bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of complications in autologous breast reconstruction using deep inferior epigastric perforator flaps: Implications for management
Authors: Wu Shannon S. , Raymer Charles , Culbert August , Schafer Rachel , Bernard Steven , Djohan Risal , Schwarz Graham , Bishop Sarah N. , Gurunian Raffi 
Published: March 2023

Background:
Deep inferior epigastric perforator (DIEP) flaps are the gold-standard for autologous breast reconstruction. This study investigated risk factors for DIEP complications in a large, contemporary cohort to optimize surgical evaluation and planning.

Methods:
This retrospective study included patients who underwent DIEP breast reconstruction between 2016-2020 at an academic institution. Demographics, treatment, and outcomes were evaluated in univariable and multivariable regression models for postoperative complications.

Results:
In total, 802 DIEP flaps were performed in 524 patients (mean age 51.2±9.6, mean BMI 29.3±4.5). Most (87%) patients had breast cancer, and 15% were BRCA-positive. There were 282 (53%) delayed and 242 (46%) immediate reconstructions, and 278 (53%) bilateral and 246 (47%) unilateral reconstructions. Overall complications occurred in 81 (15.5%) patients, including venous congestion (3.4%), breast hematoma (3.6%), infection (3.6%), partial flap loss (3.2%), total flap loss (2.3%), and arterial thrombosis (1.3%). Longer operative time was significantly associated with bilateral immediate reconstructions and higher BMI. Prolonged operative time (OR=1.16, p=0.001) and immediate reconstruction (OR=1.92, p=0.013) were significant predictors of overall complications. Partial flap loss was associated with bilateral immediate reconstructions, higher BMI, current smoking status, and longer operative time.

Conclusions:
Prolonged operative time is a significant risk factor for overall complications and partial flap loss in DIEP breast reconstruction. For each additional hour of surgical time, the risk of developing overall complications increases by 16%. These findings suggest that reducing operative time through co-surgeon approaches, consistency in surgical teams, and counseling patients with more risk factors towards delayed reconstructions may mitigate complications.
Topical nitroglycerin ointment reduces mastectomy flap necrosis in immediate autologous breast reconstruction
Authors: Yao Amy , Greige Nicolas , Ricci Joseph A. , Draper Lawrence B. , Weichman Katie E. 
Published: March 2023

Introduction:
Mastectomy flap necrosis is a common complication of immediate breast reconstruction that greatly impacts patient satisfaction and cosmetic outcomes. Topical nitroglycerin ointment, at low cost and with negligible side effects, has been shown to significantly decrease the incidence of mastectomy flap necrosis in immediate implant-based breast reconstruction. However, the utility of nitroglycerin ointment has not been studied in immediate autologous reconstruction.

Methods:
After obtaining IRB approval, a prospective cohort study of all consecutive patients undergoing immediate free flap breast reconstruction by a single reconstructive surgeon at a single institution between February 2017 and September 2021 was performed. Patients were divided into two cohorts: those receiving 30mg of topical nitroglycerin ointment to each breast at the conclusion of the operation (September 2019-September 2021) and those who did not (February 2017-August 2019). All patients underwent intraoperative SPY angiography, and mastectomy skin flaps were debrided intraoperatively based on imaging. Independent demographic variables were analyzed and dependent outcome variables included mastectomy skin flap necrosis, headache, and hypotension requiring removal of ointment.

Results:
A total of thirty-five patients (49 breasts) were included in the nitroglycerin cohort and a total of thirty-four patients (49 breasts) were included in the control group. There was no significant difference in patient demographics, medical comorbidities, or mastectomy weight between cohorts. The rate of mastectomy flap necrosis decreased from 51% in the control group to 26.5% in the group that received nitroglycerin ointment (p=0.013). There were no documented adverse events associated with nitroglycerin use.

Conclusion:
Topical nitroglycerin ointment significantly decreases the rate of mastectomy flap necrosis in patients undergoing immediate autologous breast reconstruction without significant adverse effects.
“Outcomes of the Goldilocks technique in High-risk Breast Reconstruction Patients.”
Authors: Ghanouni Arian , Thompson Peter , Losken Albert 
Published: March 2023

Background:
The Goldilocks technique seeks to provide a safe alternative for patients who are otherwise at risk of adverse complications during reconstruction. The technique involves de-epithelializing and locally contouring mastectomy skin flaps to create a breast mound. The purpose of this study was to analyze data relating to outcomes of patients undergoing this procedure and relationships between complications and patient demographics or comorbidities, as well as the likelihood of secondary reconstructive surgeries.

Methods:
A review was performed on a prospectively maintained database on all patients who underwent post mastectomy Goldilocks reconstruction between June 2017 and January 2021 at a tertiary care center. Data queried included patient demographics, comorbidities, complications, outcomes, as well as subsequent secondary reconstructive surgeries.

Results:
Our series included a total of 58 patients (83 breasts) who underwent Goldilocks reconstruction. Thirty-three patients (57%) underwent unilateral mastectomy and 25 patients (43%) underwent bilateral mastectomy. Mean age at reconstruction was 56 years (range:34 to 78 years) and 82% percent (n=48) of patients were obese (average BMI = 36.8). Forty percent (n=23) of patients underwent radiation therapy either pre- or post-operatively. Fifty-three percent (n=31) of patients underwent either neoadjuvant or adjuvant chemotherapy. When analyzed by individual breast, overall complication rate was 18%. The majority of complications were treated in office (n=9) such as infection, skin necrosis, and seroma. Six breasts experienced major complications of hematoma and skin necrosis requiring additional surgery. At the time of follow-up, 35% (n=29) of breasts had a secondary reconstruction, consisting of 17 (59%) implants, 2 (7%) expanders, 3 (10%) fat grafting, and 7 (24%) autologous reconstruction using latissimus or DIEP flaps. The rate of complication for secondary reconstruction was 14% (seroma: 1, hematoma: 1, wound healing delay: 1, infection: 1).

Conclusions:
The Goldilocks breast reconstruction technique is safe and effective for high-risk breast reconstruction patients. While early post-operative complications are limited, patients should be counseled on the likelihood of a subsequent secondary reconstruction procedure to achieve the aesthetic outcome they may desire.
Marinagarivorans cellulosilyticus sp. nov., a cellulolytic bacterium isolated from the deep-sea off Noma-misaki, Japan
Authors: Tsudome Mikiko , Tachioka Mikako , Miyazaki Masayuki , Tsuda Miwako , Takaki Yoshihiro , Deguchi Shigeru 
Published: March 2023

Cells from strain GE09T, isolated from an artificially immersed nanofibrous cellulose plate in the deep sea, were Gram-stain-negative, motile, aerobic cells that could grow with cellulose as their only nutrient. Strain GE09T was placed among members of

Cellvibrionaceae

, in the

Gammaproteobacteria

, with

Marinagarivorans algicola

Z1T, a marine degrader of agar, as the closest relative (97.4 % similarity). The average nucleotide identity and digital DNA–DNA hybridization values between GE09T and

M. algicola

Z1T were 72.5 and 21.2 %, respectively. Strain GE09T degraded cellulose, xylan and pectin, but not starch, chitin and agar. The different carbohydrate-active enzymes encoded in the genomes of strain GE09T and

M. algicola

Z1T highlights their differences in terms of target energy sources and reflects their isolation environments. The major cellular fatty acids of strain GE09T were C18 : 1
ω7c, C16 : 0 and C16 : 1
ω7c. The polar lipid profile showed phosphatidylglycerol and phosphatidylethanolamine. The major respiratory quinone was Q-8. Based on these distinct taxonomic characteristics, strain GE09T represents a new species in the genus

Marinagarivorans

, for which we propose the name Marinagarivorans cellulosilyticus sp. nov. (type strain GE09T=DSM 113420T=JCM 35003T).
Towards understanding the influence of innovative work behavior on healthcare organizations’ performance: the mediating role of transformational leaders
Authors: Alshahrani Ibraheem , Al-Jayyousi Odeh , Aldhmour Fairouz , Alderaan Thamer 
Published: March 2023

PurposeThe study's aims are to identify healthcare innovation variables, explore innovative work behavior’s (IWB's) influence on Saudi health sector companies and evaluate the mediating function of transformational leadership in the link between IWB and healthcare organizations. In this backdrop, the purpose of the current research was to investigate the impact of creative work behavior on organizational performance and the role of transformational leadership in this process.Design/methodology/approachThe objective of this quantitative cross-sectional study was to examine, according to 587 participants, the perceived elements of creative work behavior (RQ1). In various 10 departments of the 5 Dammam Health Network (DHN) in the Eastern Province of Saudi Arabia, online questionnaires were used to collect data. SmartPLS 3 software was used to analyze the data.FindingsThe findings indicated that healthcare professionals perceive the elements of autonomy, competence, relatedness, motivation and knowledge sharing as key features that influence high efficiency in organizational efficiency (p < 0.001). IWB also had a significant and direct positive influence on organizational performance (p < 0.001). Transformational leadership behavior had an insignificant negative effect on employees’ task performance when considering organizational performance (P = 0.122). Therefore, the mediation role did not affect the relationship with IWB concerning employees’ task performance, suggesting that transformational leadership behaviors did not have a mediating effect on the effectiveness of employees’ task performance.Originality/valueThis article contains original analysis and interpretation highlighting integrating IWB and transformational leadership into Saudi Arabia's national healthcare system that can help address specific difficulties facing healthcare practitioners.
Dynamic connectedness among Pakistani stock markets and its major trading partners
Authors: Akram Muhammad , Hunjra Ahmed Imran , Malik Imran Riaz , Al-Faryan Mamdouh Abdulaziz Saleh 
Published: March 2023

PurposeInternationalization and financial deregulation have caused market participants and policymakers to consider the significance of financial connectedness and the spillover effects of shocks. In this context, this research is a pioneering effort to investigate the direction and magnitude of return volatility spillovers between Pakistan’s financial markets and those of its key trade partners. This paper examines the relationship between return and volatility spillover in the financial markets of Pakistan and its major trading partners.Design/methodology/approachTen countries are selected for empirical examination of dynamic connectedness among Pakistan and its major trading partner’s stock markets. This study utilizes a spillover index approach model and considers daily, weekly and monthly datasets spanning 25 years from 1995 to 2019.FindingsThe results indicate that stock markets provide efficient channels for return and volatility spillovers. Moreover, it is found that the intensity of spillovers during the financial crisis is more intense as these crises are major determinants of contagion; consequently, investors, speculators and policymakers use these events for their respective purposes.Originality/valueResearchers, practitioners, policymakers and investors may all benefit from the findings in areas including risk management, portfolio diversification and trading methods.
Measuring “sustainable development” in vernacular settlements: a case study Behramkale, Türkiye
Authors: Ergöz Karahan Ebru , Göçer Özgür , Boyacıoğlu Didem , Shrestha Pranita 
Published: March 2023

PurposeThe main objective of this paper is to critically assess sustainable development in the context of Behramkale, a vernacular village in Türkiye.Design/methodology/approachVernacular Heritage Sustainable Architecture analysis framework has been adopted to understand and assess vernacular architecture and sustainable development in Behramkale.FindingsThe vernacular design of the old Behramkale settlement has shown more sustainable characteristics as compared to the new development area. Key findings show that trade-offs were made with respect to environmental and sociocultural aspects of sustainable development to achieve economic sustainability.Research limitations/implicationsFuture research with more in-depth interviews would be helpful to find out the inhabitants’ response to the conservation practices.Practical implicationsBased on the research conducted, life cycle analysis and sustainable strategies of vernacular settlements can be useful tools to design, develop and improve old settlements, as well as newly established settlements.Social implicationsKey lessons learned from conservation practices can help to identify well-adapted solutions to respond to the needs of local communities in Türkiye and similar vernacular settlements in the Mediterranean region.Originality/valueThis paper critically assesses sustainable development in the context of vernacular architecture, heritage conservation and rural sustainability. Conservation practices in Türkiye are evaluated deeply as there is limited research in this field within the Mediterranean heritage conversation and sustainable development context.
Laser powder bed fusion of granulation-sintering-deoxygenation WC/18Ni300 composites: anisotropic microstructure characterization and wear properties
Authors: Yao Bibo , Li Zhenhua , Teng Baoren , Liu Jing 
Published: March 2023

Purpose
Laser powder bed fusion (LPBF) can be used to fabricate complex extrusion die without the limitation of structures. Layer-by-layer processing leads to differences in microstructures and wear properties. This study aims to investigate the microstructure evolution and effects of tungsten carbide (WC) on the wear properties of LPBF-printed 18Ni300.

Design/methodology/approach
Economical spherical granulation-sintering-deoxygenation (GSD) WC-reinforced 18Ni300 steel matrix composites were produced by LPBF from powder mixtures of WC and 18Ni300. The effects of WC contents on anisotropic microstructures and wear properties of the composites were investigated.

Findings
The relative density is more than 99% for all the composites except 25% WC/18Ni300 composite. The grain sizes distributed on the top cross-section are smaller than those on the side cross-section. After adding WC particles, more high-angle grain boundaries and larger Schmid factor generate, and deformed grains decrease. With increasing WC contents, the hardness first decreases and then increases but the wear volume loss decreases. The side cross-section of the composite has higher hardness and better wear resistance. The 18Ni300 exhibits adhesive wear accompanying with abrasive wear, while plowing and fatigue wear are the predominant wear mechanisms of the composites.

Originality/value
Economical spherical GSD WC particles can be used to improve the wear resistance. The novel WC/18Ni300 composites are suitable for the application under the abrasive wear condition with low stress.
Communities in infrastructure habitats are species rich but only partly support species associated with semi‐natural grasslands
Authors: Dániel‐Ferreira Juliana , Fourcade Yoan , Bommarco Riccardo , Wissman Jörgen , Öckinger Erik 
Published: March 2023

Abstract

Biodiversity linked to traditionally managed semi‐natural grasslands is declining, despite conservation efforts. At the same time, the area of novel grassland habitats along linear infrastructure, such as road verges and power line corridors, is increasing and in some regions surpass the area of semi‐natural grasslands. An open question is to what extent these novel grasslands can complement or even replace traditionally managed grasslands as habitat for grassland species.

We compared the alpha (species richness) and beta (abundance‐based dissimilarities) diversity of plants, bumblebees and butterflies among semi‐natural pastures, verges of small and big roads, power line corridors and uncultivated field borders nested within 32 landscapes (2 × 2 km squares). Landscapes had either high or low road density and were with or without power line corridors. Across landscapes there was also a gradient in the area of semi‐natural pastures.

Alpha diversity of all three species groups was as high in power line corridors and verges of small roads as in semi‐natural pastures, regardless of landscape composition. Although all habitat types shared a large proportion of species, community composition differed among habitats for all three species groups. The beta diversity of plants and butterflies was driven primarily by the replacement of species (turnover), while the beta diversity of bumblebees was driven by a rarer occurrence of certain species in road verges (nestedness). This means that linear infrastructure habitats cannot fully replace the role of semi‐natural grasslands for plant and pollinator diversity.

The area of road verges, power line corridors and semi‐natural pastures in the landscape influenced community composition of plants and butterflies, but not the similarity in community composition among habitats within landscapes.

Policy implications. Although novel grasslands along linear infrastructures have high numbers of grassland species, they only support a part of the biodiversity found in traditionally managed semi‐natural grasslands. Therefore, protecting and restoring semi‐natural grasslands should continue to be a priority for the conservation of grassland biodiversity. However, especially in landscapes where the area of semi‐natural grasslands is low, road verges and power line corridors can be important habitats for a number of grassland plants and insects and should be managed to promote biodiversity.
No consistencies in abundance–impact relationships across herbaceous invasive species and ecological impact metrics
Authors: Fenesi Annamária , Botta‐Dukát Zoltán , Miholcsa Zsombor , Szigeti Viktor , Molnár Csaba , Sándor Dorottya , Szabó Anna , Kuhn Thomas , Kovács‐Hostyánszki Anikó 
Published: March 2023

Abstract

The general shape (from linear to complex curve), direction (negative and positive) and strength (steepness of the slope) of abundance–impact relationships for different impact metrics are poorly known, despite their importance in understanding and predicting ecological repercussions of invasive species. It is also an open question how the functional traits of invasive species may influence the abundance–impact relationship.

We studied 11 widespread herbaceous invasive alien species of East‐Central Europe and their 16 impact metrics (resident plant communities' ecological characteristics, trait composition, functional diversity and soil parameters) by sampling invaded and similar, uninvaded sites (space‐for‐time substitution method). Our aim was to (1) investigate the detailed ecological impacts of invasive plants on native plant communities; (2) explore the type of cover–impact relationships across impact metrics and their consistency across species and (3) study whether the cover–impact relationship depends on functional traits of invasive species.

When considering all invasive species together, we found that invaded plant communities were less species rich and less functionally even but showed higher values of Rao's Q diversity index, and higher nitrogen, phosphorus and organic carbon soil nutrient content compared to uninvaded communities. However, the species‐wise analyses revealed strikingly different impacts among the 11 invasive species and also among impact metrics.

Regarding the type of cover–impact relationships, we found no consistencies across invasive species and impact metrics. Still, nonlinear relationships prevailed when species were analysed together and linear relationships when species were studied individually. The functional traits of the invasive species explained only a small part of this response heterogeneity; mostly, the small‐seeded perennial invasive species affected the cover–species richness relationship.

Synthesis: Herbaceous invasive plant species have a cover‐dependent impact on resident plant communities, but there are no consistent patterns across impact metrics and invasive species. Specific traits or trait syndrome of invasive species may affect the heterogeneity of cover–impact relationships, but that would need further study. We highlighted the importance of impact assessments involving invasive species' abundance to unmask cryptic impacts for species that show contrasting effects along an abundance gradient.
Prokaryotic community dynamics and nitrogen‐cycling genes in an oxygen‐deficient upwelling system during La Niña and El Niño conditions
Authors: Pajares Silvia , Merino‐Ibarra Martín , Farías Laura 
Published: March 2023

AbstractDissolved oxygen regulates microbial distribution and nitrogen cycling and, therefore, ocean productivity and Earth's climate. To date, the assembly of microbial communities in relation to oceanographic changes due to El Niño Southern Oscillation (ENSO) remains poorly understood in oxygen minimum zones (OMZ). The Mexican Pacific upwelling system supports high productivity and a permanent OMZ. Here, the spatiotemporal distribution of the prokaryotic community and nitrogen‐cycling genes was investigated along a repeated transect subjected to varying oceanographic conditions associated with La Niña in 2018 and El Niño in 2019. The community was more diverse during La Niña and in the aphotic OMZ, dominated by the Subtropical Subsurface water mass, where the highest abundances of nitrogen‐cycling genes were found. The largest proportion of the Gulf of California water mass during El Niño provided warmer, more oxygenated, and nutrient‐poor waters towards the coast, leading to a significant increase of Synechococcus in the euphotic layer compared with the opposite conditions during La Niña. These findings suggest that prokaryotic assemblages and nitrogen genes are linked to local physicochemical conditions (e.g. light, oxygen, nutrients), but also to oceanographic fluctuations associated with ENSO phases, indicating the crucial role of climate variability in microbial community dynamics in this OMZ.
Potential value of efficacy prediction and treatment of natural killer cells in extensive stage small cell lung cancer
Authors: Cui Yanan , Zhao Peiyan , Cheng Ying , Ren Xiubao 
Published: March 2023

AbstractAlthough the emergence of immunotherapy has broken the deadlock of extensive stage small cell lung cancer (ES‐SCLC), the study of markers for predicting efficacy is the key to the breakthrough of immunotherapy, and exploring more innovative, efficient and safe treatment models is also an important research direction of ES‐SCLC. As an important part of inherent immunity, natural killer (NK) cells have become a hot spot because activated NK cells can directly kill tumor cells and may also influence tumor microenvironment immunomodulation. To date, emerging experimental research on NK cells in tumor therapy and immunoregulation has been published, but specific reviews of its role in ES‐SCLC are limited. Hence, in this review, we briefly summarize the current status of immunotherapy and the exploration of biomarker in ES‐SCLCs, with focus on the potential value of efficacy prediction and treatment of NK cells, and finally discuss the limitations and development prospects of NK cells in ES‐SCLC immunotherapy research.