bluuebunny/crossref_metadata_2025_split huggingface dataset:
From large-for-size to large-for-flow: A paradigm shift in liver transplantation
Authors: Rossignol Guillaume , Muller Xavier , Couillerot Joris , Lebosse Fanny , Delignette Marie-Charlotte , Mohkam Kayvan , Mabrut Jean-Yves 
Published: April 2023

Liver graft-recipient matching remains challenging, and both morphologic and hemodynamic characteristics have been shown to be relevant indicators of post-transplant outcomes. However, no combined analysis is available to date. To study the impact of both morphologic and hemodynamic characteristics of liver grafts on transplantation outcomes, we retrospectively evaluated all consecutive 257 liver transplantations with prospective hemodynamic measurements from 2017 to 2020 in a single-center perspective. First, a morphologic analysis compared recipients with or without large-for-size (LFS), defined by a graft/recipient weight ratio >2.5% and excluding extreme LFS. Second, a hemodynamic analysis compared recipients with or without low portal flow (LPF; <80 mL/min per 100 g of liver tissue). Third, an outcome analysis combining LPF and LFS was performed, focusing on liver graft-related morbidity (LGRM), graft and patient survival. LGRM was a composite endpoint, including primary nonfunction, high-risk L-Graft7 category, and portal vein thrombosis. Morphologic analysis showed that LFS (n=33; 12.9%) was not associated with an increased LGRM (12.1% vs 9.4%; p=0.61) or impaired graft and patient survival. However, the hemodynamic analysis showed that LPF (n=43; 16.8%) was associated with a higher LGRM (20.9% vs 7.5%, p = 0.007) and a significantly impaired 90-day graft and patient survival. Multivariable analysis identified LPF but not LFS as an independent risk factor for LGRM (OR: 2.8%; CI:1.088–7.413; and p = 0.03), 90-day (HR: 4%; CI: 1.411–11.551; and p = 0 .01), and 1-year patient survival. LPF is a significant predictor of post-liver transplantation morbi-mortality, independent of LFS when defined as a morphologic metric alone. Consequently, we propose the novel concept of large-for-flow, which may guide graft selection and improve perioperative management of LPF.
Performances of HEART score to predict 6-month prognostic of emergency department patients with chest pain: a retrospective cohort analysis
Authors: Fiore Giorgio , Pinto Giuseppe , Preda Alberto , Rampa Lorenzo , Gaspardone Carlo , Oppizzi Michele , Slavich Massimo , Di Napoli Davide , Bianchi Gianluca , Etteri Massimiliano , Margonato Alberto , Fragasso Gabriele 
Published: April 2023

Background and importance
Chest pain is a frequent cause of patient admissions in emergency departments (EDs). Clinical scores can help in the management of chest pain patients with an undefined impact on the appropriateness of hospitalization or discharge when compared to usual care.

Objectives
The aim of this study was to assess the performances of the HEART score to predict the 6-month prognostic of patients presenting to the ED of a tertiary referral university hospital with non-traumatic chest pain.

Design, settings, and participants
From 7040 patients presenting with chest pain from 1 January 2015 to 31 December 2017, after applying exclusion criteria (ST-segment elevation >1 mm, shock, absence of telephone number) we selected a sample of 20% chosen randomly. We retrospectively assessed the clinical course, definitive diagnosis, and HEART score according to ED final report. Follow-up was made by telephone interview with discharged patients. In hospitalized patients, clinical records were analyzed to evaluate major adverse cardiac events (MACE) incidence.

Outcome measure and analysis
The primary endpoint was MACE, comprising cardiovascular death, myocardial infarction, or unscheduled revascularization at 6 months. We assessed the diagnostic performance of the HEART score in ruling out MACE at 6 months. We also assessed the performance of ED usual care in the management of chest pain patients.

Results
Of 1119 screened, 1099 were included for analysis after excluding patients lost to follow-up; 788 patients (71.70%) had been discharged and 311 (28.30%) were hospitalized. Incident MACE was 18.3% (n = 205). The HEART score was retrospectively calculated in 1047 patients showing increasing MACE incidence according to risk category (0.98% for low risk, 38.02% for intermediate risk, and 62.21% for high risk). Low-risk category allowed to safely exclude MACE at 6 months with a negative predictive value (NPV) of 99%. Usual care diagnostic performance showed 97.38% sensitivity, 98.24% specificity, 95.5% positive predictive value, and 99% NPV, with an overall accuracy of 98.00%.

Conclusions
In ED patients with chest pain, a low HEART score is associated with a very low risk of MACE at 6 months.
Computer assisted interpretation of Tc-99m mercaptoacetyltriglycine diuretic scintigraphy enhances resident performance
Authors: Taylor Andrew T. , Fazlur Rahman A.K.M. , Folks Russell D. , Moncayo Valeria , Savir-Baruch Bital , Plaxton Nicholas , Polsani Aruna , Halkar Raghuveer K. , Dubovsky Eva V. , Garcia Ernest V. , Manatunga Amita 
Published: April 2023

Objective
iRENEX is a software module that incorporates scintigraphic and clinical data to interpret 99mTc- mercaptoacetyltriglycine (MAG3) diuretic studies and provide reasons for their conclusions. Our objectives were to compare iRENEX interpretations with those of expert physicians, use iRENEX to evaluate resident performance and determine if iRENEX could improve the diagnostic accuracy of experienced residents.

Methods
Baseline and furosemide 99mTc-MAG3 acquisitions of 50 patients with suspected obstruction (mean age ± SD, 58.7 ± 15.8 years, 60% female) were randomly selected from an archived database and independently interpreted by iRENEX, three expert readers and four nuclear medicine residents with one full year of residency. All raters had access to scintigraphic data and a text file containing clinical information and scored each kidney on a scale from +1.0 to −1.0. Scores ≥0.20 represented obstruction with higher scores indicating greater confidence. Scores +0.19 to −0.19 were indeterminate; scores ≤−0.20 indicated no obstruction. Several months later, residents reinterpreted the studies with access to iRENEX. Receiver operating characteristic (ROC) analysis and concordance correlation coefficient (CCC) quantified agreement.

Results
The CCC among experts was higher than that among residents, 0.84, versus 0.39, respectively, P < 0.001. When residents reinterpreted the studies with iRENEX, their CCC improved from 0.39 to 0.73, P < 0.001. ROC analysis showed significant improvement in the ability of residents to distinguish between obstructed and non-obstructed kidneys using iRENEX (P = 0.036).

Conclusion
iRENEX interpretations were comparable to those of experts. iRENEX reduced interobserver variability among experienced residents and led to better agreement between resident and expert interpretations.
Cardiac atrial metabolism quantitative assessment with analog and digital time of flight-PET/computed tomography
Authors: Hesse Michel , Marchandise Sébastien , Gerber Bernhard , Roelants Véronique 
Published: April 2023

Background
Evaluation of left atrium (LA) remodeling is becoming increasingly relevant in understanding several pathological cardiac conditions. 18F-FDG-PET/computed tomography (CT), the current gold standard for metabolic evaluation of the left ventricle, could be extended to LA using the latest PET technologies. We sought to perform a phantom study to optimize the reconstruction algorithm in this context.

Methods
The liver, heart cavity and walls of an anthropomorphic phantom were filled with typical patient 18F-FDG activity concentrations. Acquisitions were performed on an analog and on a digital TOF-PET/CT, and reconstructed with and without resolution recovery (RR). The Richardson-Lucy RR method was used, either through a third-party software or through the PET/CT manufacturer algorithm. Activity recoveries in the atria and ventricles and signal-to-noise ratios were evaluated to identify the best reconstruction and RR parameters. The same methodology was applied on a patient cardiac study.

Results
Analog PET/CT with the third-party RR cannot improve the activity recovery without markedly degrading the image quality. For the digital PET/CT, the optimal algorithm was the manufacturer RR reconstruction using four iterations and 15 subsets combined with five RR iterations. This reconstruction improved the LA activity recovery from 58% to 70% while preserving images of diagnostic quality. Similar results were obtained for the patient study.

Conclusion
The digital TOF-PET/CT with the identified optimal reconstruction can be used to quantitatively analyze the LA uptake in 18F-FDG cardiac studies while still preserving image reading quality. This may lead to more precise cardiovascular disease status evaluation, especially when atria are concerned.
Reconstruction of partial auricular skin cancer defects: a review of current techniques
Authors: Noor Anthony , Thomson Neil 
Published: April 2023

Purpose of review
To discuss the principles of auricular reconstruction and review recently published literature in the field.

Recent findings
Auricular reconstruction poses several challenges to the surgeon aiming to restore form and function following skin cancer resection. Various techniques have been described in the literature with many modifications also reported to address their shortcomings. An algorithmic approach based on the location and composition of the defect is recommended. In many instances, more than one technique can be used, and the operating surgeon should be familiar with these to determine the optimal approach for the individual patient.

Summary
This review highlights the updates in well established techniques as well as modern modifications. Furthermore, a framework for decision-making in auricular reconstruction is presented.
Update on congenital ear molding
Authors: Roby Brianne Barnett , Woods Tiffanie , Chinnadurai Sivakumar 
Published: April 2023

Purpose of review
Congenital ear deformities are characterized by distorted, but still present, landmarks of the auricle. Interventions include early treatment with ear molding or delayed surgical treatment. The purpose of this review is to provide an update on the latest information related to ear molding for congenital ear deformities.

Recent findings
Various ear molding techniques date back to the 1980s, but with the availability of commercially available molding systems, interest and use has blossomed in recent years. As more longitudinal research results are obtained, ear molding has been proven to be a highly effective treatment, although the best technique and length of treatment remains unclear.

Summary
While it is clear that earlier intervention is ideal, due to lack of public awareness, patients often present later, and it remains controversial what age to offer ear molding interventions to and still expect success. Ear molding interventions are becoming increasingly covered by insurance due to evidence of preventing long-term psychological morbidities and the need for future surgical interventions.
Accuracy of Anorectal Manometry to Detect the Rectoanal Inhibitory Reflex in Children: Awake Versus Under General Anesthesia
Authors: Baaleman Desiree F. , Mishra Samir , Koppen Ilan J.N. , Oors Jac. M. , Benninga Marc A. , Bali Neetu , Vaz Karla H. , Yacob Desale , Di Lorenzo Carlo , Lu Peter L. 
Published: April 2023

Objectives:
Our objective was to investigate if there is a difference in the detection of the rectoanal inhibitory reflex (RAIR) when an anorectal manometry (ARM) is performed awake or under general anesthesia.

Methods:
A retrospective review of ARM studies was performed to identify children who had undergone ARMs both while awake and under general anesthesia. We compared ARM outcomes including the detection of the RAIR and anal canal resting pressure.

Results:
Thirty-four children had received ARMs both while awake and under general anesthesia (53% female, median age at first ARM 7.5 years [range 3–18 years]). In 9 of 34 (26%) children the RAIR was solely identified during ARM under general anesthesia and not during ARM while awake. In 6 of 9 (66%) this was unrelated to the balloon volumes used during balloon inflations. In 4 of 34 (12%) children, assessment of the RAIR was inconclusive during ARM under general anesthesia due to too low, or loss of anal canal pressure. In 2 of those children, ARMs while awake showed presence of a RAIR. Anal canal resting pressures were higher during ARM while awake versus ARM under general anesthesia (median 70 [interquartile range, IQR 59–85] vs 46 mmHg [IQR 36–65] respectively, P < 0.001).

Conclusions:
General anesthesia may affect the detection of a RAIR in 2 ways. On the one hand, it may facilitate better visualization in children in whom a RAIR could not be visualized while awake. On the other hand, it may cause a loss of anal canal pressure resulting in an inconclusive test result.
Nonautoimmune overt hypothyroidism in the early stages of nephrotic syndrome: a case report from Somalia
Authors: Adan Abdisamad Mohamed , Siyad Mohamed Osman , Jeele Mohamed Osman Omar 
Published: April 2023

Introduction:
Nephrotic syndrome (NS) was first characterized in 1827 as the occurrence of proteinuria greater than or equal to 3.5 g/24 h, hypoalbuminemia (albumin≤3.0 g/dl), peripheral edema, hyperlipidemia, lipiduria caused by increased permeability of the renal glomerulus. Persistent proteinuria will eventually lead to hypothyroidism.

Case presentation:
In the presenting case, we reported a 26-year-old male patient with no known history of chronic disease who presented to the emergency department with a complaint of 1-week generalized edema, nausea, fatigue, and generalized ache in the extremities. He was diagnosed with NS complicated by hypothyroidism and was hospitalized for 3 weeks. After 3 weeks of treatment and close monitoring, the patient’s clinical condition and laboratory investigations were improved, and was discharged in good health.

Conclusion:
Hypothyroidism in the early stages of NS is a rare entity which may be encountered and physicians should be aware that hypothyroidism can be seen at any stage of NS.
Comparative study of wound infection between elective and emergency abdominal surgeries: a retrospective cohort study
Authors: Jadoon Sarosh Khan , Khan Raja Muhammad Ijaz , Khan Taufeeq Ahmed , Akhtar Naheed , Qayyum Yasir , Kumar Kamlesh , Kumar Rahul Robaish , Aarti  , Shahab Ramsha , Asghar Muhammad Sohaib 
Published: April 2023

Objective:
The objective of this study was to determine the frequency of wound infection among patients with abdominal surgeries and to compare the surgical site infection following elective versus emergency abdominal surgeries in a tertiary care hospital.

Subjects and methods:
All patients who fulfilled the inclusion criteria in the Department of General Surgery were included in the study. After taking informed written consent history was taken, clinical examination and patients were divided into two groups: group A (elective abdominal surgery) and group B (emergency abdominal surgery), patients in both groups were compared for the outcome that is surgical site infection.

Result:
A total of 140 patients who underwent abdominal surgery were included. Wound infection in abdominal surgeries was noted in 26 patients (18.6%), in group A wound infection was noted in 7 (5%), while in group B wound infection was seen in 19 (13.6%).

Conclusion:
The rate of wound infection in patients with abdominal surgeries was not low among the study population and the rate of wound infection was higher in emergency abdominal surgeries as compared with elective abdominal surgeries.
Benign inoperable tracheal stenosis in COVID versus non-COVID patients at the pandemic epicenter: a case series
Authors: Perwaiz Muhammad , Durrance Richard , Bogart Michael , obata Reiichiro , Bradley Ellen C. 
Published: April 2023

Background:
The COVID-19 pandemic has exponentially expanded the number of patients requiring treatment for chronic respiratory failure. One consequence is an increase in the number of patients requiring intubation and mechanical ventilation. Benign inoperable tracheal stenosis presents a challenge, especially in COVID-19 patients.

Methods:
We describe a case series of 15 patients with Benign inoperable tracheal stenosis treated with interventional bronchoscopy over a 15-month period. These patients were divided into two groups, COVID and non-COVID. We used an electrocautery snare as an electrocautery knife to cut the stenotic segment followed by four injections of 1 mg submucosal Decadron via a Wang needle. Patients were subsequently followed by the pulmonary clinic. Institutional review board approval was not required as per our institutional policy for a retrospective case series.

Results:
There was a high degree of success with this intervention, with a low rate of recurrence. We also noticed the following differences between the two subgroups. COVID tracheal stenosis was longer in length, had a higher percentage of cartilage involvement, and was located more distal to cords than the non-COVID group. The median age was younger in the COVID group.

Conclusions:
COVID pandemic an enormous number of intubations and tracheotomies have been performed. As a result, there will be an increased prevalence of tracheal stenosis. Most of these cases can be effectively treated with surgery. Dealing with complex inoperable cases remains a dilemma. Our case series/research article is an attempt to provide an easy technique with a high cure rate.
Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia
Authors: Lysaker Paul H. , Chernov Nikita , Moiseeva Tatyana , Sozinova Marta , Dmitryeva Nadezhda , Makarova Anastasiya , Kukla Marina , Myers Evan , Karpenko Olga , Kostyuk Georgiy 
Published: April 2023

Abstract
Alexithymia, or deficits in emotion recognition, and metacognitive capacity have been noted both in psychosis and eating disorders and potentially linked to psychopathology. This study sought to compare levels of impairments in these phenomena and their associations with psychopathology in groups with eating disorders and psychosis. Participants with diagnoses of a schizophrenia spectrum disorder (SSD; n = 53), anorexia (n = 40), or bulimia (n = 40) were recruited from outpatient clinics. Alexithymia was measured with the Toronto Alexithymia Scale; emotion recognition, with the Ekman Faces Test; and metacognition, with the Metacognitive Assessment Scale–Abbreviated. Psychopathology was measured with the Eating Attitudes Test, Body Image Questionnaire, and Positive and Negative Syndrome Scale. Results indicated that the SSD group had significantly poorer metacognitive function than either eating disorder group. Metacognition was related to body image in the anorexia group and a range of different forms of general psychopathology in the bulimia group. Alexithymia was related to eating disorder behaviors in the bulimia group.
Structured Callouts, the Shared Mental Model, and Teamwork
Authors: Wolfgang Matthew , Labudde Emily J. , Ruff Kristen , Geis Gary , Frey Mary , Boyd Stephanie , Harun Nusrat , Kerrey Benjamin T. 
Published: April 2023

Objectives
The shared mental model is essential to high-quality resuscitations. A structured callout (SCO) is often performed to establish the shared mental model, but the literature on SCOs is limited. The objectives of this study are to describe performance of SCOs during pediatric medical emergencies and to determine whether a SCO is associated with better teamwork.

Methods
This was a retrospective study in the resuscitation area of an academic pediatric emergency department, where performance of a SCO is a standard expectation. Only medical or nontrauma patients were eligible for inclusion. Data collection was performed by structured video review by 2 observers and verified by a third blinded observer. A SCO was defined as team leader (Pediatric Emergency Medicine fellow or faculty physician) verbalization of at least 1 element of the patient history/examination or an assessment of patient physiology and 1 element of the diagnostic or therapeutic plan. We independently measured teamwork using the Teamwork Emergency Assessment Measure (TEAM) tool.

Results
We reviewed 60 patient encounters from the pediatric emergency department resuscitation area between April 2018 and June 2020. Median patient age was 6 years; the team leader was a Pediatric Emergency Medicine fellow in 55% of encounters. The physician team leader performed a SCO in 38 (63%) of patient encounters. The TEAM scores were collected for 46 encounters. Mean TEAM score (SD) was 42.3 (1.7) in patients with a SCO compared with 40.0 (3.0) in those without a SCO (P = 0.007).

Conclusions
Performance of a SCO was associated with better teamwork, but the difference was of unclear clinical significance.
Assisted Partner Notification Services Are Safe and Effective as They Are Brought to Scale in Mozambique
Authors: Golden Matthew R. , Mamudo Allend , Vio Ferruccio , Branigan Erin , Paredes Zulmira , Maiela Adelina , Augusto Orvalho , Couto Aleny , Amane Guita , Chicuecue Noela , Wate Joaquim , Mudender Florindo 
Published: April 2023

Background:
The World Health Organization recommends that persons diagnosed with HIV be offered assisted partner notification services (APS). There are limited data on the safety of APS as implemented in public health programs.

Setting:
Three public health centers in Maputo, Mozambique, 2016–2019.

Methods:
Counselors offered APS to persons with newly diagnosed HIV and, as part of a program evaluation, prospectively assessed the occurrence of adverse events (AEs), including (1) pushing, abandonment, or yelling; (2) being hit; and (3) loss of financial support or being expelled from the house.

Results:
Eighteen thousand nine hundred sixty-five persons tested HIV-positive in the 3 clinics, 13,475 (71%) were evaluated for APS eligibility, 9314 were eligible and offered APS, and 9219 received APS. Index cases (ICs) named 8933 partners without a previous HIV diagnosis, of whom 6137 tested and 3367 (55%) were diagnosed with HIV (case-finding index = 0.36). APS counselors collected follow-up data from 6680 (95%) of 7034 index cases who had untested partners who were subsequently notified; 78 (1.2%) experienced an AE. Among 270 ICs who reported a fear of AEs at their initial APS interview, 211 (78%) notified ≥1 sex partner, of whom 5 (2.4%) experienced an AE. Experiencing an AE was associated with fear of loss of support (odds ratio [OR] 4.28; 95% confidence interval [CI]: 1.50 to 12.19) and having a partner who was notified, but not tested (OR 3.47; 95% CI: 1.93 to 6.26).

Conclusion:
Case-finding through APS in Mozambique is high and AEs after APS are uncommon. Most ICs with a fear of AEs still elect to notify partners with few experiencing AEs.