bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reactive Psychosis
Authors: Castagnini Augusto C. , Berrios German E. 
Published: July 2023

Abstract
Reactive psychosis (RP) is a trauma-induced category whose meaning has varied in relation to the role attributed to lived experiences or vulnerable personality. It has long been described in different countries, but seldom investigated under the influence of symptom-based psychiatric classifications. This article aims to examine the development of RP since the early 20th century, outline how it has been incorporated in modern diagnostic classifications, and set out empirical findings. It is likely that variations in terminology and diagnostic practice have affected estimates of the frequency and hampered the validity of RP in earlier studies. To enhance reliability, RP underwent several changes in successive Diagnostic and Statistical Manual of Mental Disorders and ICD versions and was eventually replaced with descriptive categories for short-lived psychotic disorders. Clinical observations during the COVID-19 pandemic attest the durability of RP, but the current categories prove unhelpful in identifying it and have failed to encourage research.
Transumbilical Silicone Implant Breast Augmentation
Authors: Huang Wen-Chi , Tsai Ming-Feng , Yang San-Tsun , Chen Shu-Hsien , Ou Kuang-Wen , Tung Kwang-Yi , Huang Wen-Chen , Yu Chia-Meng 
Published: July 2023

Summary:
In transumbilical breast augmentation (TUBA) with prefilled silicone implants, technical challenges remain to accommodate more implant options and dissection planes. The authors aimed to demonstrate the feasibility of TUBA using various types of prefilled silicone implants (TUSBA) and its applicability for subglandular, subfascial, dual-plane implantation. In the early stage, TUSBA was primarily performed using endoscope-assisted blunt dissection, and later converted to full endoscopy dissection to achieve better results. An endoscope was used to confirm the pocket and check bleeding for both groups. For the endoscope-assisted group, surgical techniques were modified from conventional TUBA. In full endoscopy TUSBA, the entire dissection process was performed under endoscopic monitoring. Preliminary data of patients undergoing TUSBA from June of 2016 to April of 2021 were retrospectively reviewed. Breast implants with smooth, textured, or nanotextured surface properties and round or anatomic shapes were used, with sizes up to 500 mL. Seventy-four patients with a mean age of 36.4 years (range, 21 to 55 years) were enrolled in this study. Follow-up ranged from 1 month to 4.5 years (mean, 15.6 months). No excessive postoperative pain in breast or abdomen was reported. Surgery outcomes were aesthetically pleasing in both groups. In the endoscope-assisted group, 3 patients (4.6%) required major revisional procedures. No revision was required in the full-endoscopy group. TUSBA with various types of silicone implants is feasible and accommodable to all dissection planes. The full-endoscopy technique is helpful in reducing the higher complication rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Venous Thromboembolism after DIEP Flap Breast Reconstruction: Review of Outcomes after a Postoperative Prophylaxis Protocol
Authors: Tuaño Krystle R. , Yang Jerry H. , Fisher Marlie H. , Le Elliot , Khatter Neil J. , Kalia Nargis , Colakoglu Salih , Cohen Justin B. , Kaoutzanis Christodoulos , Chong Tae W. , Mathes David W. 
Published: July 2023

Background:
Deep inferior epigastric perforator (DIEP) flap breast reconstruction is among the higher-risk patient groups for venous thromboembolism (VTE) in plastic surgery. Surgeons often opt for a patient-specific approach to postoperative anticoagulation, and the field has yet to come to a consensus on VTE chemoprophylaxis regimens.

Methods:
A new chemoprophylaxis protocol was introduced starting in March of 2019 that involved 2 weeks of treatment with enoxaparin, regardless of patient risk factors. A retrospective chart review was conducted on all patients who underwent DIEP flap breast reconstruction at the authors’ institution between January of 2014 and March of 2020. Patients were grouped based on whether they enrolled in the new VTE protocol in the postoperative period or not. Patient demographics, prophylaxis type, and outcomes data were recorded, retrospectively. The primary outcome measure was postoperative VTE incidence.

Results:
Risk of VTE was significantly higher in patients discharged without VTE prophylaxis compared with patients discharged with prophylaxis (3.7% versus 0%; P = 0.03). Notably, zero patients in the VTE prophylaxis group developed a deep venous thrombosis or pulmonary embolism. In addition, the risk of a VTE event was 25 times greater in patients with a Caprini score greater than or equal to 6 (P = 0.0002).

Conclusion:
The authors demonstrate the successful implementation of a 2-week VTE chemoprophylaxis protocol in DIEP flap breast reconstruction patients that significantly reduces the rate of VTE while not affecting the rate of hematoma complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Topical Tranexamic Acid Does Not Reduce Hematoma in Reduction Mammaplasty: A Double-Blind Randomized Controlled Trial
Authors: Yao Amy , Wang Fei , Benacquista Teresa , Draper Lawrence B. , Garfein Evan S. , Monaco Casian , Tepper Oren M. , Weichman Katie E. , Ricci Joseph A. 
Published: July 2023

Background:
Breast reduction mammaplasty is among the most common procedures in plastic surgery, with a 1% to 7% postoperative hematoma incidence reported. Tranexamic acid (TXA) has been shown to reduce perioperative bleeding and need for transfusion when administered intravenously or topically, but it remains underused in plastic surgery. This study aims to investigate whether topical administration of topical TXA reduces postoperative hematoma following breast reduction mammaplasty.

Methods:
A double-blind randomized controlled trial of 98 patients (196 breasts) undergoing bilateral primary reduction mammaplasty at a single academic institution was performed. Patients were used as internal matched controls, with one breast randomized to receive 1000 mg of topical TXA before closure, and the other receiving saline. All members of the surgical team and the patient were blinded as to which breast received the study drug. Postoperative complications, including hematoma within 30 days of surgery, drain outputs, and duration of drain use, were compared between treatment and placebo breasts.

Results:
The overall hematoma rate was 1.5%. There was no significant association between application of TXA and development of a hematoma (P = 0.56) or other complications. The hematoma rate of patients enrolled in the trial was similar to the overall rate of hematoma during the study period (1.5% versus 2.4%; P = 0.511). In a multivariate model, TXA was not significantly associated with differences in drain output after controlling for resection weight, age, and duration of drain use (P = 0.799). No adverse effects or thromboembolic events from TXA were observed.

Conclusion:
Topical application of TXA does not decrease the incidence of hematoma following reduction mammaplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.
Hepatic steatosis and NAFLD are common and associated with cardiometabolic risk in a primary prevention cohort of people with HIV
Authors: Lake Jordan E. , Taron Jana , Ribaudo Heather J. , Leon-Cruz Jorge , Utay Netanya S. , Swaminathan Shobha , Fitch Kathleen V. , Kileel Emma M. , Paradis Kayla , Fulda Evelynne S. , Ho Ken S. , Luetkemeyer Anne F. , Johnston Carrie D. , Zanni Markella V. , Douglas Pamela S. , Grinspoon Steven K. , Lu Michael T. , Fichtenbaum Carl J. 
Published: July 2023

Background:
Hepatic steatosis, including non-alcoholic fatty liver disease (NAFLD), is common among people with HIV (PWH). We present baseline steatosis prevalence and cardiometabolic characteristics among REPRIEVE substudy participants.

Methods:
REPRIEVE is an international, primary cardiovascular disease prevention, randomized, controlled trial of pitavastatin calcium vs. placebo among 7,769 PWH ages 40–75 years on antiretroviral therapy (ART) and with low-to-moderate cardiovascular risk. A subset of participants underwent non-contrast computed tomography, with hepatic steatosis defined as mean hepatic attenuation <40 HU or liver/spleen ratio <1.0, and NAFLD defined as steatosis in the absence of frequent alcohol use or viral hepatitis.

Results:
Of 687 evaluable persons, median age was 51 years, BMI 27 kg/m2, CD4+ T cell count 607 cells/mm3; 17% natal female sex, 36% Black, 24% Hispanic, and 98% HIV-1 RNA <400 copies/mL. Hepatic steatosis prevalence was 22% (149/687), and NAFLD 21% (96/466). Steatosis/NAFLD prevalence was higher in males and with older age, non-Black race, and higher BMI and waist circumference. Both were associated with BMI >30 kg/m2, Metabolic Syndrome components, higher ASCVD risk score, HOMA-IR, LpPLA-2 and hs-CRP, and lower high-density lipoprotein cholesterol. Of HIV-/ART-specific characteristics, only history of an AIDS-defining illness was more common among persons with steatosis/NAFLD. After adjusting for age, sex and race/ethnicity, BMI >30 kg/m2, HOMA-IR >2.0, Metabolic Syndrome and each of its components were associated with NAFLD prevalence.

Conclusions:
In this cohort with controlled HIV and low-to-moderate cardiovascular risk, hepatic steatosis and NAFLD were common and associated with clinically relevant metabolic and inflammatory disturbances, but not current HIV- or ART-related factors.
Differentiation of Sinonasal NKT From Diffuse Large B-Cell Lymphoma Using Machine Learning and MRI-Based Radiomics
Authors: Zhang Yiyin , Lin Naier , Xiao Hanyu , Xin Enhui , Sha Yan 
Published: July 2023

Purpose
The aim of this study was to construct and validate a noninvasive radiomics method based on magnetic resonance imaging to differentiate sinonasal extranodal natural killer/T-cell lymphoma from diffuse large B-cell lymphoma.

Methods
We collected magnetic resonance imaging scans, including contrast-enhanced T1-weighted imaging and T2-weighted imaging, from 133 patients with non-Hodgkin lymphoma (103 sinonasal extranodal natural killer/T-cell lymphoma and 30 diffuse large B-cell lymphoma) and randomly split them into training and testing cohorts at a ratio of 7:3. Clinical characteristics and image performance were analyzed to build a logistic regression clinical-image model. The radiomics features were extracted on contrast-enhanced T1-weighted imaging and T2-weighted imaging images. Maximum relevance minimum redundancy, selectKbest, and the least absolute shrinkage and selection operator algorithms (LASSO) were applied for feature selection after balancing the training set. Five machine learning classifiers were used to construct the single and combined sequences radiomics models. Sensitivity, specificity, accuracy, precision, F1score, the area under receiver operating characteristic curve, and the area under precision-recall curve were compared between the 15 models and the clinical-image model. The diagnostic results of the best model were compared with those of 2 radiologists.

Results
The combined sequence model using support vector machine proves to be the best, incorporating 7 features and providing the highest values of specificity (0.903), accuracy (0.900), precision (0.727), F1score (0.800), and area under precision-recall curve (0.919) with relatively high sensitivity (0.889) in the testing set, along with a minimum Brier score. The diagnostic results differed significantly (P < 0.05) from those of radiology residents, but not significantly (P > 0.05) from those of experienced radiologists.

Conclusions
Magnetic resonance imaging based on machine learning and radiomics to identify the type of sinonasal non-Hodgkin lymphoma is effective and has the potential to help radiology residents for diagnosis and be a supplement for biopsy.
Patients with both traumatic brain injury and hemorrhagic shock benefit from resuscitation with whole blood
Authors: Hatton Gabrielle E. , Brill Jason B. , Tang Brian , Mueck Krislynn M. , McCoy C. Cameron , Kao Lillian S. , Cotton Bryan A. 
Published: July 2023

BACKGROUND
Hemorrhagic shock in the setting of traumatic brain injury (TBI) reduces cerebral blood flow and doubles mortality. The optimal resuscitation strategy for hemorrhage in the setting of TBI is unknown. We hypothesized that, among patients presenting with concomitant hemorrhagic shock and TBI, resuscitation including whole blood (WB) is associated with decreased overall and TBI-related mortality when compared with patients receiving component (COMP) therapy alone.

METHODS
An a priori subgroup of prospective, observational cohort study of injured patients receiving emergency-release blood products for hemorrhagic shock is reported. Adult trauma patients presenting November 2017 to September 2020 with TBI, defined as a Head Abbreviated Injury Scale of ≥3, were included. Whole blood group patients received any cold-store low-titer Group O WB units. The COMP group received fractionated blood components alone. Overall and TBI-related 30-day mortality, favorable discharge disposition (home or rehabilitation), and 24-hour blood product utilization were assessed. Univariate and inverse probabilities of treatment-weighted multivariable analyses were performed.

RESULTS
Of 564 eligible patients, 341 received WB. Patients who received WB had a higher injury severity score (median, 34 vs. 29), lower scene blood pressure (104 vs. 118), and higher arrival lactate (4.3 vs. 3.6, all p < 0.05). Univariate analysis noted similar overall mortality between WB and COMP; however, weighted multivariable analyses found WB was associated with decreased overall mortality and TBI-related mortality. There were no differences in discharge disposition between the WB group and COMP group.

CONCLUSION
In patients with concomitant hemorrhagic shock and TBI, WB transfusion was associated with decreased overall mortality and TBI-related mortality. Whole blood should be considered a first-line therapy for hemorrhage in the setting of TBI.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
A genome wide association study to identify germline variants associated with cancer-associated cachexia - a preliminary analysis
Authors: Narasimhan Ashok , Kumaran Mahalakshmi , Gioulbasanis Ioannis , Skipworth Richard J E , Bathe Oliver F , Kaasa Stein , Strasser Florian , Gagnon Bruno , Baracos Vickie , Damaraju Sambasivarao 
Published: July 2023

AbstractBackgroundCancer cachexia is characterized by severe loss of muscle and fat involving a complex interplay of host-tumor interactions. While much emphasis has been made in understanding the molecular mechanisms associated with cachexia, understanding the heritable component of cachexia remains less explored. The current study aims to identify Copy Number Variants (CNV) as genetic susceptibility determinants for weight loss in patients with cancer cachexia using genome wide association study (GWAS) approach.MethodsA total of 174 age-matched patients with esophagogastric or lung cancer were classified as weight losing (>10% weight loss) or weight stable participants (<2% weight loss). DNA was genotyped using Affymetrix SNP 6.0 arrays to profile CNVs. We tested CNVs with >5% frequency in the population for association with weight loss. Pathway analysis was performed using the genes embedded within CNVs. To understand if the CNVs in the present study are also expressed in skeletal muscle of patients with cachexia, we utilized two publicly available human gene expression datasets to infer the relevance of identified genes in the context of cachexia.ResultsAmong the associated CNVs, 5414 CNVs had embedded protein coding genes. Of these, 1583 CNVs were present at >5% frequency. We combined multiple contiguous CNVs within the same genomic region and called them Copy Number Variable Region (CNVR). This led to identifying 896 non-redundant CNV/CNVRs which encompassed 803 protein coding genes. Genes embedded within CNVs were enriched for several pathways implicated in cachexia and muscle wasting including JAK-STAT signaling, Oncostatin M signaling, Wnt signaling and PI3K-Akt signaling. This is the first proof of principle GWAS study to identify CNVs as genetic determinants for cancer cachexia. Further, we show that a subset of CNV/CNVR embedded genes identified in the current study are common with the previously published skeletal muscle gene expression datasets, indicating that expression of CNV/CNVR genes in muscle may have functional consequences in patients with cachexia These genes include CPT1B, SPON1, LOXL1, NFAT5, RBFOX1 and PCSK6 to name a few.ConclusionThis is the first proof of principle GWAS study to identify CNVs as genetic determinants for cancer cachexia. The data generated will aid in future replication studies in larger cohorts to account for genetic susceptibility to weight loss in patients with cancer cachexia.
Systemic hypoxemia catalyzes cerebral oxidative-nitrosative stress during extreme apnea in humans: implications for cerebral bioenergetic function
Authors: Bailey Damian M. , Bain Anthony R. , Hoiland Ryan L. , Barak Otto F. , Drvis Ivan , Stacey Benjamin S. , Iannetelli Angelo , Davison Gareth W. , Dahl Rasmus H. , Berg Ronan M.G. , MacLeod David B. , Dujic Zeljko , Ainslie Philip N. 
Published: July 2023

ABSTRACTBACKGROUNDVoluntary asphyxia induced by apnea in competitive breath hold (BH) divers affords a unique opportunity to examine integrated mechanisms underlying the preservation of cerebral bioenergetic function. This study examined to what extent physiological extremes of oxygen (O2) demand and carbon dioxide (CO2) production impact redox homeostasis and corresponding red blood cell (RBC)-mediated cerebral vasodilation.METHODSTen ultra-elite apneists (6 men, 4 women) aged 33 ± 9 (mean ± SD) years old performed two maximal dry apneas preceded by, [1] normoxic normoventilation resulting in severe hypoxemic hypercapnia apnea (HHA) and [2] hyperoxic hyperventilation designed to prevent hypoxemia resulting in isolated hypercapnic apnea (IHA). Transcerebral exchange kinetics of ascorbate radicals (A·-, electron paramagnetic resonance spectroscopy), lipid hydroperoxides (LOOH, spectrophotometry) and nitric oxide metabolites (NO, tri-iodide reductive chemiluminescence) were calculated as the product of global cerebral blood flow (gCBF, duplex ultrasound) and radial arterial (a) to internal jugular venous (v) concentration gradients determined at eupnea and after apnea.RESULTSApnea duration increased from 306 ± 62 s during HHA to 959 ± 201 s during IHA (P = <0.001), resulting in individual nadirs of 29 mmHg and 40 % for PaO2and SaO2respectively in HHA and PaCO2peak of 68 mmHg in IHA. Apnea resulted in a more pronounced elevation in the net cerebral output (v>a) of A·-and LOOH in HHA (P = <0.05 vs. IHA). This coincided with a lower apnea-induced increase in gCBF (P = <0.001 vs. IHA) and related suppression in plasma nitrite () uptake (a>v) (P = < 0.05 vs. IHA), implying reduced consumption and delivery of NO consistent with elevated cerebral oxidative-nitrosative stress (OXNOS). While apnea-induced gradients consistently reflected plasmaconsumption (a>v) and RBC iron nitrosylhemoglobin formation (v>a), we failed to observe equidirectional gradients consistent withS-nitrosohemoglobin consumption and plasmaS-nitrosothiol delivery.CONCLUSIONSThese findings highlight a key catalytic role for hypoxemia in cerebral OXNOS withreduction the more likely mechanism underlying endocrine NO vasoregulation with the capacity to transduce physiological O2-CO2gradients into graded vasodilation.
Performance of progressive generations of GPT on an exam designed for certifying physicians as Certified Clinical Densitometrists
Authors: Valdez Dustin , Bunnell Arianna , Lim Sian Y. , Sadowski Peter , Shepherd John A. 
Published: July 2023

ABSTRACTBackgroundArtificial intelligence (AI) large language models (LLMs) such as ChatGPT have demonstrated the ability to pass standardized exams. These models are not trained for a specific task, but instead trained to predict sequences of text from large corpora of documents sourced from the internet. It has been shown that even models trained on this general task can pass exams in a variety of domain-specific fields, including the United States Medical Licensing Examination. We asked if LLMs would perform as well on a much narrower subdomain tests designed for medical specialists. Furthermore, we wanted to better understand how progressive generations of GPT (generative pre-trained transformer) models may be evolving in the completeness and sophistication of their responses even while generational training remains general. In this study, we evaluated the performance of two versions of GPT (GPT 3 and 4) on their ability to pass the certification exam given to physicians to work as osteoporosis specialists and become a certified clinical densitometrists.MethodsA 100-question multiple-choice practice exam was obtained from a 3rdparty exam preparation website that mimics the accredited certification tests given by the ISCD (international society for clinical densitometry). The exam was administered to two versions of GPT, the free version (GPT Playground) and ChatGPT+, which are based on GPT-3 and GPT-4, respectively (OpenAI, San Francisco, CA). The systems were prompted with the exam questions verbatim. If the response was purely textual and did not specify which of the multiple-choice answers to select, the authors matched the text to the closest answer. Each exam was graded and an estimated ISCD score was provided from the exam website. In addition, each response was evaluated by a rheumatologist CCD and ranked for accuracy using a 5-level scale. The two GPT versions were compared in terms of response accuracy and length.ResultsThe average response length was 11.6 ±19 words for GPT-3 and 50.0±43.6 words for GPT-4. GPT-3 answered 62 questions correctly resulting in a failing ISCD score of 289. However, GPT-4 answered 82 questions correctly with a passing score of 342. GPT-3 scored highest on the “Overview of Low Bone Mass and Osteoporosis” category (72% correct) while GPT-4 scored well above 80% accuracy on all categories except “Imaging Technology in Bone Health” (65% correct). Regarding subjective accuracy, GPT-3 answered 23 questions with nonsensical or totally wrong responses while GPT-4 had no responses in that category.ConclusionIf this had been an actual certification exam, GPT-4 would now have a CCD suffix to its name even after being trained using general internet knowledge. Clearly, more goes into physician training than can be captured in this exam. However, GPT algorithms may prove to be valuable physician aids in the diagnoses and monitoring of osteoporosis and other diseases.