bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gram-Negative Rod Breast Wound Infections After Postcancer Reconstructive Surgery
Authors: Vasiloudes Kritos P. , Pate Donna M. , Greene John N. 
Published: January 2023

Background
After mastectomy, breast reconstructive surgeries using breast tissue expander (BTE) placement have a particularly high risk of infection. Whereas previous studies showed these infections to consist of primarily gram-positive organisms, gram-negative rods consist of up to 26% of the microorganisms isolated in some studies. Here we highlight the prevalence of gram-negative rods, particularly Pseudomonas aeruginosa, in BTE infections.

Methods
We used a retrospective chart review at a comprehensive cancer center to identify BTE infections caused by gram-negative rods over a 2-yearperiod. We collected data on the organism from wound cultures and antimicrobial susceptibilities.

Results
During this period, we isolated 38 gram-negative rod infections from BTE surgeries from a sample size of 215 organisms. The most common gram-negative rod was P. aeruginosa (44.7%), followed by Serratia marcescens (15.7%) and Klebsiella pneumoniae (7.9%). All Pseudomonas and Klebsiella isolates were susceptible to all antibiotics tested; Serratia isolates were resistant to cefazolin and cefoxitin. Significant resistance to ampicillin, cefazolin, cefoxitin, and ceftazidime was found in the organisms tested. Antipseudomonal antimicrobials, notably cefepime, piperacillin/tazobactam, ciprofloxacin, tobramycin, and gentamicin, had activity against all organisms tested.

Conclusions
Perioperative antimicrobial prophylaxis consisting of cefazolin often does not have activity against gram-negative rods. In addition, postoperative antibiotics often do not have activity against Pseudomonas. In our study sample, all antibiotics tested had activity against Pseudomonas. Empiric antibiotics used to treat postsurgical BTE infections should include activity against Pseudomonas.
Physiologic considerations of pig-to-human kidney xenotransplantation
Authors: Tatapudi Vasishta S. , Griesemer Adam D. 
Published: January 2023

Purpose of review
The greatest challenge facing end-stage kidney disease (ESKD) patients is the scarcity of transplantable organs. Advances in genetic engineering that mitigate xenogeneic immune responses have made transplantation across species a potentially viable solution to this unmet need. Preclinical studies and recent reports of pig-to-human decedent renal xenotransplantation signify that clinical trials are on the horizon. Here, we review the physiologic differences between porcine and human kidneys that could impede xenograft survival. Topics addressed include porcine renin and sodium handling, xenograft water handling, calcium, phosphate and acid-base balance, responses to porcine erythropoietin and xenograft growth.

Recent findings
Studies in nonhuman primates (NHPs) have demonstrated that genetically modified pig kidneys can survive for an extended period when transplanted into baboons. In recent studies conducted by our group and others, hyperacute rejection did not occur in pig kidneys lacking the α1,3Gal epitope transplanted into brain-dead human recipients. These experimental trials did not study potential clinical abnormalities arising from idiosyncratic xenograft responses to human physiologic stimuli due to the brief duration of observation this model entails.

Summary
Progress in biotechnology is heralding an era of xenotransplantation. We highlight the physiologic considerations for xenogeneic grafts to succeed.
The lupus nephritis classification: lost in translation
Authors: Whittier William L. 
Published: January 2023

Purpose of review
The ISN/RPS lupus nephritis classification is in the process of undergoing a revision. It has lost its way and morphed from a classification based on pathophysiology of disease into a staging system based on the extent of spread and prognosis.

Recent findings
There are multiple different pathophysiologic processes that contribute to lupus nephritis. The current classification is inadequate, as it does not highlight these differences and thus squanders the opportunity to develop targeted therapies. Its focus is on the extent of disease as opposed to the pattern of injury, which defines the disease. To delineate the cause, we must include immunofluorescent and electron microscopy, which will help define the pattern of injury.

Summary
To determine eventual targeted treatments for lupus nephritis, we must first classify the disease according to the available pathophysiologic mechanisms. In the upcoming revision, including the immunofluorescence and electron microscopy and eliminating the overemphasis on extent of disease are the first steps to categorizing the lupus nephritis classes accurately.
Novel therapeutic and diagnostic approaches for preeclampsia
Authors: Vatish Manu , Powys Veronica R. , Cerdeira Ana Sofia 
Published: January 2023

Purpose of review
This review will summarize recent findings relating to the diagnostic approach to preeclampsia and current avenues of research aimed at modifying the underlying disease process.

Recent findings
Growing international consensus supports a broad preeclampsia definition that incorporates maternal end-organ and uteroplacental dysfunction. Recent evidence demonstrates that this definition better identifies women and babies at risk of adverse outcomes compared to the traditional definition of hypertension and proteinuria. Multiple studies have demonstrated the usefulness and cost-effectiveness of angiogenic biomarkers such as soluble fms-like tyrosine kinase-1 and placental growth factor as a clinical adjunct to diagnose and predict severity of preeclampsia associated outcomes. Current novel therapeutic approaches to preeclampsia target pathogenic pathways (e.g. antiangiogenesis) or downstream effects such as oxidative stress and nitric oxide. Recent findings relating to these promising candidates are discussed. Multicenter clinical trials are needed to evaluate their effectiveness and ability to improve fetal and maternal outcomes.

Summary
We provide an updated framework of the current approaches to define and diagnose preeclampsia. Disease modifying therapies (in particular, targeting the angiogenic pathway) are being developed for the first time and promise to revolutionize the way we manage preeclampsia.
Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism
Authors: Chen Ziyuan , Wang Pengfei , Zhang Mengzhou , Wen Shuheng , Cheng Hao , Wang Ning , Wu Mingzhe , Wang Ziwei , Li Bingxuan , Guo Xiangshen , Zhang Yujian , Guan Dawei , Wang Linlin , Zhao Rui 
Published: January 2023

Abstract
Pulmonary thromboembolism (PTE) is a common cause of sudden unexpected death in forensic and clinical practice. Although the prevention of thrombosis has been paid more attention in clinical practice in recent years, the number of deaths due to PTE remains extensive. In the present study, 145 cases of fatal PTE were collected and retrospectively analyzed from 2001 to 2020 at the School of Forensic Medicine, China Medical University in Liaoning Province, northeast of China. The demographic characteristics, risk factors of PTE, origins of thrombi, and time interval from the occurrence of main risk factors to PTE were retrospectively analyzed. The 40 to 59 age group accounted for the 51.0% of the total cases. Immobilization, trauma (especially fracture of the pelvis, femur, tibia, or fibula), surgery, cesarean section, and mental disorders were the top 5 high-risk factors. Among the involved cases, 92.9% of the PTE (130/140) occurred within 60 days and peak at 8 to 15 days after the exposure of main risk factors. According to the autopsy findings, 87.6% of the thrombi blocked the bilateral pulmonary arteries at pulmonary hilus, with a maximum diameter of 1.6 cm and a maximum length of 21.9 cm, which were mainly derived from lower limb (65.5%) or pelvic veins (10.3%). Although the embolus limited the pulmonary circulation, there is no difference on the ratio of lung-to-heart weight between PTE and the disease-free accident victims. Overall, our present retrospective study provides important information for the forensic analysis on the cause of death and potential guidance on clinical prevention of PTE.
Pediatric Septic Shock Care Pathways in General Emergency Departments
Authors: Workman Jennifer K. , Keenan Heather T. , Weir Charlene R. 
Published: January 2023

Objectives
Many academic pediatric emergency departments (PEDs) have successfully implemented pediatric septic shock care pathways. However, many general emergency departments (GEDs), who see the majority of pediatric ED visits, have not. This study aims to compare the workflow, resources, communication, and decision making across these 2 settings to inform the future implementation of a standardized care pathway for children with septic shock in the GED.

Methods
We used the critical incident technique to conduct semistructured interviews with 24 ED physicians, nurses, and technicians at one PED and 2 GEDs regarding pediatric septic shock care. We performed a thematic analysis using the Framework Method to develop our coding schema through inductive and deductive analyses. We continued an iterative process of revising the schema until we reached consensus agreement and thematic saturation.

Results
We identified the following 6 themes: (1) functioning like a “well-oiled machine” may be key to high performance; (2) experiencing the sequence of care for children with sepsis as invariant and predictable may be essential to high-quality performance; (3) resilience and flexibility are characteristic of high levels of performance; (4) believing that “the buck stops here” may contribute to more accountability; (5) continuous system learning is essential; and (6) computerized clinical decision support may not be optimized to drive decision-making at the point of care. Commentary from GED and PED participants differed across the 6 themes, providing insight into the approach for standardized care pathway implementation in GEDs.

Conclusions
Pediatric septic shock workflow, decision making, and system performance differ between the PED and GEDs. Implementation of a standardized care pathway in GEDs will require a tailored approach. Specific recommendations include (1) improving shared situation awareness; (2) simulation for knowledge, skill, and team-based training; and (3) promoting a culture of continuous learning.
HIV viral load monitoring during monkeypox virus infection among people with HIV
Authors: Raccagni Angelo Roberto , Mileto Davide , Galli Laura , Bruzzesi Elena , Canetti Diana , Rizzo Alberto , Bertoni Costanza , Clemente Tommaso , Alberton Francesca , Castagna Antonella , Nozza Silvia 
Published: January 2023

Objectives:
Aims of this study were to assess the characteristics of Mpox among people with HIV (PWH) and describe the change of some immune-virological parameters during Mpox virus infection.

Design:
Case series of PWH diagnosed with Mpox between May and July 2022 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy.

Methods:
Real-time PCR was used to detect Mpox virus on oropharyngeal, cutaneous, genital and rectal swabs, plasma, seminal fluids, and urines. The values of the CD4+ lymphocytes and HIV-RNA were assessed both at Mpox diagnosis and after Mpox virological clearance and were compared to those prior to Mpox. The relationship between the symptoms clinical duration of Mpox and the CD4+ cell count at diagnosis was assessed with Spearman's correlation coefficient.

Results:
Overall, 28 PWH on antiretroviral therapy with Mpox were evaluated. HIV-RNA did not substantially change at Mpox infection with respect to previous virological profile (P = 0.721). However, at time of Mpox diagnosis, we observed a detectable HIV-RNA (196 copies/ml) in one individual previously undetectable (HIV-RNA < 20 copies/ml) and an increase to 1.220 copies/ml in a previously viremic subject (HIV-RNA = 263 copies/ml). No significant differences in CD4+ cell count were found before and at time of Mpox diagnosis (P = 0.151) and a higher CD4+ cell count at Mpox diagnosis was marginally related to a lower duration of Mpox symptoms (r = −0.341, P = 0.068).

Conclusions:
Among PWH, we advise monitoring HIV viral load at Mpox diagnosis and during follow-up, as well as providing counseling on the results, due to the important individual and community implications.
A Systematic Review of Electromagnetic Treatments for Body Contouring
Authors: Swanson Eric 
Published: January 2023

Background
Energy-based treatments include ultrasound, lasers, cryolipolysis, and radiofrequency. The most recent energy treatment for noninvasive body contouring is electromagnetic treatments—a hot topic in plastic surgery today. A systematic review to assess efficacy and safety has not been published.

Methods
An electronic search was performed using PubMed to identify the literature describing electromagnetic treatments. Measurements from imaging studies were tabulated and compared.

Results
Fourteen clinical studies were evaluated. Two studies included simultaneous radiofrequency treatments. In 11 studies, the Emsculpt device was used; in 2 studies, the Emsculpt-Neo device was used. One study included a sham group of patients. The usual protocol was 4 treatments given over a 2-week period. No complications were reported. Eight studies included abdominal measurement data obtained using magnetic resonance imaging, computed tomography, or ultrasound. Photographic results were typically modest. Photographs showing more dramatic results also showed unexplained reductions in untreated areas.
Measurement variances were high. The mean reduction in fat thickness was 5.5 mm. The mean increment in muscle thickness was 2.2 mm. The mean decrease in muscle separation was 2.9 mm (P = 0.19). Early posttreatment ultrasound images in 1 study showed an echolucent muscle layer, compared with a more echodense layer at the baseline, consistent with tissue swelling after exercise. Almost all studies were authored by medical advisors for the device manufacturer.

Discussion
Measurement data show small reductions in fat thickness, occurring almost immediately after the treatments. Adipocyte removal without tissue swelling would be unique among energy-based treatments. Similarly, muscle hypertrophy is not known to occur acutely after exercise; muscle swelling likely accounts for an early increment in muscle thickness. Any improvement in the diastasis recti is likely fictitious.

Conclusions
Electromagnetic treatments, either administered alone or in combination with radiofrequency, are safe. However, the evidence for efficacy is tenuous. Measured treatment effects are very small (<5 mm). Conflict of interest and publication bias are major factors in studies evaluating energy-based alternatives. The evidence-based physician may not be satisfied that an equivocal treatment benefit justifies the time and expense for patients.
Current Practices and Trends in Midface Rejuvenation
Authors: Shehan Jennifer N. , Ryll Lucia S. , LeClair Jessica , Ezzat Waleed H. 
Published: January 2023

Background
Cosmetic approaches to midface aging are complex and vary in their treatment methodology. The nature of cosmetic surgery limits clinical trial data, forcing surgeons to rely on small studies and professional preferences when choosing an approach. Our study aimed to quantitatively assess national trends in midface rejuvenation practices.

Methods
We conducted a cross-sectional study consisting of a survey administered through the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Plastic Surgeons listservs. To evaluate trends, techniques were grouped into 2 categories: minimally invasive (injectable fillers, fat transfer, fat repositioning) or invasive (deep plane facelift, subperiosteal lift, malar/cheek alloplastic implant, bone grafting/bone advancement).

Results
Two hundred thirty-two survey responses were received. Of the total respondents, 46.52% were certified by the American Board of Facial Plastic and Reconstructive Surgery, and 48.26% were certified by the American Board of Plastic Surgery. Minimally invasive techniques were far more preferred (66.67%) over invasive (33.33%) techniques, with injectable fillers as the most common technique (34.88%), followed by fat transfer (20.93%). Deep plane facelift was preferred over subperiosteal lift (18.60% vs 7.91%, respectively). Surgeons board certified by the American Board of Facial Plastic and Reconstructive Surgery were more inclined to perform invasive techniques over those board certified by the American Board of Plastic Surgery (P = 0.0427).

Conclusion
This study quantitatively assessed national trends in cosmetic approaches to midface aging. Our data suggest that trends among surgeons across the United States have shifted toward favoring minimally invasive techniques over more invasive approaches.
Anti-interleukin-6 Antibody Clazakizumab in Antibody-mediated Kidney Transplant Rejection: Effect on Donor-derived Cell-free DNA and C-X-C Motif Chemokine Ligand 10
Authors: Mayer Katharina A. , Doberer Konstantin , Halloran Philip F. , Budde Klemens , Haindl Susanne , Mühlbacher Jakob , Eskandary Farsad , Viard Thierry , Casas Silvia , Jilma Bernd , Böhmig Georg A. 
Published: January 2023

Background.
Targeting interleukin-6 (IL-6) was shown to counteract donor-specific antibody production and antibody-mediated rejection (AMR) activity. It is not known whether, or to what extent, IL-6 antagonism modulates biomarkers indicative of tissue damage (donor-derived cell-free DNA [dd-cfDNA]) and parenchymal inflammation (C-X-C motif chemokine ligand [CXCL] 10).

Methods.
We report a secondary endpoint analysis of a phase 2 trial of anti-IL-6 antibody clazakizumab in late AMR (ClinicalTrials.gov, NCT03444103). Twenty kidney transplant recipients were randomized to treatment with clazakizumab or placebo over 12 wk (part A), followed by an extension in which all recipients received clazakizumab through week 52 (part B). Biomarkers were evaluated at day 0 and after 12 and 52 wk, respectively.

Results.
Fractional dd-cfDNA (dd-cfDNA[%]) did not significantly change under clazakizumab, with no differences between study arms (clazakizumab versus placebo) at week 12 (1.65% [median; interquartile range: 0.91%–2.78%] versus 0.97% [0.56%–2.30%]; P = 0.25) and no significant decrease from weeks 12 to 52 (1.15% [0.70%–2.38%] versus 1.0% [0.61%–1.70%]; P = 0.25). Similarly, urine CXCL10 was not different between groups at week 12 (55.7 [41.0–91.4] versus 60.2 [48.8–208.7.0] pg/mg creatinine; P = 0.44) and did not change over part B (CXCL10 [pg/mg creatinine]: from 58 [46.3–93.1] to 67.4 [41.5–132.0] pg/mL creatinine; P = 0.95). Similar results were obtained for serum CXCL10. There was no association between biomarker levels and resolution of molecular and morphologic AMR activity.

Conclusions.
Our results suggest that IL-6 blockade does not significantly affect levels of dd-cfDNA[%] and CXCL10. Subtle responses to this therapeutic principle may be overlooked by early biomarker surveillance.
Liver Transplantation for Budd-Chiari Syndrome in the MELD Era
Authors: Alqahtani Saleh A. , Schneider Carolin , Sims Omar T. , Gurakar Ahmet , Tamim Hani , Bonder Alan , Saberi Behnam 
Published: January 2023

Background.
To evaluate clinical characteristics and factors associated with survival among liver transplantation (LT) recipients with Budd-Chiari syndrome (BCS), with or without transjugular intrahepatic portosystemic shunt (TIPS), in the post–Model for End-stage Liver Disease era.

Methods.
We extracted data from the United Network for Organ Sharing database on all adult (≥18 y old) waitlisted candidates and recipients of LT with BCS in the United States between 2002 and 2019. Multivariable Cox regression was used to determine predictors of mortality and hazard ratios (HRs).

Results.
A total of 647 BCS patients were waitlisted between 2002 and 2019. BCS was an indication for LT in 378 (0.2%) of all adult LT recipients during the study period. Of BCS patients who received LT, approximately three-fourths (72.3%) were alive for up to 10 y. We found no significant difference in LT outcomes in BCS patients with or without TIPS. Longer length of hospital stay following LT (HR, 1.32; 95% confidence interval [CI], 1.19-1.47), Black/African American race (HR, 2.24; 95% CI, 1.38-3.64), diabetes (HR, 3.17; 95% CI, 1.62-6.21), donor risk index (HR, 1.44; 95% CI, 1.05-1.99), and lower albumin levels at the time of transplantation (HR, 0.66; 95% CI, 0.50-0.88) were negatively associated with survival after LT. Interestingly, neither the Model for End-stage Liver Disease nor prior TIPS showed a significant association with survival after LT.

Conclusions.
These findings demonstrate good comparable survival among TIPS versus no TIPS in LT recipients with BCS. The decision for TIPS versus LT should be individualized on a case-by-case basis.
Opicapone Pharmacokinetics and Effects on Catechol-O-Methyltransferase Activity and Levodopa Pharmacokinetics in Patients With Parkinson Disease Receiving Carbidopa/Levodopa
Authors: LeWitt Peter , Liang Grace S. , Olanow C. Warren , Kieburtz Karl D. , Jimenez Roland , Olson Kurt , Klepitskaya Olga , Loewen Gordon 
Published: January 2023

Objectives
Levodopa (LD) administered with dopa decarboxylase inhibitor is predominantly metabolized in the periphery by catechol-O-methyltransferase (COMT) to 3-O-methyldopa (3-OMD). Catechol-O-methyltransferase inhibition can improve treatment outcomes by decreasing variability in circulating LD concentrations. Opicapone is a once-daily COMT inhibitor approved in the US adjunctive to carbidopa (CD)/LD in patients with Parkinson disease experiencing “OFF” episodes. This study aimed to evaluate the pharmacokinetics and pharmacodynamics of once-daily opicapone 50 mg adjunctive to CD/LD in patients with stable Parkinson disease.

Methods
Once-daily opicapone 50 mg was administered the evenings of days 1 to 14. Participants were randomized to receive CD/LD (25/100 mg) every 3 or 4 hours (Q3H or Q4H). Participants received Q3H or Q4H CD/LD on days 1, 2, and 15 and their usual CD/LD regimen on other days. Serial blood samples were collected to determine plasma opicapone, LD, and 3-OMD concentrations and erythrocyte soluble COMT (S-COMT) activity. The effects of opicapone on S-COMT, LD, and 3-OMD were assessed. Mean (SD) values are presented.

Results
Sixteen participants were enrolled. At steady-state (day 14), opicapone C
max (peak plasma concentration) and AUC0-last (area under the curve-time curve) were 459 ± 252 ng/mL and 2022 ± 783 ng/mL·h, respectively. Maximum COMT inhibition was 83.4 ± 4.9% of baseline on day 14. After opicapone administration, LD total AUC, peak concentration, and trough concentration increased; peak-to-trough fluctuation index decreased. Correspondingly, 3-OMD total AUC, peak concentration, and trough concentration decreased.

Conclusions
Adding once-daily opicapone 50 mg to LD resulted in marked and extended COMT inhibition, which increased systemic exposure to LD. These changes translated into higher trough concentrations and decreased peak-to-trough fluctuations for LD.