bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why We Left: A Qualitative Investigation of Former Physician Assistant Faculty
Authors: Graham-Burnet Karen 
Published: April 2023

Introduction
In an era of rapid professional growth, retaining a workforce of career physician assistant (PA) educators is crucial; yet, PA education has historically struggled with faculty retention. The purpose of this study was to examine the lived experiences of PAs who have left academia in order to better understand PA faculty attrition.

Methods
Purposeful sampling was used to identify PAs who had recently left academic positions, with recruitment continuing until thematic saturation was reached. A total of 18 semi-structured interviews were conducted via phone or email, and a thematic qualitative analysis of the transcripts was completed.

Results
Ineffective leadership, unsustainable workloads, inadequate mentorship or training, erroneous expectations of academic work, and a “pull” back to clinical practice emerged as dominant themes in participants' decisions to leave academia. Ineffective leadership was an issue at both the program and the institutional level, resulting in feelings of inadequate institutional support. The availability of clinical jobs facilitated attrition decisions by providing an easily accessible exit from academia.

Discussion
This research provides a model for understanding PA faculty attrition and has implications for retention. Effective program leadership that supports new faculty development, creates sustainable workloads, and advocates for the program within the institution has a significant role in faculty retention. Leadership development should be a priority for the profession and is vital to securing a PA education workforce. A limitation of this study is that the data were collected prepandemic, so the impact of recent cultural and institutional changes is unknown.
Validation of the AViTA BPM636 upper arm blood pressure monitor in adults and pregnant women according to the ANSI/AAMI/ISO 81060-2:2013
Authors: Lee Chien-Nan , Wu Cho-Kai , Huang I-Chih 
Published: April 2023

Objective
To evaluate the accuracy of the AViTA oscillometric upper arm home blood pressure (BP) monitor in adult and pregnant populations according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/ International Organization for Standardization (ANSI/AAMI/ISO) Universal Standard (ISO 81060-2:2013).

Methods
BP measurements on the upper arm were performed on 85 adult subjects and 46 pregnant subjects. The AViTA BPM636 and a standard mercury reference sphygmomanometer were applied and followed the same arm sequential BP measurement method. The universal cuff of the test device was used for arm circumference of 22–42 cm.

Results
For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 1.1 ± 5.49/2.9 ± 5.17 mmHg (systolic/diastolic) for adults; and -2.2 ± 5.93/1.5 ± 4.92 mmHg (systolic/diastolic) for pregnant women. For criterion 2, the SD of the averaged BP differences between the test device and reference BP per adult subject was 4.45/4.20 mmHg (systolic/diastolic) and per pregnant women was 4.66/3.96.

Conclusion
The AViTA BPM636 had passed the criteria of the ANSI/AAMI/ISO 81060-2:2013 protocol and can be recommended for home BP measurements in adults and pregnant populations.
Calcium phosphate microcrystallopathy as a paradigm of chronic kidney disease progression
Authors: Kuro-o Makoto 
Published: April 2023

Purpose of review
Calciprotein particles (CPP) are colloidal mineral–protein complexes mainly composed of solid-phase calcium phosphate and serum protein fetuin-A. CPP appear in the blood and renal tubular fluid after phosphate intake, playing critical roles in (patho)physiology of mineral metabolism and chronic kidney disease (CKD). This review aims at providing an update of current knowledge on CPP.

Recent findings
CPP formation is regarded as a defense mechanism against unwanted growth of calcium phosphate crystals in the blood and urine. CPP are polydisperse colloids and classified based on the density and crystallinity of calcium phosphate. Low-density CPP containing amorphous (noncrystalline) calcium phosphate function as an inducer of FGF23 expression in osteoblasts and a carrier of calcium phosphate to the bone. However, once transformed to high-density CPP containing crystalline calcium phosphate, CPP become cytotoxic and inflammogenic, inducing cell death in renal tubular cells, calcification in vascular smooth muscle cells, and innate immune responses in macrophages.

Summary
CPP potentially behave like a pathogen that causes renal tubular damage, chronic inflammation, and vascular calcification. CPP have emerged as a promising therapeutic target for CKD and cardiovascular complications.
Kidney stones, hypercalciuria, and recent insights into proximal tubule calcium reabsorption
Authors: Alexander R. Todd 
Published: April 2023

Purpose of review
Most kidney stones are composed of calcium, and the greatest risk factor for kidney stone formation is hypercalciuria. Patients who form kidney stones often have reduced calcium reabsorption from the proximal tubule, and increasing this reabsorption is a goal of some dietary and pharmacological treatment strategies to prevent kidney stone recurrence. However, until recently, little was known about the molecular mechanism that mediates calcium reabsorption from the proximal tubule. This review summarizes newly uncovered key insights and discusses how they may inform the treatment of kidney stone formers.

Recent findings
Studies examining claudin-2 and claudin-12 single and double knockout mice, combined with cell culture models, support complementary independent roles for these tight junction proteins in contributing paracellular calcium permeability to the proximal tubule. Moreover, a family with a coding variation in claudin-2 causing hypercalciuria and kidney stones have been reported, and reanalysis of Genome Wide Association Study (GWAS) data demonstrates an association between noncoding variations in CLDN2 and kidney stone formation.

Summary
The current work begins to delineate the molecular mechanisms whereby calcium is reabsorbed from the proximal tubule and suggests a role for altered claudin-2 mediated calcium reabsorption in the pathogenesis of hypercalciuria and kidney stone formation.
Direct trans-vestibular feminization thyroid laryngochondroplasty
Authors: Neiderman Narin N Carmel , Arbel Shimrit , Diamant Noa , Wolfman Karin , Yanko Ravit , Lior Yotam , Kidron Anat , Ianculovici Clariel , Kleinman Shlomo , Oestreicher-Kedem Yael 
Published: April 2023

Background:
Feminization laryngochondroplasty (FLC) evolved from a midcervical incision to a submental less visible incision. This scar may be unacceptable to the patient since it bears witness to gender reassignment. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar, however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. We propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. We describe a novel minimally invasive, direct trans-vestibular use of the chin reshaping incision, and describe our experience with it.

Methods:
The medical records of all patients who underwent direct trans-vestibular FLC (DTV-FLC) from December 2019 to September 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative and follow-up courses, complications, and functional and cosmetic results were retrieved.

Results:
Nine transgender females were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1-2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful.

Conclusions:
The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results.
Neurofibromatosis type II and facial paralysis - clinical evaluation and management.
Authors: Mohanty Ahneesh J. , DeVahl Julie , Kutz Walter J. , Rozen Shai M. 
Published: April 2023

Background:
Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges due to its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, and use of antineoplastic agents in its management. Facial reanimation literature on managing this patient population is scant.

Methods:
A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the last 13 years were retrospectively reviewed for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes.

Results:
12 patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness prior to surgical intervention was 8 months. On presentation, 1 patient suffered bilateral facial weakness, 11 had multiple cranial nerves involvement, and 7 were treated with antineoplastic agents. 2 patients underwent gracilis free functional muscle transfer, 5 underwent masseteric-to-facial nerve transfer, of whom 2 were dually innervated with a cross facial nerve graft, and 1 patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical exam was normal. Additionally, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period.

Conclusions:
Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal exam, affected outcomes.
Perforator-Based Cross Midline Flaps of the Trunk: A Paradigm Shift in Flap Design
Authors: Angrigiani Claudio , Rancati Alberto , Nahabedian Maurice Y. , Spinelli Esteban , Breppe Pablo , Rancati Agustin 
Published: April 2023

Introduction:
The traditional design for truncal perforator flaps are ipsilateral without midline decussation. The presumed rational is to minimize the risk of distal flap necrosis. In this paper we present our experience and results contralateral truncal perforator flaps designed and raised crossing the midline.

Methods:
This retrospective analysis included 43 patients (25 men and 18 women) who underwent reconstructive surgery from 1984 to 2021 using a contralateral flap design crossing the midline in the anterior trunk and upper back. Considerations included: pathology, location, as well as the dimensions of the defect and flap. An arithmetic and weighted mean with their 95% CI was estimated to compare ipsilateral and contralateral techniques.

Results:
Contralateral flaps utilized included the internal mammary perforator flap (n=28) superficial superior epigastric artery (n=8), superior epigastric perforator (n=2), and the 2 nd or 9 th dorsal intercostal artery perforator flaps (n=5). All of these flaps excluding the superficial superior epigastric artery demonstrated length and coverage surface averages that were significantly greater than those traditional ipsilateral flaps. However, with the contralateral superficial superior epigastric artery, both measures were statistically similar to those traditional ipsilateral flaps.

Conclusions:
The anatomic variation design suggests that trunk midline is not a barrier and that perforator flaps in these two regions may be raised on different longitudinal axes without compromising vitality.
Prophylactic Muscle Flaps in Patients with Oncologic Spine Disease Decrease Wound Complication Rates: A single institution cohort study
Authors: Dalton Tara , Darner Grant , McCray Edwin , Price Meghan , Baëta Cesar , Erickson Melissa , Karikari Isaac O. , Abd-El-Barr Muhammad M. , Goodwin C. Rory , Brown David A. 
Published: April 2023

Background:
Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closures are known to reduce wound healing complications in high risk patients, but the efficacy in oncologic spine patients is not well established.

Methods:
A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. We performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as well as postoperative wound complication data.

Results:
A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke (p=0.005) and had a higher incidence of prior spine irradiation (p=0.002). Postoperatively, 5 (6%) patients in the MF group developed wound complications, compared to 14 (17%) patients in the control group (p=0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in 6 (7%) control patients and 1 (1%) MF patient (p=0.053).

Conclusions:
Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention.
False-Positive Radioactive Iodine Uptake Caused by Cervical Myofascitis in a Patient With Differentiated Thyroid Carcinoma
Authors: Tan Xiang , Wang Hao , Deng Yujiao , He Limeng , Zhang Wei 
Published: April 2023

AbstractA 31-year-old woman with a history of papillary thyroid cancer underwent ablative131I therapy. Posttherapeutic whole-body131I scintigraphy revealed abnormally increased activity in the neck. Additional SPECT/CT images localized the activity in the bilateral peripheral fascia of the platysma.
Malignant Melanoma of the External Auditory Canal on 68Ga-FAPI PET/CT
Authors: Liu Ya , Ding Haoyuan , Wan Zibei , Fan Dongmei , Huang Zhanwen 
Published: April 2023

Abstract
External ear melanomas are relatively rare and usually occur in the regions of helix and ear lobes. Rarer still are primary melanomas of the external auditory canal. We report findings of melanoma of the external auditory canal on 68Ga-FAPI PET/CT in a 56-year-old man who presented with sharp pain in the external auditory canal for 7 months.
Role of Preoperative Hepatobiliary Scintigraphy in Children Requiring Liver Resection
Authors: Chaurasiya Kailash , Kireeva Elena , Yadgarov Mikhail , Akhaladze Dmitry , Likar Yury 
Published: April 2023

Purpose
The risk of posthepatectomy liver failure (PHLF) remains an important concern following major liver resection. Assessment of future remnant liver function (FRLF) by hepatobiliary scintigraphy has shown its significance to prevent PHLF after major liver resection in adults with a threshold value of FRLF greater than 2.7%/min per m2. However, such data for pediatric patients were not published.

Methods
A total of 77 pediatric patients with liver tumors who underwent 1-stage liver resection were included in this study. Assessment of FRLF, future remnant liver volume (FRLV), and the ratio of remnant liver volume to body weight (RLV-BWR) was performed before the surgery.

Results
All patients had RLV-BWR values of more than 0.5%/kg. Future remnant liver volume values ranged from 19% to 89%, and FRLF values ranged from 1.8% to 31.8%/min per m2. Only 7 of 77 patients had FRLV values less than 25%, but their FRLF values exceeded 2.7%/min per m2. Two patients developed grade A and grade B PHLF.

Conclusion
Future remnant liver volume and the RLV-BWR can be used in most pediatric patients for the assessment of liver before hepatectomy. According to our data, implementation of FRLF assessment using hepatobiliary scintigraphy can be most beneficial for children with FRLV of less than 25%. The cutoff value of FRLV greater than 25% can be slightly decreased with minimal risk of developing PHLF. However, to establish a new cutoff value for FRLV in children, further prospective studies including larger numbers of patients with FRLV of less than 25% are needed.
Blood Pressure Challenge Reduces Hematomas in Gender-Affirming Mastectomy
Authors: Slate-Romano John J. , Zeyl Victoria G. , Beqiri Dardan , Sobti Nikhil , Rao Vinay , Kwan Daniel 
Published: April 2023

Background
Gender-affirming mastectomy is a common surgery for the treatment of gender incongruence and gender dysphoria and improves quality of life. Hematoma rates for gender-affirming double incision mastectomies are between 2.8% and 8.1%. This study aims to investigate the utility of a blood pressure challenge, whereby the patient's blood pressure is medically increased intraoperatively to reveal bleeding vessels that can be addressed with additional hemostasis before skin closure, to reduce postoperative hematoma.

Methods
A retrospective chart review of patients who underwent gender-affirming double incision mastectomies over a 6-year period by a single surgeon was conducted. Surgeries were separated into a blood pressure challenge experimental group and a non–blood pressure challenge control group. Demographics, surgical characteristics, and postoperative complications were compared between the 2 cohorts using Pearson χ2, Fisher exact, t tests, univariate logistic regression, and multivariable logistical regression. Significance was established at P < 0.05.

Results
A total of 92 patients (184 breasts) were included with 32 patients (64 breasts) in the control group and 60 (120 breasts) in the blood pressure challenge group. In the control group, there were 5 hematomas (7.81%) compared with 1 (0.83%) in the blood pressure challenge group (P = 0.02). On univariate logistical regression analysis, blood pressure challenge was the only variable significantly associated with hematoma (odds ratio, 0.1; 95% confidence interval, 0.01–0.63; P = 0.04). On multivariable logistical regression, after controlling for age, body mass index, smoking status, and mass of excised breast tissue, patients who underwent blood pressure challenge demonstrated lower hematoma rates (odds ratio, 0.08; 95% CI, 0.004–0.59; P = 0.04).

Conclusions
Using an intraoperative blood pressure challenge was associated with reduced hematoma rates. Guidelines for blood pressure challenge goals should be established to standardize care and reduce complications in gender-affirming mastectomies.
Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation
Authors: Peel John K. , Pullenayegum Eleanor M. , Naimark David , Aversa Meghan , Liu Mingyao , Del Sorbo Lorenzo , Barrett Kali , Sander Beate , Keshavjee Shaf 
Published: April 2023

Background:
Ex-vivo lung perfusion (EVLP) sustains and allows advanced assessment of potentially useable donor lungs prior to transplantation, potentially relieving resource constraints.

Objective:
We sought to characterize the effect of EVLP on organ utilization and patient outcomes

Methods:
We performed a retrospective, before-after cohort study using linked institutional data sources of adults wait-listed for lung transplant and donor organs transplanted in Ontario, Canada between 2005–2019. We regressed the annual number of transplants against year, EVLP use, and organ characteristics. Time-to-transplant, waitlist mortality, primary graft dysfunction, tracheostomy insertion, in-hospital mortality, and chronic lung allograft dysfunction (CLAD) were evaluated using propensity score-weighted regression.

Results:
EVLP availability (P=0.01 for interaction) and EVLP use (P<0.001 for interaction) were both associated with steeper increases in transplantation than expected by historical trends. EVLP was associated with more donation after circulatory death (DCD) and extended-criteria donors transplanted, while the numbers of standard-criteria donors remained relatively stable. Significantly faster time-to-transplant was observed after EVLP was available (hazard ratio [HR] 1.64 [1.41–1.92]; P<0.001). Fewer patients died on the waitlist after EVLP was available, but no difference in the hazard of waitlist mortality was observed (HR 1.19 [0.81–1.74]; P=0.176). We observed no difference in the likelihood of CLAD before versus after EVLP was available.

Conclusions:
We observed a significant increase in organ transplantation since EVLP was introduced into practice, predominantly from increased acceptance of DCD and extended-criteria lungs. Our findings suggest that EVLP-associated increases in organ availability meaningfully alleviated some barriers to transplant.
Sphingomicrobium sediminis sp. nov., isolated from marine sediment in the Republic of Korea
Authors: Kim Chul-Hwan , Yoo Yeonjae , Khim Jong Seong , Xu Xiaoyue , Kim Bogun , Choi In-Geol , Kim Jae-Jin 
Published: April 2023

A Gram-stain-negative, rod-shaped, bright-orange coloured bacterium without flagellum, designated as strain GRR-S6-50T, was isolated from a tidal flat of Garorim bay, Taean-gun, Chungcheongbuk-do, Republic of Korea. Cells grew aerobically at 20–37 °C (optimum, 30 °C), pH 7.0–10.0 (optimum, pH 7.0) and with 1–5 % (w/v) NaCl (optimum, 3 %). The 16S rRNA gene sequence analysis demonstrated that strain GRR-S6-50T was closely related to

Sphingomicrobium aestuariivivum

AH-M8T with a sequence similarity of 97.80 % followed by

Sphingomicrobium astaxanthinifaciens

CC-AMO-30BT (97.44 %),

Sphingomicrobium marinum

CC- AMZ-30MT (97.16 %),

Sphingomicrobium arenosum

CAU 1457T (96.37 %),

Sphingomicrobium flavum

CC-AMZ-30NT (95.31 %) and

Sphingomicrobium lutaoense

CC-TBT-3T (95.23 %). The average nucleotide identity and digital DNA–DNA hybridization values with related strains ranged from 74.5 to 77.3% and 21.1 to 35.0 %, respectively. The G+C content of strain GRR-S6-50T was 63.30 mol%. The strain has ubiquinone-10 as the predominant respiratory quinone and the major fatty acids were C18 : 3
ω6c (54.57 %) and C17 : 1
ω6c (10.58 %). The polar lipids consisted of phosphatidylethanolamine, phosphatidylglycerol, three unidentified lipids and one glycolipid. On the basis of the results of phylogenetic, phenotypic and chemotaxonomic studies, strain GRR-S6-50T is regarded to represent a novel species within the genus

Sphingomicrobium

, for which the name Sphingomicrobium sediminis sp. nov. (KACC 22562T=KCTC 92123T=JCM 35084T) is proposed.