bluuebunny/crossref_metadata_2025_split huggingface dataset:
The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic
Authors: Melnyk Bernadette Mazurek , Hsieh Andreanna Pavan , Tan Alai , McAuley James W. , Matheus Maritza , Larson Bayli , Dopp Anna Legreid 
Published: May 2023

Objectives
The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error.

Methods
Pharmacist (N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error.

Results
The response rate was 6.4% (N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months.

Conclusions
Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.
The future of commercial genetic testing
Authors: Solomon Benjamin D. 
Published: May 2023

Purpose of review
There are thousands of different clinical genetic tests currently available. Genetic testing and its applications continue to change rapidly for multiple reasons. These reasons include technological advances, accruing evidence about the impact and effects of testing, and many complex financial and regulatory factors.

Recent findings
This article considers a number of key issues and axes related to the current and future state of clinical genetic testing, including targeted versus broad testing, simple/Mendelian versus polygenic and multifactorial testing models, genetic testing for individuals with high suspicion of genetic conditions versus ascertainment through population screening, the rise of artificial intelligence in multiple aspects of the genetic testing process, and how developments such as rapid genetic testing and the growing availability of new therapies for genetic conditions may affect the field.

Summary
Genetic testing is expanding and evolving, including into new clinical applications. Developments in the field of genetics will likely result in genetic testing becoming increasingly in the purview of a very broad range of clinicians, including general paediatricians as well as paediatric subspecialists.
Immunosuppression in HIV-positive kidney transplant recipients
Authors: Sorohan Bogdan Marian , Ismail Gener , Leca Nicolae 
Published: May 2023

Purpose of study
The purpose of this review is to provide the current state of immunosuppression therapy in kidney transplant recipients (KTR) with HIV and to discuss practical dilemmas to better understand and manage these patients.

Recent findings
Certain studies find higher rates of rejection, which raises the need to critically assess the approach to immunosuppression management in HIV-positive KTR. Induction immunosuppression is guided by transplant center-level preference rather than by the individual patient characteristics. Earlier recommendations expressed concerns about the use of induction immunosuppression, especially utilizing lymphocyte-depleting agents; however, updated guidelines based on newer data recommend that induction can be used in HIV-positive KTR, and the choice of agent be made according to immunological risk. Likewise, most studies point out success with using first-line maintenance immunosuppression including tacrolimus, mycophenolate, and steroids. In selected patients, belatacept appears to be a promising alternative to calcineurin inhibitors with some well established advantages. Early discontinuation of steroids in this population carries a high risk of rejection and should be avoided.

Summary
Immunosuppression management in HIV-positive KTR is complex and challenging, mainly because of the difficulty of maintaining a proper balance between rejection and infection. Interpretation and understanding of the current data towards a personalized approach of immunosuppression could improve management in HIV-positive KTR.
The Effect of Pectoral Nerve Blocks on Opioid use and Postoperative Pain in Masculinizing Mastectomy: A Randomized Controlled Trial
Authors: Wallace Adam B. , Song Siyou , Yeh Peter , Kim Esther A. 
Published: May 2023

BACKGROUND:
Bilateral masculinizing mastectomy is the most common gender affirmation operation performed. Currently, there is lack of data regarding intraoperative and postoperative pain control for this population. It is our aim to study the effects of the Pecs I and II regional nerve blocks in patients undergoing masculinizing mastectomy.

METHODS:
A randomized, double-blind, placebo-controlled trial was performed. Patients undergoing bilateral gender affirmation mastectomy were randomized to receive either a Pecs block with Ropivacaine or placebo injection. The patient, surgeon, and anesthesia team were blinded to the allocation. Intraoperative and postoperative opioid requirements were collected and recorded as morphine milligram equivalents (MME). Participants recorded postoperative pain scores at specific time points on the day of surgery through postoperative day seven.

RESULTS:
50 patients were enrolled between July, 2020 and February, 2022. 27 were randomized to the intervention group, and 23 to the control group with 43 patients undergoing analysis. There was no significant difference in intraoperative morphine milligram equivalents (MME) between the Pecs block group and control (9.8 vs. 11.1, p=0.29). Additionally, there was no difference in postoperative MME between the groups (37.5 vs. 40.0, p=0.72). Postoperative pain scores were also similar between the groups at each specified time point.

CONCLUSIONS:
There was no significant reduction in opioid consumption or postoperative pain scores in patients undergoing bilateral gender affirmation mastectomy who received a regional anesthetic when compared to placebo. Additionally, a postoperative opioid sparing approach may be appropriate for patients undergoing bilateral masculinizing mastectomy.
Impact of Initial Filling Medium on Outcomes of Subpectoral Two-Stage Implant-Based Breast Reconstruction: Air Versus Saline
Authors: Bae Juyoung , Lee Kyeong-Tae , Jeon Byung Joon , Mun Goo-Hyun , Bang Sa Ik , Pyon Jai Kyong 
Published: May 2023

BACKGROUND:
In two-stage expander-based breast reconstruction, the use of air as the initial filling medium has been suggested to confer clinical advantages over conventional saline, but this has not been demonstrated in a large series. The present study aimed to evaluate the association between material type (air versus saline) for initial expander filling and postoperative outcomes.

METHODS:
This retrospective study included patients who underwent immediate subpectoral tissue expander-based breast reconstruction between January 2018 and March 2021. The subjects were categorized into two groups according to the material used for initial filling; saline-inflated expanders, which were used during the first 22 months consecutively; and air-inflated expanders, which were used during the latter 17 months consecutively. Complications including mastectomy flap necrosis, and postoperative expansion profiles were compared. Multivariable analyses were performed to identify independent predictors of postoperative complications.

RESULTS:
A total of 443 breasts (400 patients), including 161 air-filled and 282 saline-filled, were analyzed. The two groups had similar baseline characteristics. The air-filled group showed a significantly lower rate of mastectomy flap necrosis; this difference remained significant after the adjustment for other variables in the multivariable analysis. The rates of other complications did not differ between the two groups. The air-filled group had fewer office visits and a shorter period to complete expansion.

CONCLUSIONS:
The use of air for initial expander filling could provide safe and reliable outcomes with reduced patient discomfort during postoperative expansion; thus, air-filled expanders might be an effective alternative to saline-filled expanders.
Combined subbrow blepharoplasty and brow fat pad transfer for the simultaneous correction of dermatochalasis and sunken upper eyelids
Authors: Qu Linghan , Liang Zhen , Wang Jianzhang , Zhang Juan , Yu Zhou , Song Baoqiang 
Published: May 2023

Background:
Women commonly have upper eyelid dermatochalasis and upper eyelid depression due to advancing age. Blepharoplasty is a suitable method for dermatochalasis but not sunken eyelid. This study proposed a novel technique for eyelid rejuvenation by simultaneously correcting dermatochalasis and sunken upper eyelids in middle-aged women.

Methods:
Forty patients underwent subbrow blepharoplasty combined with brow fat pad transfer. The ellipse-shape skin and subcutaneous tissue underneath the eyebrow were measured, demarcated, and excised. The orbicularis oculi muscle beneath the subcutaneous tissue was exposed and dissected in the upper-third area. The brow fat pad was turned downward using the lower edge as the pedicle and was fixed in the layer of retro-orbicularis oculi fat (ROOF) to fill the depressed area in the upper eyelid. The lower muscle flap was fixed to the supraorbital rim periosteum and upper musculocutaneous flaps, thereby forming a cross flap for interlocking fixation. The surgical outcomes were evaluated using Antera 3D camera and the Global Aesthetic Improvement Scale (GAIS).

Results:
The depth and volume of upper eyelid depression significantly decreased 3 months after the surgery and stabilized within 6 months. The GAIS scores significantly improved after the surgery, and the postoperative outcomes were acceptable.

Coclusion
The Novel technique is simple and effective for simultaneously correcting dermatochalasis and sunken upper eyelids in middle-aged women. The surgical outcomes are predictable and acceptable to most patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV
Ultrasound to Improve the Anatomic Approach to the Temple and a Retrospective Study on the Efficacy of Large-Volume Autologous Fat Grafting
Authors: Ge Haojie , Lin Biaobin , Fang Bairong 
Published: May 2023

Background:
Autologous fat grafting (AFG) has been used widely in temporal-hollowing augmentation, but its efficacy and safety are unclear. The authors examined the use of Doppler ultrasound (DUS) in large-volume lipofilling after performing an anatomic study of the temporal region.

Methods:
To clarify safe and stable levels of AFG of the temporal fat compartments, 5 cadaveric heads (10 sides) were dissected after dye was injected into targeted fat pads with DUS guidance. In addition, the authors retrospectively analyzed 100 patients with temporal fat transplantation, including groups with conventional AFG (n = 50) and DUS-guided large-volume AFG (n = 50).

Results:
The anatomic study revealed the approach of 5 injection planes and 2 fat compartments in the temporal region: the superficial and deep temporal fat pads. In the AFG study, all patients were female, and there were no statistically significant differences between the groups in age, body mass index, tobacco or steroid use, or previous filling history. Between the conventional AFG group and the DUS-guided large-volume AFG group, the average volume of temporal lipofilling per side was 10.55 ± 2.25 versus 22.32 ± 5.19 mL/side (P < 0.001), surgeon Likert scale score was 2.86 ± 0.97 versus 4.24 ± 0.66 (P < 0.001), and rate of satisfaction was 74% versus 92% (P < 0.05) (statistically significant differences).

Conclusions:
The anatomic approach to the main temporal fat compartment is feasible. DUS-guided large-volume AFG is an effective and safe way to improve temporal hollowing augmentation.
Accumulation of 18F-FDG at Anomalous Systemic Arterial Supply to Normal Lung on 18F-FDG PET/CT
Authors: Usmani Sharjeel , Jain Anjali , Al Riyami Khulood , Munir Javeria , Abubakar Sofiullah 
Published: May 2023

Abstract
Anomalous systemic arterial supply to normal lung is an anatomical variant in which a portion of the lung is supplied by a systemic vessel without a distinct pulmonary sequestration. We report a case of mild to moderate accumulation of 18F-FDG in the medial basal segment of left lung; corresponding CT images localize this uptake in the tortuous artery arising from the descending aorta with similar uptake to that of descending aorta. Findings are suggestive of anomalous systemic arterial supply to normal segments of the lung. Hybrid PET/CT allows precise anatomical localization and helps in differentiate benign mimics of disease, which can alter patient management.
Pierre Robin Sequence and Respiratory Distress: Long-Term Evolution in Patients Submitted to the Conservative Treatment
Authors: Freitas Renato da Silva , do Prado Daniel , Guarezi Nasser Isis J. , Peressutti Carolina , Ogawa Vanessa S. 
Published: May 2023

Background:
Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, cleft palate, and airway distress. The aims of initial treatment are the improvement of airway and feeding. There are many therapeutic options, including conservative techniques (prone positioning and nasopharyngeal tube) and invasive procedures (mandibular distraction and tracheostomy). In our center, initially conservative treatment is the rule and many patients have been treated with nasopharyngeal tube.

Objective:
The aim was to analyze of the clinical evolution of respiratory distress in infants with PRS submitted to nonsurgical treatment.

Methods:
A retrospective and observational descriptive evaluation was carried out with 56 patients with the PRS at Centro de Atendimento Integral ao Fissurado Labiopalatal (CAIF). 21 patients were selected to a transversal phase.

Results:
The treatment has started in an average age of 1.5 months (±2.09) and 17 (94.4%) had respiratory distress at birth. Polysomnographic exams showed an average apnea/hypopnea index of 0.93, an average number of central apnea/hour of 0.3, an average number of obstructive apnea of 0.6 and an average oxygen saturation of 92%. There was the predominance of esthetic profile in class II with 16 (88.9%) patients in this group, and orthodontic profile in class II with 15 (83.3%) patients.

Conclusion:
The conservative treatment has presented remarkable results in the treatment of respiratory distress in bearers of PRS with a decrease of obstructive sleep events considering the growth of patient and the development of mandibular growth as well.
Clinical Application of a Resembling Rectangular Flap on Lateral Lip in Unilateral Cheiloplasty: A Modified Millard’s Technique
Authors: Wang Xiaorong , Liao Lishu , Li Yijun , Tang Shengyu , Li Wanshan 
Published: May 2023

Purpose:
This clinical study aimed to design and utilize a modified rotation-advancement technique (MRAT) with a resembling rectangular flap on the lateral lip for primary unilateral cheiloplasty and evaluated its postoperative outcomes.

Materials and Methods:
A retrospective study was conducted on patients with a unilateral cleft lip who had undergone initial cheiloplasty with MRAT. The postoperative outcomes were assessed for nasolabial symmetry by photogrammetry. Repeated measures of ANOVA and two independent samples t tests were applied for statistical analysis.

Results:
Twenty patients with unilateral cleft lip met the inclusion criteria. Postoperatively, the patients had well-shaped nasal sill and centered nasal columella. In addition to, the bilateral symmetrical ratios noticeably improved (P<0.001). Simultaneously, the postoperative outcomes were independent of the cleft type and height differences of the two peaks (P>0.05).

Conclusions:
Unilateral cheiloplasty using the present MRAT can better preserve the nasolabial structure and symmetry. The postoperative scar is concealed and simulates a normal philtral ridge.
Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial)
Authors: Watanabe Jun , Takemasa Ichiro , Kotake Masanori , Noura Shingo , Kimura Kei , Suwa Hirokazu , Tei Mitsuyoshi , Takano Yoshinao , Munakata Koji , Matoba Shuichiro , Yamagishi Sigeru , Yasui Masayoshi , Kato Takeshi , Ishibe Atsushi , Shiozawa Manabu , Ishii Yoshiyuki , Yabuno Taichi , Nitta Toshikatsu , Saito Shuji , Saigusa Yusuke , Watanabe Masahiko ,   for the EssentiAL Trial Group
Published: May 2023

Objective:
The aim of the present randomized controlled trial was to evaluate the superiority of indocyanine green fluorescence imaging (ICG-FI) in reducing the rate of anastomotic leakage in minimally invasive rectal cancer surgery.

Background:
The role of ICG-FI in anastomotic leakage in minimally invasive rectal cancer surgery is controversial according to the published literature.

Methods:
This randomized, open-label, phase 3, trial was performed at 41 hospitals in Japan. Patients with clinically stage 0–III rectal carcinoma less than 12 cm from the anal verge, scheduled for minimally invasive sphincter-preserving surgery were preoperatively randomly assigned to receive a blood flow evaluation by ICG-FI (ICG+ group) or no blood flow evaluation by ICG-FI (ICG− group). The primary endpoint was the anastomotic leakage rate (grade A+B+C, expected reduction rate of 6%) analyzed in the modified intention-to-treat population.

Results:
Between December 2018 and February 2021, a total of 850 patients were enrolled and randomized. After the exclusion of 11 patients, 839 were subject to the modified intention-to-treat population (422 in the ICG+ group and 417 in the ICG− group). The rate of anastomotic leakage (grade A+B+C) was significantly lower in the ICG+ group (7.6%) than in the ICG− group (11.8%) (relative risk, 0.645; 95% confidence interval 0.422–0.987; P=0.041). The rate of anastomotic leakage (grade B+C) was 4.7% in the ICG+ group and 8.2% in the ICG− group (P=0.044), and the respective reoperation rates were 0.5% and 2.4% (P=0.021).

Conclusions:
Although the actual reduction rate of anastomotic leakage in the ICG+ group was lower than the expected reduction rate and ICG-FI was not superior to white light, ICG-FI significantly reduced the anastomotic leakage rate by 4.2%.
Comprehensive Cost Implications of Commercially Available Noninvasive Colorectal Cancer Screening Modalities
Authors: Allen Casey J , Bloom Nathan , Rothka Michael , Rao Pavan , Wagner Patrick L , Bartlett David L , Farah Katie , Chalikonda Sricharan 
Published: May 2023

BACKGROUND:
There is an increasing usage of noninvasive screening modalities for colorectal cancer (CRC), primarily the fecal immunochemical test (FIT) and multi-target stool DNA test (Cologuard [CG]). The aim of this study was to determine the comprehensive, long-term cost implications of these noninvasive screening modalities.

STUDY DESIGN:
Using a national insurer-based administrative dataset, patients screened for CRC from January 1, 2019 to December 31, 2019 were analyzed. A hierarchical logic system was used to determine the primary screening modality for each patient. The total annual costs in US dollars ($) were extrapolated using number of patients screened, costs per test, screening intervals, and costs incurred from false results. Patients within our tumor registry diagnosed with CRC were matched to their claims data, and cancer stage distribution was compared.

RESULTS:
Of 119,334 members who underwent noninvasive screening, 38.1% underwent screening with FIT and 40.0% with CG. The combined annual cost for these 2 screening modalities was $13.7 million. By transitioning to FIT alone for all noninvasive screening, the total annual cost would decrease to $7.9 million, resulting in a savings of approximately $5.8 million per year. Additionally, by combining data from the network cancer registry and insurer-based claims dataset, we were able to match 533 individuals who underwent screening and were later diagnosed with CRC. The rate of early-stage (stage 0 to II) disease was found to be similar between those screened with FIT and CG (59.5% FIT vs 63.2% CG; p = 0.77).

CONCLUSIONS:
The adoption of FIT as the primary noninvasive CRC screening method has the potential to generate significant cost savings, and therefore, carries significant value implications for a large population health system.
An Atlas of Adaptive Evolution in Endemic Human Viruses
Authors: Kistler Kathryn E. , Bedford Trevor 
Published: May 2023

AbstractThrough antigenic evolution, viruses like seasonal influenza evade recognition by neutralizing antibodies elicited by previous infection or vaccination. This means that a person with antibodies well-tuned to an initial infection will not be protected against the same virus years later and that vaccine-mediated protection will decay. It is not fully understood which of the many endemic human viruses evolve in this fashion. To expand that knowledge, we assess adaptive evolution across the viral genome in 28 endemic viruses, spanning a wide range of viral families and transmission modes. We find that surface proteins consistently show the highest rates of adaptation, and estimate that ten viruses in this panel undergo antigenic evolution to selectively fix mutations that enable the virus to escape recognition by prior immunity. We compare overall rates of amino acid substitution between these antigenically-evolving viruses and SARS-CoV-2, showing that SARS-CoV-2 viruses are accumulating protein-coding changes at substantially faster rates than these endemic viruses.
The COVID-19 mRNA vaccine Comirnaty induces anaphylactic shock in an anti-PEG hyperimmune large animal model: Role of complement activation in cardiovascular, hematological and inflammatory mediator changes
Authors: Barta Bálint András , Radovits Tamás , Dobos Attila Balázs , Kozma Gergely Tibor , Mészáros Tamás , Berényi Petra , Facskó Réka , Fülöp Tamas Gyula , Merkely Béla , Szebeni János 
Published: May 2023

AbstractBackgroundComirnaty, Pfizer-BioNTech’s polyethylene-glycol (PEG)-containing Covid-19 vaccine, can cause hypersensitivity reactions (HSRs) in a small fraction of immunized people which can, very rarely, culminate in life-threatening anaphylaxis. A role of anti-PEG antibodies (Abs) has been proposed, but causality has not yet been proven in an animal model. This study aimed to provide such evidence using anti-PEG hyperimmune pigs (i.e., pigs displaying very high levels of anti-PEG Abs). We also sought to find evidence for the role of complement (C) activation and thromboxane A2 (TXA2) release in blood as contributing effects to anaphylaxis.MethodsPigs (n=6) were immunized with 0.1 mg/kg PEGylated liposome (Doxebo) i.v. the rise of anti-PEG IgG and IgM was measured in serial blood samples with ELISA. After 2-3 weeks, during the height of seroconversion, the animals were injected i.v. with 1/3 human vaccine dose (HVD) of Comirnaty, and the hemodynamic (PAP, SAP), cardiopulmonary (HR, EtCO2,), hematological parameters (WBC, granulocyte, lymphocyte, and platelet counts) and blood immune mediators (anti-PEG IgM and IgG Abs, C3a and TXA2) were measured as endpoints of HSRs.ResultsA week after immunization of 6 pigs with Doxebo, the level of anti-PEG IgM and IgG rose 5-10-thousands-fold in all animals, and they all developed anaphylactic shock to i.v. injection of 1/3 HVD of Comirnaty. The reaction, starting within 1 min, led to the abrupt decline of SAP along with maximal pulmonary hypertension, decreased pulse pressure amplitude, tachycardia, granulo- and thrombocytopenia, and paralleling rises of plasma C3a and TXB2 levels. These vaccine effects were not observed in non-immunized pigs.ConclusionsConsistent with previous studies with PEGylated nano-liposomes, these data show a causal role of anti-PEG Abs in the anaphylaxis to Comirnaty. The reaction involves C activation, and, hence, it represents C activation-related pseudo-allergy (CARPA). The setup provides the first large-animal model for mRNA-vaccine-induced anaphylaxis in humans.