledge of genetic testing practice guidelines as poor/very poor. The most ordered test was PGx (32.2%), followed by chromosomal microarray (23.0%). 73.4% reported that PGx is at least slightly useful in child and adolescent psychiatry. Most (62.8%) were asked by a patient/family to order PGx in the past 12 months and 41.7% reported they would order PGx in response to a family request. Those who ordered a PGx test were more likely to have been asked by a patient/family and to work in private practice. 13.8% of respondents agreed/strongly agreed that a PGx test can predict the effectiveness of specific antidepressants. Some respondents also indicated they would make clinical changes based on PGx information even if a medication was currently effective and there were no side effects.ConclusionsGenetic testing has become routine clinical care in child and adolescent psychiatry. Despite this, many providers rate their associated knowledge as poor/very poor. Patient requests were associated with ordering practices and providers misinterpretation of PGx may be leading to unnecessary changes in clinical management. There is need for further education and support for clinicians.
Associations of Healthy Lifestyle and Socioeconomic Status with Cognitive Function in U.S. Older Adults
Authors: Wang Xin , Bakulski Kelly M. , Paulson Henry L. , Albin Roger L. , Park Sung Kyun 
Published: January 2023

AbstractWe investigated the complex relations of socioeconomic status (SES) and healthy lifestyles with cognitive functions among older adults in 1,313 participants, aged 60 years and older, from the National Health and Nutrition Examination Survey 2011-2014. Cognitive function was measured using an average of the standardized z-scores of the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning and delayed recall tests, the Animal Fluency Test, and the Digit Symbol Substitution Test. Latent class analysis of family income, education, occupation, health insurance, and food security was used to define composite SES (low, medium, high). A healthy lifestyle score was calculated based on smoking, alcohol consumption, physical activity, and the Healthy-Eating-Index-2015. In survey-weighted multivariable linear regressions, participants with 3 or 4 healthy behaviors had 0.07 (95% CI: 0.005, 0.14) standard deviation higher composite cognitive z-score, relative to those with one or no healthy behavior. Participants with high SES had 0.37 (95% CI: 0.29, 0.46) standard deviation higher composite cognitive z-score than those with low SES. No statistically significant interaction was observed between healthy lifestyle score and SES. Our findings suggested that higher healthy lifestyle scores and higher SES were associated with better cognitive function among older adults in the United States.
Left atrial substrate characterization based on bipolar voltage electrograms acquired with multipolar, focal and mini-electrode catheters– the CHAZE-Substrate study
Authors: Knecht Sven , Schlageter Vincent , Badertscher Patrick , Krisai Philipp , Jousset Florian , Spies Florian , Küffer Thomas , Madaffari Antonio , Schaer Beat , Osswald Stefan , Sticherling Christian , Kühne Michael 
Published: January 2023

AbstractBackgroundBipolar voltage (BV) electrograms for left atrial (LA) substrate characterization depend on catheter design and electrode configuration. The aim of the study was to investigate the relationship between the BV amplitude (BVA) using four different catheters and to identify their specific LA cutoffs for scar and healthy tissue.MethodsConsecutive high-resolution electroanatomic mapping was performed using a multipolar Orion catheter (Orion-map), a duo-decapolar variable circular mapping catheter (Lasso-Map) and an irrigated focal ablation catheter with minielectrodes (Mifi-map). Virtual remapping using the Mifi-map was performed with a 4.5 mm tip-size electrode configuration (Nav-map). BVAs were compared in voxels of 3×3×3 mm3. The equivalent BVA cutoff for every catheter was calculated for established reference cutoff values of 0.1 mV, 0.2 mV, 0.5 mV, 1.0 mV, and 1.5 mV.ResultsWe analyzed 25 patients (72% men, age 68±15 years). For scar tissue, a 0.5 mV cutoff using the Nav corresponds to a lower cutoff of 0.35 mV for the Orion and of 0.48 mV for the Lasso. Accordingly, a 0.2 mV cutoff corresponds to a cutoff of 0.09 mV for the Orion and of 0.14 mV for the Lasso. For a healthy tissue cutoff at 1.5 mV, a larger BVA cutoff for the small electrodes of the Orion and the Lasso was determined of 1.68 mV and 2.21 mV, respectively.ConclusionsWhen measuring LA BVA in scar and healthy tissue, relevant differences were seen between focal, multielectrode and mini-electrode catheters. Adapted cutoffs for scar and healthy tissue are required.