bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of the Vertical Distribution of the Phyllosphere Differ Between Microbial Groups and the Epi- and Endosphere in a Tropical Forest
Authors: Schimann Heidy , Vacher Corinne , Coste Sabrina , Louisanna Eliane , Fort Tania , Zinger Lucie 
Published: April 2023

The determinants of phyllosphere microbial communities are drawing much attention given their functional importance for their plant host fitness and health. Identifying these determinants remains challenging in neotropical forests, considering the diversity of the tree hosts and the strong vertical heterogeneity of abiotic conditions within the canopy and at the scale of the leaf. Here, we studied fungal and bacterial communities living in the endophytic and epiphytic phyllosphere in tree species across vertical gradients, from the top of the canopy to the ground. We used DNA metabarcoding to characterize microbial communities and measured abiotic variables and foliar traits to characterize environmental heterogeneity. The assembly of fungal communities was more driven by deterministic processes compared with bacteria, with endo- and epiphytic communities being similarly shaped by the host identity and unmeasured parameters. In contrast, in bacterial communities, the relative importance of deterministic processes decreased from endophytic to epiphytic communities. Bacterial epi- and endophytic communities were partly and differently determined by the position within the canopy, the host identity, and leaf traits, suggesting an effect of the vertical gradient and a stronger selection in the inner tissues of the leaf than on its surface. The tree host exerts a selective pressure on microbial communities but the leaf as microhabitat also contributes significantly to the assembly of microbial communities. Discrepancies exist between fungi and bacteria that probably reflect different life-history traits and ecological strategies, emphasizing the need to study these communities jointly if we are to fully understand plant–phyllosphere interactions. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Preferences on Delivery of Cancer Rehabilitation Services for Cancer-Related Disability Among Older Individuals Surviving Breast Cancer: A Qualitative Study
Authors: Brick Rachelle , Lyons Kathleen Doyle , Bender Catherine , Eilers Rachel , Ferguson Robert , Pergolotti Mackenzi , Toto Pamela , Skidmore Elizabeth , Leland Natalie E. 
Published: April 2023

Background:
Older individuals surviving breast cancer often encounter cancer-related disability as a short-term or long-term effect of cancer and related treatment. Cancer rehabilitation interventions have the potential to prevent, mitigate, or remediate cancer-related disability. However, use of these services remains limited. Understanding the priorities and perspectives of older individuals surviving breast cancer is key to developing effective and implementable cancer rehabilitation interventions. This qualitative descriptive study examined individuals' preferred and valued methods of cancer rehabilitation intervention delivery.

Methods:
Using a qualitative descriptive design, older individuals surviving breast cancer (n = 14) completed a single, telephone-based, semistructured interview. Interviews explored survivors' preferences for cancer rehabilitation service delivery. Interview transcriptions were thematically analyzed. Open codes were inductively generated and reviewed for agreement by an independent reviewer. The codes were deductively organized. Differences were resolved through consensus meetings.

Results:
Findings revealed preferred intervention delivery characteristics for intervention setting, mode of delivery, format, and timing. Participants predominantly preferred interventions delivered in community-based settings, with both in-person and remote components. Participants also appeared to value one-on-one interventions and those delivered posttreatment. Survivors' overarching preferences were based on desire for patient-centric care, one-on-one therapist time, complex medical schedules, and financial concerns.

Conclusion:
Study findings provide guidance on the modification of existing and creation of new cancer rehabilitation interventions addressing cancer-related disability in older individuals surviving breast cancer. Adoption of stakeholder-driven intervention delivery characteristics may improve value and acceptability of interventions. Future intervention research should incorporate and test these characteristics to ensure their effectiveness in real-world settings.
Application of the R2C2 Model to In-the-Moment Feedback and Coaching
Authors: Lockyer Jocelyn , Lee-Krueger Rachelle , Armson Heather , Hanmore Tessa , Koltz Elizabeth , Könings Karen , Mahalik Anne , Ramani Subha , Roze des Ordons Amanda , Trier Jessica , Zetkulic Marygrace , Sargeant Joan 
Published: April 2023

Purpose
The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use.

Method
A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor–learner dyads. Data were collected during feedback sessions and follow-up interviews between March 2021 and July 2022. The research team familiarized themselves with the data, used a coding template to document examples of the model’s application, reviewed the initial framework and revised the coding template, indexed and summarized the data, created a summary document, examined the transcripts for alignment with each model phase, and identified illustrative quotations and overarching themes.

Results
Fifteen dyads were recruited from 8 disciplines (11 preceptors were paired with a single resident [n = 9] or a single medical student [n = 2]; 2 preceptors each had 2 residents). All dyads were able to apply the R2C2 phases of building relationships, exploring reactions and reflections, and confirming content. Many struggled with the coaching components, specifically in creating an action plan and follow-up arrangements. Preceptor skill in applying the model, time available for feedback conversations, and the nature of the relationship impacted how the model was applied.

Conclusions
The R2C2 model can be adapted to contexts where in-the-moment feedback conversations occur shortly after a clinical encounter. Experiential learning approaches applying the R2C2 model are critical. Skillful application of the model requires that learners and preceptors go beyond confirming an area of change and deliberately engage in coaching and cocreating an action plan.
Anterior cervical discectomy and fusion and pneumonia: use of the VASQIP database
Authors: Koutsouras George W. , Wade Michael , Marawar Satyajit 
Published: April 2023

Background:
Anterior cervical discectomy and fusion (ACDF) may alleviate cervical radiculopathy and myelopathy, with risks including dysphagia, cerebrospinal fluid leakage, neurological injury, and post operative pneumonia (POP). The incidence of POP among non-veteran patients who underwent ACDF surgery was 0.45%. Military veterans may have higher overall complication rates after undergoing ACDF. We aimed to describe the incidence and risk factors of POP among military veterans undergoing ACDF.

Methods:
This study was a retrospective analysis of the United States Veteran Affairs Surgical Quality Improvement Program database. We assessed the patients who underwent ACDF between January 2001 and December 2017. Bivariate and multivariate statistical analyses were performed to identify the rates of POP and the factors that may increase POP risk.

Results:
Among the 18,468 patients, 195 (1.06%) experienced POP. Independent risk factors included male sex, chronic steroid use, preoperative sepsis, diabetes, poor overall health, inpatient surgery, and emergency surgery. Multilevel ACDF was associated with a higher POP rate (P<0.001). In the multivariate analysis, patients with a history of severe chronic obstructive pulmonary disease (COPD) were more than twice as likely to experience POP than those without severe COPD (P<0.001). An additional hour in surgery was associated with 16% higher odds of POP (P<0.001).

Conclusions:
The incidence of POP following ACDF is greater than the nonveteran population, which may be contributed by several factors including COPD, inpatient surgery and length of surgery. The identification of veterans as a high-risk population can potentially help guide decision making when ACDF is considered.

Level of Evidence:
III.
Outcomes of primary total joint arthroplasty in patients with a history of solid organ transplantation, a single institution analysis
Authors: Alvarez Paul M. , Curatolo Christian , Desai Miraj N. , Malik Azeem T. , Roebke Logan J. , Pigott Matthew 
Published: April 2023

Background:
An increasing number of patients with a history of solid organ transplantation (SOT) are presenting for total joint arthroplasty (TJA). The primary aim of this study is to evaluate clinical outcomes after primary total joint arthroplasty in patients with a history of SOT compared to matched controls.

Methods:
We performed a review of prospectively collected data on consecutive adult patients with a history of SOT undergoing TJA from January 2014 to January 2021. Pearson-Chi square tests were used to compare differences in baseline demographics and clinical characteristics between SOT and matched controls. Multi-variate logistic regression analyses were used to assess whether patients who had a prior SOT were at higher risk of experiencing post-operative complications, readmissions, reoperations, longer length of stay and non-home discharges after primary TJA.

Results:
A total of 81 operations met inclusion criteria which were compared to 82 age matched controls without a history of SOT. Patients with a history of SOT were more likely to require a hospitalization greater than 2 days compared to the control group (n=63, 77.8% vs. n=16, 19.5%; P=0.011), had an increased risk of hyperkalemia (n=15, 18.5% vs. n=1, 1.2%; P=0.049), and any post-operative complication (n=55, 67.9% vs. n=21, 25.6%; P=0.025).

Conclusions:
Despite the increased risk of acute post-operative complications and longer hospital stays, primary TJA has been shown to be a safe and effective option for treatment of DJD or AVN in patients with a history of SOT when completed via a multi-disciplinary approach.

Level of Evidence:
Retrospective Analysis, Level IV.
More than six months delay in anterior cruciate ligament reconstruction is associated with a higher risk of pre-reconstruction meniscal and chondral damage
Authors: Safdari Mohammadreza , Rasuli Ostadi Abdolshakur , Makhmalbaf Nahid , Makhmalbaf Mahshid , Makhmalbaf Hadi 
Published: April 2023

Background:
There is no consensus regarding the optimal timing of anterior cruciate ligament reconstruction (ACLR) and its clinical importance. Here, we compared the rate of the pre-reconstruction meniscus and cartilage injury, also the knee function, between the early ACLR (within six months of injury) and late ACLR (after six months of the injury).

Methods:
Retrospectively, 192 patients with an ACL tear who underwent ACLR within six months of injury (n=53) or after six months of injury (n=132) were included. Autograft bone patellar tendon bone was used as the graft choice. The rate of pre-reconstruction meniscal injury and chondral damage (Outerbridge classification) was compared between the two groups. The knee function, evaluated in the last follow-up using the Lysholm knee scale, was also compared.

Results:
The mean time from injury to surgery was 3.9±1.3 mo in the early group and 8.8±2.3 mo in the late group The pre-reconstruction meniscal injury was detected in 24 (45.3%) patients in the early ACLR group and 93 (66.9%) patients in the late ACLR group (P=0.006). Pre-reconstruction chondral damage was detected in six (11.3%) patients of the early ACLR group and 32 (23%) patients of the late ACLR group (P=0.049). The mean Lysholm knee scale was 86.7±6 (range 82-92) in the early ACLR group and 81.9±4.4 (range 80-84) in the late ACLR group (P<0.001).

Conclusion:
The higher rate of pre-reconstruction meniscal and chondral damage and lower functional score in the late ACLR group suggests avoiding ACLR delay more than six months after the injury.

Level of Evidence: IV.
Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends
Authors: De la Fuente Hagopian Alexa , Farhat Souha , Doval Andres F. , Reddy Narainsai K. , Yazid Mark M. , Echo Anthony 
Published: April 2023

Background:
Targeted muscle reinnervation has been adopted as a strategy for the management and prevention of phantom limb pain and symptomatic neuroma formation for patients undergoing lower extremity amputation. The procedure is often performed by surgeons different from those performing the amputation, creating scheduling dilemmas. The purpose of this study was to analyze historic trends in lower extremity amputation scheduling in a single hospital system to evaluate if offering routine immediate targeted muscle reinnervation is practical.

Methods:
De-identified data over a five-year period for all patients undergoing lower extremity amputation were collected. The data gathered included the specialty performing the amputation, weekly distribution of cases, start time, and end time, among others.

Results:
A total of 1549 lower extremity amputations were performed. There was no statistically significant difference in average number of below-the-knee amputations (172.8) and above-the-knee amputations (137.4) per year. Top specialties performing amputations were vascular surgery (47.8%), orthopedic surgery (34.5%), and general surgery (13.85%). No significant difference was noted in the average number of amputations across the week, per year. Most cases started between 6 am and 6 pm (96.4%). The average length of stay after surgery was 8.26 days.

Conclusions:
In a large, nontrauma hospital system, most lower extremity amputations are performed during typical working hours and are evenly distributed throughout the week. Understanding peak timing of amputations may allow for targeted muscle reinnervation to be performed concurrently with amputation procedure. Data presented will be a first step to optimizing amputation scheduling for patients in a large nontrauma health system.
TRPM2 regulates cell cycle through the Ca2+-CaM-CaMKII signaling pathway to promote HCC
Authors: Cai Xiaobo , Yu Xiazhen , Yang Jiawen , Lu Lin , Hua Ning , Duan Xin , Ye Peiwu , Ni Lei , Jiang Linhua , Yang Wei , Liang Tingbo , Yu Peilin 
Published: April 2023

Background:
HCC is one of the most common causes of cancer-related deaths. Transient receptor potential melastatin 2 (TRPM2), a Ca2+-permeable cation channel, was reported to be involved in carcinogenesis and tumor growth recently. However, whether TRPM2 is involved in the pathogenesis and progression of HCC remains unclear. Herein, we systematically elucidated the functional role of TRPM2 in HCC cell cycle regulation and proliferation.

Approach and Results:
We determine TRPM2 expression to be strongly upregulated in the tumor tissues of HCC patients and associated with a negative prognosis. TRPM2 is highly expressed in HCC cell lines Huh-7 and HepG2 cells, rather than in normal hepatocytes. Inhibition or silencing of TRPM2, or inhibition of the downstream Ca2+-CaM-CaMKII signaling pathway, significantly suppressed the proliferation of Huh-7 and HepG2 cells by arresting the cell cycle at the G1/S phase, accompanied with reduced expression of G1/S checkpoint proteins. Importantly, inhibition or depletion of TRPM2 remarkably slowed down the growth of patient-derived xenografts and Huh-7 xenografts in mice.

Conclusion:
Our results indicate that TRPM2 promotes HCC cell proliferation via activating the Ca2+-CaM-CaMKII signaling pathway to induce the expression of the key G1/S regulatory proteins and accelerate the cell cycle. This study provides compelling evidence of TRPM2 involvement in a previously unrecognized mechanism that drives HCC progression and demonstrates that TRPM2 is a potential target for HCC treatment.
Efficiency of a polymer-coated phacoemulsification tip in cataract surgery
Authors: Cardenas Ivan A. , Ungricht Emilie L. , Zaugg Brian , Olson Randall J. , Pettey Jeff H. 
Published: April 2023

Purpose:
To determine whether there is a difference in efficiency during phacoemulsification when using the hybrid polymer tip compared with the metal balanced tip, as measured by cumulative dissipated energy (CDE) and total procedure time.

Setting:
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:
Experimental study.

Methods:
Phacoemulsification was performed with the Centurion Vision System and Infiniti OZil handpiece, with a 30-degree bevel metal balanced tip and hybrid polymer tip. The vacuum was set at 500 mm Hg and the aspiration flow rate at 50 mL/min. Power was changed for torsional and longitudinal ultrasound (US) at 20%, 40%, 60%, 80%, and 100%. Hardened porcine lenses were cut into 200 two mm cubes, 10 for each specified tip/power setting. They were placed into an artificial anterior chamber filled with a balanced salt solution, and phacoemulsification was performed. A second observer randomly assigned the US type and power. The same observer timed trials with a stopwatch, and CDE was recorded.

Results:
There were no significant differences in time or CDE for any power levels or US modes when comparing the 2 tips.

Conclusions:
No significant difference in efficiency was observed when comparing the metal balanced tip with the hybrid polymer tip. Given the known improved safety profile and the overall equivalent efficiency of the hybrid tip, it could improve the performance of beginning and advanced surgeons in the future. Future study is needed to evaluate other setting combinations and to evaluate the hybrid tip in clinical settings.
Outcomes after microsurgical treatment of lymphedema: a systematic review and meta-analysis
Authors: Meuli Joachim N. , Guiotto Martino , Elmers Jolanda , Mazzolai Lucia , di Summa Pietro G. 
Published: April 2023

Background:
Microsurgical treatment options for lymphedema consist mainly of lymphovenous anastomosis (LVA) and vascularized lymph node transfers (VLNTs). There are no standard measurements of the effectiveness of these interventions and reported outcomes vary among studies.

Methods:
A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cinahl, Cochrane, and ProQuest in October 2020, with an update in February 2022. Firstly, a qualitative summary of the main reported outcomes was performed, followed by a pooled meta-analysis of the three most frequently reported outcomes using a random effects model. Randomized controlled trials, prospective cohorts, retrospective cohorts, and cross-sectional and case–control studies that documented outcomes following microsurgery in adult patients were included. Studies of other surgical treatments (liposuction, radical excision, lymphatic vessel transplantation) or without reported outcomes were excluded. The study protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42020202417). No external funding was received for this review.

Results:
One hundred fifty studies, including 6496 patients, were included in the systematic review. The qualitative analysis highlighted the three most frequently reported outcomes: change in circumference, change in volume, and change in the number of infectious episodes per year. The overall pooled change in excess circumference across 29 studies, including 1002 patients, was −35.6% [95% CI: −30.8 to −40.3]. The overall pooled change in excess volume across 12 studies including 587 patients was −32.7% [95% CI: −19.8 to −45.6], and the overall pooled change in the number of cutaneous infections episodes per year across 8 studies including 248 patients was −1.9 [95% CI: −1.4 to −2.3]. The vast majority of the studies included were case series and cohorts, which were intrinsically exposed to a risk of selection bias.

Conclusion:
The currently available evidence supports LVA and vascularized lymph node transfers as effective treatments to reduce the severity of secondary lymphedema. Standardization of staging method, outcomes measurements, and reporting is paramount in future research in order to allow comparability across studies and pooling of results.
Quantization of extraoral free flap monitoring for venous congestion with deep learning integrated iOS applications on smartphones: a diagnostic study
Authors: Hsu Shao-Yun , Chen Li-Wei , Huang Ren-Wen , Tsai Tzong Yueh , Hung Shao-Yu , Cheong David Chon-Fok , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Huang Jung-Ju , Tsao Chung-Kan , Lin Chih-Hung , Chuang David Chwei-Chin , Wei Fu-Chan , Kao Huang-Kai 
Published: April 2023

Background:
Free flap monitoring is essential for postmicrosurgical management and outcomes but traditionally relies on human observers; the process is subjective and qualitative and imposes a heavy burden on staffing. To scientifically monitor and quantify the condition of free flaps in a clinical scenario, we developed and validated a successful clinical transitional deep learning (DL) model integrated application.

Material and Methods:
Patients from a single microsurgical intensive care unit between 1 April 2021 and 31 March 2022, were retrospectively analyzed for DL model development, validation, clinical transition, and quantification of free flap monitoring. An iOS application that predicted the probability of flap congestion based on computer vision was developed. The application calculated probability distribution that indicates the flap congestion risks. Accuracy, discrimination, and calibration tests were assessed for model performance evaluations.

Results:
From a total of 1761 photographs of 642 patients, 122 patients were included during the clinical application period. Development (photographs =328), external validation (photographs =512), and clinical application (photographs =921) cohorts were assigned to corresponding time periods. The performance measurements of the DL model indicate a 92.2% training and a 92.3% validation accuracy. The discrimination (area under the receiver operating characteristic curve) was 0.99 (95% CI: 0.98–1.0) during internal validation and 0.98 (95% CI: 0.97–0.99) under external validation. Among clinical application periods, the application demonstrates 95.3% accuracy, 95.2% sensitivity, and 95.3% specificity. The probabilities of flap congestion were significantly higher in the congested group than in the normal group (78.3 (17.1)% versus 13.2 (18.1)%; 0.8%; 95% CI, P<0.001).

Conclusion:
The DL integrated smartphone application can accurately reflect and quantify flap condition; it is a convenient, accurate, and economical device that can improve patient safety and management and assist in monitoring flap physiology.