bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quilting Suture Technique After Mastectomy: A Meta-Analysis
Authors: Drivas Eleni , Gachabayov Mahir , Kajmolli Agon , Stadlan Zehavya , Felsenreich Daniel Moritz , Castaldi Maria 
Published: May 2023

Background There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy. Methods MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings. Results Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; P < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; P = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; P = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; P = .17) did not significantly vary between QS and CC. Conclusion This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
Liver Transplantation in Elderly Recipients: Is Age Just a Number?
Authors: Kurian Joshua , Matevish Lauren E. , Feizpour Cyrus , Shah Jigesh A. , Hwang Christine , Hanish Steven I. , Mufti Arjmand R. , Neill-Fogus Susan , Vagefi Parsia A. , Patel Madhukar S. 
Published: May 2023

Background The proportion of older patients on the liver transplant waitlist continues to increase. With limited existing data to guide liver transplant evaluation of elderly patients, we aimed to study selection practices and outcomes of patients ≥70 years old. We hypothesized that 1-year patient and graft survival would not differ between appropriately selected elderly patients and those who are younger. Methods All patients referred for liver transplantation between 2018 and 2020 were stratified into elderly (age ≥70) and young (age <70) cohorts. Evaluation data pertaining to medical, surgical, and psychosocial risk assessment were reviewed. Recipient characteristics and post-operative outcomes, primarily 1-year graft and patient survival, were compared, with a median follow-up of 16.4 months. Results 322 patients underwent transplant out of 2331 referred. Elderly patients represented 230 of these referrals and 20 underwent transplant. The most common reasons for denial of elderly patients were multiple medical comorbidities (49%), cardiac risk (15%) and psychosocial barriers (13%). The median MELD of elderly recipients was lower (19 vs 24, P = .02), and proportion of hepatocellular carcinoma was higher (60% vs 23%, P < .001). There was no difference in 1-year graft (elderly 90.9% vs young 93.3%, P = .72) or patient survival (elderly 90.9% vs young 94.7%, P = .88). Discussion Liver transplant outcomes and survival are not affected by advanced age in carefully evaluated and selected recipients. Age should not be considered an absolute contraindication for liver transplant referral. Efforts should be made to develop guidelines for risk stratification and donor–recipient matching that optimize outcomes in elderly patients.
Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients
Authors: Alvarez Claudia A. , Grigorian Areg , Swentek Lourdes , Chin Theresa , Guner Yigit , Goodman Laura , Kuza Catherine , Nahmias Jeffry 
Published: May 2023

Background Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective “armor” layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity. Methods The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed. Results 12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups. Discussion Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.
Is eGFR ≥60 mL/min/1.73 m2 in Patients Undergoing Coronary Angiography Really Safe for Contrast Nephropathy?
Authors: Comoglu Mustafa , Acehan Fatih , Katipoglu Bilal , Demir Burak F. , Guven Cetin Zehra , Ates Ihsan 
Published: May 2023

The aim of the present study was to define the risk factors associated with contrast-induced acute kidney injury (CI-AKI) in patients who underwent coronary artery angiography (CAG). In this retrospective cohort study, patients who underwent CAG between March 2014 and January 2022 were evaluated. A total of 2923 eligible patients were included in the study. Univariate and multivariate logistic regression analysis was used to identify the predictive factors. CI-AKI developed in 77 (2.6%) of 2923 patients. In multivariate analysis, diabetes mellitus (DM), chronic kidney disease (CKD), and estimated glomerular filtration rate (eGFR) were found to be independent factors associated with CI-AKI. In the subgroup analysis of patients with eGFR ≥60 mL/min/1.73 m2, eGFR remained a predictor of CI-AKI (Odds ratio (OR): .89, 95% CI: .84-.93; that is, a lower eGFR remains a risk factor for CI-AKI). In the receiving operating characteristic (ROC) analysis of patients with eGFR ≥60 mL/min/1.73 m2, the area under the curve of the eGFR was .826. Using the ROC curve based on Youden’s index, the eGFR cut-off was found to be 70 mL/min/1.73 m2 for patients with eGFR ≥60 mL/min/1.73 m2. eGFR is also an important risk factor in patients with eGFR 60-70 mL/min/1.73 m2.
Priapism Associated With the Addition of Hydroxyzine to Risperidone: A Case Report
Authors: Elfessi Zane , Jhawar Archana , Martino Julie 
Published: May 2023

Background: Hydroxyzine hydrochloride is a piperazine derivative antihistamine that is used in the treatment of anxiety. Its tendency to cause somnolence makes it an attractive option for patients with anxiety-induced insomnia. Despite its antihistamine activity, hydroxyzine is noted to have alpha-adrenergic antagonism activity. Other alpha-adrenergic inhibitors have been implicated in medication-induced priapism, including risperidone. Risperidone is a second-generation antipsychotic that primarily blocks serotonin and dopamine receptors, while also inhibiting alpha-1 and alpha-2 receptors with high affinity. Objective: We report a case of a first-of-its-kind case report of a patient who was stable on risperidone and presented with priapism after taking hydroxyzine nightly for the previous 10 days. Results: A 35-year-old male with a past psychiatric history of depression, generalized anxiety disorder, schizoaffective disorder, presented to the emergency department with priapism for 15 hours that required intracaveronsal phenylephrine hydrochloride and manual drainage to achieve detumescence. The patient was on a stable dose risperidone but reported taking hydroxyzine 50 mg nightly for anxiety and insomnia 10 days prior to emergency department admission. Upon resolution of the priapism, the patient stopped hydroxyzine, but continued risperidone. The patient had another prolonged erection 10 days after stopping hydroxyzine; however, he reported that it resolved spontaneously without intervention after 4 hours. Conclusion: This case report demonstrates the risk of addition of hydroxyzine to antipsychotics which can result in an increased risk of priapism or prolonged episodes.
Partnership types and coital frequency as predictors of gonorrhea and chlamydia among young MSM and young transgender women
Authors: Janulis Patrick , Goodreau Steven M , Morris Martina , Birkett Michelle , Phillips Gregory , Risher Kathryn , Mustanski Brian , Jenness Samuel M 
Published: May 2023

Background Sexually transmitted infections pose a major public health challenge in the United States and this burden is especially acute in subpopulations like young men who have sex with men (YMSM) and young transgender women (YTW). Yet, the direct behavioral antecedents of these infections are not well understood making it difficult to identify the cause of recent increases in incidence. This study examines how variations in partnership rates and the number of condomless sex acts are associated with STI infections among YMSM-YTW. Method This study leveraged 3 years of data from a large longitudinal cohort of YMSM-YTW. A series of generalized linear mixed models examined the association between the number of condomless anal sex acts, number of one-time partners, number of casual partners, and number of main partners and chlamydia, gonorrhea, or any STI. Results Results indicated the number of casual partners was associated with gonorrhea [aOR = 1.17 (95% CI: 1.08, 1.26)], chlamydia [aOR = 1.12 (95% CI: 1.05, 1.20)], and any STI [aOR = 1.14 (95% CI: 1.08, 1.21)] while the number of one-time partners was only associated with gonorrhea [aOR = 1.13 (95% CI: 1.02, 1.26)]. The number of condomless anal sex acts was not associated with any outcome. Conclusion These findings suggest the number of casual partners is a consistent predictor of STI infection among YMSM-YTW. This may reflect the quick saturation of risk within partnerships making the number of partners, rather than the number of acts, the more relevant factor for STI risk.
Effect of Styrene Content and ZnO-Stearic Acid on the Dynamic Mechanical Properties of Electron Beam Vulcanised Styrene-Co-Butadiene Rubber
Authors: Abdel-Aziz M.M. , Youssef H.A. , Miligy A.A. El , Yoshii F. , Makuuchi K. 
Published: May 2023

The dynamic mechanical properties of electron beam vulcanized Styrene-Co-butadiene rubber (SBR) in presence of different additives over a wide temperature range were investigated. Also, the effect of HAF carbon black, the ZnO-Stearic acid system, and styrene content on the other mechanical properties was studied. It was found that, the more pronounced contribution from by ZnO was in SBR (23.5% styrene) where the storage modulus and damping as well as tensile strength, elongation, tear strength, hardness and abrasion resistance were remarkably improved. The high efficiency of ZnO toward SBR (23.5% styrene) compared with SBR (46% styrene) may be attributed to the enhancement of the crosslinking density as a result of there being more butadiene units in the former.
Continuous Manufacturing of Thermoplastic Composite Sheets
Authors: Ostgathe M. , Mayer C. , Neitzel M. 
Published: May 2023

For high speed press forming of fibre reinforced thermoplastic sheet materials, a high impregnation quality is advantageous for utilisation of the potential regarding mechanical properties. Hence, the impregnation process is crucial to material properties and economy. In this paper the influence of process parameters on mechanical properties is investigated using an isobaric double belt press technique. Relevant process parameters are defined and varied using the Taguchi technique. Evaluating impregnation quality with 3-point bending tests and micrographs, the influence and meaning of process parameters is specified. Process parameters are optimised regarding flexural stress and strength, and a process window for a fabric reinforced polyamide PA 12 is defined.
EPDM Elastomers as Impact Modifiers for Contaminated, Recycled HDPE
Authors: Tall Stefan , Karlsson Sigbritt , Albertsson Ann-Christine 
Published: May 2023

The value of recycled high-density polyethylene (HDPE) is lowered if it contains impurities of PP, PS or PET, hut the embrittlement (partial loss of ductility and toughness) that arises when HDPE is blended with these more rigid polymers can be counteracted by the addition of an impact modifier. In this work, two EPDM grades with different monomer compositions have been evaluated as impact modifiers to upgrade recycled HDPE. Both elastomers improved the tensile impact strength and elongation at yield, at the expense of reduced modulus and yield strength. These effects were more pronounced for an amorphous EPDM with 58 wt% ethylene than for a semicrystalline EPDM with 72 wt% ethylene. The reduced impact strength and yield elongation caused by up to 10% polystyrene or PET could be compensated for by adding an amount of amorphous EPDM equal to half the weight of the contaminant polymer. The effect of EPDM modification on the morphology of the HDPE phase was studied by differential scanning calorimetry. The thermal history of the material is shown to be an important factor, influencing the ability of the HDPE to crystallise.
High Performance Environments: The Case for Polymeric Flexible Hoses*
Authors: Simmons David 
Published: May 2023

The connecting elements, particularly hoses, in fluid power systems often endure most stress. The demands on hoses are increasing, requiring improved performance in difficult operating environments. The various factors in high performance environments are examined: pressure, temperature, aggressive fluids, abrasion resistance, service lifetime, small installation and operating space and offshore conditions. Following an analysis of the various elements in thermoplastic hose construction, the ability of thermoplastic hoses to fulfil the demanding factors in high performance environments is discussed. It is concluded that thermoplastic hoses provide the optimum solutions to many application problems.
Outcomes After Pharyngeal Flap Surgery in Children: A Comparison of Lined Versus Unlined Flaps
Authors: Fuller Colin , Reed Gardner J. , Speed Olivia , Thomason Ashlen , Zaniletti Isabella , Buckmiller Lisa , Johnson Adam , Hartzell Larry 
Published: May 2023

Objective The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. Design Retrospective cohort study. Setting Tertiary children's hospital. Patients Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. Outcome measures We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). Results 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p  =  0.037) and more likely to have cleft palate (63/119 vs 14/41; p  =  0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p  =  0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p  =  0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p  =  0.032). PSA scores were found to be lower (less hypernasal) after PFU (p  =  0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p  =  0.001), while PFT (p  =  0.525) did not demonstrate a statistical difference. Conclusion The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications.
Adverse Events of SARS-CoV-2 Therapy: A Pharmacovigilance Study of the FAERS Database
Authors: Pannu Viraaj , Udongwo Ndausung , Imburgio Steven , Johal Anmol , Mararenko Anton , Pozdniakova Helen , Amin Tasnuva , Patel Swapnil , Hossain Mohammad , Mushtaq Arman , Liu Edward , Fune Jose M. , Heaton Joseph 
Published: May 2023

Background: Over the past 2 years of the several strategies recommended to help fight COVID-19, nirmatrelvir/ritonavir is a novel drug shown in the EPIC-HR phase 2 to 3 clinical trial to lower COVID-19-related death or hospitalization at day 28 when compared with placebo. Objective: Our study’s aim was to explore the reported adverse events (AEs) associated with nirmatrelvir/ritonavir use for COVID-19. Method: We conducted a retrospective analysis using the FDA Adverse Event Reporting System (FAERS) database for AEs, listing nirmatrelvir/ritonavir as the primary drug between January and June 2022. The primary outcome was the incidence of reported AEs associated with nirmatrelvir/ritonavir. The OpenFDA database was queried using Python 3.10 to collect the AEs and Stata 17 was used to analyze the database. Adverse events were analyzed by associated medication, with “Covid-19” excluded. Results: A total of 8098 reports were identified between January and June 2022. Most reported complaints in the AE system were COVID-19 and disease recurrence. The most common symptomatic AEs were dysgeusia, diarrhea, cough, fatigue, and headache. Event rates significantly rose between April and May. Disease recurrence and dysgeusia were the most commonly reported complaints for the top 8 concomitant drugs identified. Cardiac arrest, tremor, akathisia, and death were reported in 1, 3, 67, and 5 cases, respectively. Conclusions and Relevance: This is the first retrospective study done on reported AEs associated with nirmatrelvir/ritonavir use for COVID-19. COVID-19 and disease recurrence were the most reported AEs. Further monitoring of the FAERS database is warranted to periodically reassess the safety profile of this medication.
Risk of Acute Kidney Injury Based on Vancomycin Target Trough Attainment Strategy: Area-Under-the-Curve-Guided Bayesian Software, Nomogram, or Trough-Guided Dosing
Authors: Knight Joshua M. , Iso Tomona , Perez Katherine K. , Swan Joshua T. , Janak Charles E. , Ikwuagwu Judy O. , Musick William L. 
Published: May 2023

Background: Guidelines support area-under-the-curve (AUC) monitoring for vancomycin dosing which may lower overall doses and reduce acute kidney injury (AKI). Objective: The aim of this study was to compare incidence of AKI across 3 vancomycin dosing modalities: AUC-targeted Bayesian pharmacokinetic software, AUC-targeted empiric dosing nomogram, and trough-guided dosing using clinical pharmacists’ judgment. Methods: This retrospective study included adult patients with a pharmacy dosing consult who received ≥1 dose of vancomycin and ≥1 serum vancomycin level documented between January 1, 2018, and December 31, 2019. Patients with baseline serum creatinine ≥2 mg/dL, weight ≥100 kg, receiving renal replacement therapy, AKI prior to vancomycin therapy, or vancomycin ordered only for surgical prophylaxis were excluded. The primary analysis was incidence of AKI adjusted for baseline serum creatinine, age, and intensive care unit admission. A secondary outcome was adjusted incidence of an abnormal trough value (<10 or >20 μg/mL). Results: The study included 3459 encounters. Incidence of AKI was 21% for Bayesian software (n = 659), 22% for the nomogram (n = 303), and 32% for trough-guided dosing (n = 2497). Compared with trough-guided dosing, incidence of AKI was lower in the Bayesian (adjusted odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.58-0.89) and the nomogram (adjusted OR = 0.71, 95% CI: 0.53-0.95) groups. Compared with trough-guided dosing, abnormal trough values were less common in the Bayesian group (adjusted OR = 0.83, 95% CI: 0.69-0.98). Conclusion and Relevance: Study results suggest that use of AUC-guided Bayesian software reduces the incidence of AKI and abnormal trough values compared with trough-guided dosing.
Shear strengthening of normal steel reinforced concrete beams using post-tensioned metal straps fully wrapped around the beams
Authors: Abdullah Wrya 
Published: May 2023

Using post-tensioned metal straps (PTMS) as a method of strengthening reinforced concrete building members is relatively new, however, it has been tested mostly on small specimens. Therefore, this study is an attempt to show the effectiveness of PTMS fully wrapped around medium- scale steel reinforced concrete (RC) beams to enhance their shear strength. For this purpose, four normal RC beams are constructed without transverse reinforcement with dimensions of 160 mm × 240 mm x 1050 mm which are width, depth, and length respectively. To strengthen the beams, PTMS is wrapped fully around the beams at different locations with different strip numbers. It is found that if used properly, PTMS can effectively alter the type of failure of the beams from a brittle shear failure to a ductile bending failure. Additionally, the load-carrying capacity of the beam can increase by 143%, 170%, and 182% by using two, four, and six strips of PTMS respectively. Moreover, the deflection capacity increases by 643%, 557%, and 653% by using two, four, and six straps of PTMS. Finally, after using PTMS on the beam there is a reduction in the number of cracks and the location of their appearance will be localized in the center of the beam.