bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operation Diversify Plastic Surgery: An Innovative Strategy to Increase Diversity in Plastic and Reconstructive Surgery
Authors: Downer Mauricio A. , Hill Dorian , Mulenga Chilando , Vinson Ariel , Soto Edgar , Bashorun Olatunde , McCauley DeCoria , Wiltz Kylar , Newman Ashley , Butler Paris D. 
Published: September 2023

Summary:
Healthcare disparities remain a significant problem facing the US healthcare system with recent evidence of persistent racial and ethnic disparities especially among patients from minority backgrounds. Recent studies have documented advantages to a racially and ethnically diverse surgical workforce such as higher patient satisfaction scores, superior patient compliance with physician recommendations, and increased participation in clinical research studies by minority patients. In plastic and reconstructive surgery (PRS), there is a noted deficit among residents and faculty that come from ethnically underrepresented in medicine (URiM) backgrounds despite recent efforts to increase diversity in PRS surgeons. URiM medical students from three of the four historically Black medical universities organized to discuss pathways to PRS. Operation Diversify Plastic Surgery is a student-led organization that was developed to address the lack of diversity in PRS, challenges faced by students from institutions that lack PRS residency training programs, and unique factors that affect URiM students interested in PRS. Available studies note that mentoring relationships and research opportunities were instrumental in recruiting URiM students into PRS residency programs. Operation Diversify Plastic Surgery is an innovative solution to the insufficient URiM PRS residency candidate pool by increasing medical student exposure to PRS via educational lectures, virtual mentoring opportunities, and insights into research fellowships.
Establishment of a Simple, Reproducible, and Long-lasting Hind Limb Animal Model of Lymphedema
Authors: Morita Yuichi , Sakata Naoaki , Kawakami Ryo , Shimizu Masayuki , Yoshimatsu Gumpei , Wada Hideichi , Kodama Shohta 
Published: September 2023

Background:
Lymphedema is an intractable disease for which there is currently no established curative therapy. A reliable and long-lasting lymphedema model is essential for development of better treatments. In this study, we aimed to establish a simple, reproducible and long-lasting mouse model of lymphedema.

Methods:
Our model is characterized by a combination of a circumferential skin incision in the femoral region, complete dissection of regional lymph nodes, and ablation of the inguinal route in the femoral region. The characteristics of the lymphedema were evaluated and compared with those of two other models. One of these models involved dissection of the subiliac, popliteal, and sciatic lymph nodes (model A) and the other excision of the subiliac, popliteal, and sciatic lymph nodes with cauterization of lymphatic vessels and closure without a skin excision (model B).

Results:
Although the lymphedema in models A and B resolved spontaneously, that in the new model lasted for a month with increases in femoral circumference and hind limb volume, thickening of the skin, especially subcutaneous tissue, and congestion of peripheral lymphatic vessels. Furthermore, this model could be used for assessing the therapeutic effects of syngeneic mesenchymal stem cell transplantation. The average operation time for the new model was 14.4 ± 1.3 minutes.

Conclusion:
Long-lasting lymphedema can be achieved by our new model, making it suitable for assessing therapies for lymphedema.
Efficiency Determinants in Healthcare: A Systematic Review With an Integrated Canonical Correlation Analysis–Data Envelopment Analysis/Assurance Region Model
Authors: Samut Pınar Kaya 
Published: September 2023

Goal:
Instead of considering many variables for the accurate measurement of healthcare efficiency, working with the select few variables that really affect efficiency will provide more accurate efficiency scores. In addition, calculating the efficiency by weighting the inputs and outputs according to their effect and severity levels will give more realistic results. In this article, a three-step hybrid system with a two-stage CCA (canonical correlation analysis)–DEA/AR (data envelopment analysis/assurance region) model is proposed to obtain results of health efficiency.

Methods:
Healthcare efficiency studies conducted between 2000 and 2020 were reviewed. In this examination of the input and output variables used in the DEA of 63 previous studies, the 6 inputs and 5 outputs preferred by previous researchers were determined. Afterward, the health efficiency scores of countries represented in the research were calculated with weight-restricted DEA, and CCA was used for a priori statistical analysis in determining the weights. Thus, in this analysis of the preferred outputs and inputs with the help of CCA to estimate the relationship between multiple input and output sets, the variables that had no effect were eliminated and the ones that had an effect were included in DEA/AR with their degree of effectiveness.

Principal Findings:
For the model proposed here, three inputs and three outputs were identified by following a five-item variable reduction procedure. The numbers of doctors and nurses were identified as the most effective inputs, and infant mortality rates were found to be the most effective outputs. Therefore, health efficiency scores obtained with the proposed CCA–DEA/AR model and the basic DEA are presented together. A review of the results found fewer health-efficient countries with the weight-restricted DEA. This is proof that weighting the variables into the DEA increases the discriminating power of the method.

Practical Applications:
By applying the proposed model, healthcare administrators can analyze healthcare efficiency accurately and thus improve efficiency by transferring limited resources to the right places according to deficiencies or surpluses identified by the model's inputs. Resources can be allocated at both private and public hospitals in a way that increases healthcare efficiency outputs.
Effect of differing flap reconstruction strategies in perineal closure following advanced pelvic oncological resection: a retrospective cohort study
Authors: Galbraith Norman J. , McCollum Catherine , Di Mascio Lucia , Lowrie Joanna , Hinckley Matthew , Lo Steven , Watson Stuart , Telfer John R.C. , Roxburgh Campbell S. , Horgan Paul G. , Chong Peter S. , Quinn Martha , Steele Colin. W. 
Published: September 2023

Introduction:
Advancing approaches to locally invasive pelvic malignancy creates a large tissue defect resulting in perineal wound complications, dehiscence, and perineal hernia. Use of reconstructive flaps such as vertical rectus abdominus myocutaneous (VRAM) flap, gracilis, anterolateral thigh (ALT) and gluteal flaps have been utilised in our institution to address perineal closure. We compared outcomes using different flap techniques along with primary perineal closure in advanced pelvic oncological resection.

Methods:
A prospectively maintained database of patients undergoing advanced pelvic oncological resection in a single tertiary hospital was retrospectively analysed. This study included consecutive patients between 2014 and 2021 according to the Strengthening The Reporting of Cohort Studies in Surgery (STROCSS) criteria. Primary outcome measures were the frequency of post-operative perineal complications between primary closure, VRAM, gluteal and thigh (ALT and gracilis) reconstruction.

Results:
122 patients underwent advanced pelvic resection with perineal closure. Of these, 40 patients underwent extra-levator abdominoperineal resection (ELAPE), and 70 patients underwent pelvic exenteration. Sixty-four patients received reconstructive flap closure, which included VRAM (22), gluteal (21) and thigh flaps (19). Perineal infection and dehiscence rates were low. Infection rates were lower in the flap group despite a higher rate of radiotherapy (P<0.050). Reoperation rates were infrequent (<10%) but specific for each flap, such as donor-site hernia following VRAM and flap dehiscence after thigh flap reconstruction.

Conclusions:
In patients who are at high risk of post-operative perineal infections, reconstructive flap closure offers acceptable outcomes. VRAM, gluteal and thigh flaps offer comparable outcomes and can be tailored to the individual patient.
Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center. a cohort study
Authors: Solomon Daniel , Sarfaty Elad , Menasherov Nikolai , Bard Vyacheslav , Bueno Raphael , Kashtan Hanoch 
Published: September 2023

Background:
Esophagectomy is associated with significant perioperative morbidity. Limited data are available on the process of implementation of minimally invasive techniques in esophagectomy and related outcomes. We sought to describe implementation processes and outcomes following implementation of the first minimally invasive esophagectomy (MIE) program at a high-volume center in Israel under the mentorship of American early adopters.

Methods:
Patients who underwent esophagectomy for esophageal carcinoma 2011–2022 were included. Early and late cohorts were created for learning curve analysis. Secondary analysis included patients who underwent open esophagectomy 1997-2011.

Results:
Overall, 300 patients underwent MIE: three-field MIE (3F-MIE) was performed in 242 (80.7%) patients, two-field MIE (2F-MIE) in 58 (19.3%) patients. Following program implementation in 2012, the number of MIE performed increased during the first 3 years (n=33, 86.8% in 2015). Among 3F-MIE patients, a higher number of retrieved lymph nodes was reported during later cases (median, IQR1-3 17, 12-23 vs. 12, 8-12, P<0.001) while surgeries required a longer time (median, IQR1-3 300 minutes, 261-355 vs. 262.5, 239-300, P<0.001). Among 2F-MIE patients, the late cohort had lower rates of prolonged ICU admissions than earlier counterparts (n=2, 6.9% vs. n=9, 31%, P=0.041), overall and severe 30-day complications (n=12, 41.4% vs. n=23, 79.3%, P<0.001 and n=7, 24.1% vs. n=23, 79.3%, P=0.003).

Conclusions:
Minimally invasive esophagectomy was safely implemented. Nodal yield was higher among MIE patients than open esophagectomy. During the study years, open approach was gradually abandoned in favor of 3F-MIE procedures, while 2F-MIE increased over the course of the last years.
Diagnostic value of exfoliated tumor cells combined with DNA methylation in bronchoalveolar lavage fluid for lung cancer
Authors: Lu Huiling , Lin Dang 
Published: September 2023

Background:
To evaluate the diagnostic value of exfoliated tumor cells (ETCs) numbers combined with DNA methylation levels in bronchoalveolar lavage fluid (BALF) in lung cancer.

Methods:
BALF samples were collected from 43 patients with lung cancer and 23 with benign lung disease. ETCs were detected by the nano-enrichment method, and the methylation status of the short stature homeobox gene 2 (SHOX2) and the RAS association domain family 1, isoform A (RASSF1A) gene were detected by RT-PCR. The diagnostic value of each metric was evaluated by receiver operating characteristic curve analysis, specificity and sensitivity.

Results:
The sensitivity/specificity of RASSF1A and SHOX2 methylation detection were 44.12%/76.47% and 93.75%/87.50%, respectively. When “RASSF1A/SHOX2 methylation” was used as a positive result, the sensitivity increased to 88.24%, and the specificity decreased to 81.25%. When “RASSF1A + SHOX methylation” was used as positive, the sensitivity was reduced to 32.35%, but the specificity was increased to 100.00%. The sensitivity and specificity of ETCs detection in BALF were 89.47% and 16.67%, respectively. When “SHOX2/RASSF1A methylation + ETCs was used as a positive result, the sensitivity and specificity of the detection were 79.31% and 81.82%, respectively. When “SHOX2 + RASSF1A + ETCs” was used as positive, the sensitivity was 34.48% and the specificity was 90.91%. Receiver operating characteristic curve analysis showed that when SHOX2, RASSF1A methylation and ETCs were combined, the diagnostic sensitivity increased to 0.778.

Conclusion:
ETCs counting in combination with SHOX2 and RASSF1A methylation assays in BALF samples has demonstrated excellent sensitivity for lung cancer diagnosis and is an effective complementary tool for clinical diagnosis of lung cancer.
Vascular supply of postresection pancreatic remnant after pancreaticoduodenectomy: A cadaveric study
Authors: Rousek Michael , Kachlík David , Záruba Pavel , Pudil Jiří , Schütz Štěpán Ota , Balko Jan , Pohnán Radek 
Published: September 2023

Objectives:
The vascular supply to the neck and body of the pancreas is highly variable. The dorsal pancreatic artery is the dominant artery feeding this area. The aim of this study was to describe the vascular supply of postresection pancreatic remnants after pancreaticoduodenectomy. Patients with hazardous anatomical arrangement may be at a higher risk of postresection remnant ischemia and postoperative pancreatic fistula development.

Methods:
The modified Whipple procedure was performed on 20 cadaveric donors. The macroscopic anatomical supply of the postresection pancreatic remnant of each donor was evaluated.

Results:
The arterial supply of the postresection remnant was highly variable. In 30% of cases (6/20), the dorsal pancreatic artery was cut during the pancreatoduodenectomy or it was missing. In these cases, the area of the pancreaticojejunostomy construction was fed only through anastomoses between the transverse pancreatic artery and the pancreatic branches of the splenic artery.

Conclusions:
In 30% of cases, the arterial supply of the postresection pancreatic remnant was dependent on inconstant intraparenchymal arterial anastomoses. These patients may be at a higher risk of postoperative pancreatic fistula development.
Virtual volunteering, community support, and self-care in Chinese communities in Canada
Authors: Tan Weijia , Zhu Yidan , Wu Liuxi , Hou Jingyi , Yi Jingjing , Qi Tianyang , Zhang Weiguo 
Published: September 2023

Abstract

Objective:
Our study aimed to explore the link between environment and health, driven by a virtual volunteering program, and discuss the implications of virtual volunteering in community support in the postpandemic era.

Methods:
Using a purposive sampling strategy, we recruited 21 participants with diverse backgrounds, including age and sex. They participated in individual interviews of 1–2 hours, all of which followed a semistructured interview guide centered on topics, such as volunteer experiences, impacts, and understanding of volunteering. The audio recordings were transcribed verbatim and analyzed using a grounded theory approach.

Results:
Our data showed that interpersonal interactions through the virtual volunteering program helped participants deal with loneliness, and boosted their mental health. The social network provided participants with social support. Moreover, activities, such as dancing, yoga, Tai Chi, and singing, facilitated physical health. Participants not only learned various skills but also served as mentors, through which they increased self-efficacy through reciprocal role transformation.

Conclusions:
Our study concludes that virtual volunteer programs have a positive impact on people’s physical and mental health. The participants demonstrated different levels of resilience when their environments changed. By situating virtual volunteering as the center of people’s health, our findings suggest that people gain informational, instrumental, and emotional support through virtual volunteering. Future research should examine the experiences of individuals from other ethnic groups and settings to supplement this study.
Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study
Authors: Levasseur Julie , Fikse Lauren , Mauguen Audrey , Killinger James S. , Karam Oliver , Nellis Marianne E. 
Published: September 2023

OBJECTIVES:
To determine the incidence of bleeding in critically ill children with malignancy and to describe associated patient characteristics, interventions, and clinical outcomes.

DESIGN:
Prospective cohort study.

SETTING:
PICU in a specialized cancer hospital.

PATIENTS:
Children with malignancy or hematopoietic cell transplant 0–18 years of age were admitted to the PICU from November 2020 to November 2021.

INTERVENTIONS:
None.

MEASUREMENTS:
Patient demographic data, laboratory values, and PICU outcome data were collected. Bleeding was classified according to the Bleeding Assessment Scale in Critically Ill Children.

MAIN RESULTS:
Ninety-three bleeding patients were enrolled, and a total of 322 bleeding days were recorded. The median (interquartile range [IQR]) age was 5.8 (2.9–11.8) years and 56% (52/93) of the patients were male. There were 121 new bleeding episodes, in 593 at-risk person-days, translating into a 20% incidence rate per day (95% CI, 17–24%). The incidence of severe, moderate, and minimal bleeding was 2% (95% CI, 1–3), 4% (95% CI, 3–6), and 14% (95% CI, 12–17), respectively. Of the new bleeding episodes, 9% were severe, 25% were moderate and 66% were minimal. Thrombocytopenia was the only laboratory value independently associated with severe bleeding (p = 0.009), as compared to minimal and moderate bleeding episodes. History of radiation therapy was independently associated with severe bleeding (p = 0.04). We failed to identify an association between a history of stem cell transplant (p = 0.49) or tumor type (p = 0.76), and bleeding severity. Patients were transfused any blood product on 28% (95% CI, 22–34) of the bleeding days. Severe bleeding was associated with increased length of mechanical ventilation (p = 0.003), longer PICU stays (p = 0.03), and higher PICU mortality (p = 0.004).

CONCLUSIONS:
In this prospective cohort of children with malignancy, the incidence rate of bleeding was 20%. Most events were classified as minimal bleeding. Low platelet count and radiation therapy were variables independently associated with severe bleeding episodes.
18F-FDG PET/CT in a Patient With Epididymo-Testicular Malacoplakia
Authors: Zhao Xulong , Long Zaiying , Yu Liming , Wang Xinjie , Fu Zhanli 
Published: September 2023

Abstract
A 56-year-old man presented with a 2-month history of a mass in the right epididymo-testicular region, which exhibited heterogeneous high avidity for 18F-FDG on PET/CT. Malignant tumor was highly suspected, leading to subsequent right orchiectomy and epididymectomy. Histopathological examination revealed the presence of characteristic Michaelis-Gutmann bodies within von Hansemann macrophages, confirming the diagnosis of malacoplakia.
The genome of a steinernematid-associated Pseudomonas piscis bacterium encodes the biosynthesis of insect toxins
Authors: Awori Ryan Musumba , Hendre Prasad Suresh , Amugune Nelson O. 
Published: September 2023

Several species of soil-dwelling Steinernema nematodes are used in the biocontrol of crop pests, due to their natural capacity to kill diverse species of lepidopterans. Although this insect-killing trait is known to be augmented by the nematodes’ Xenorhabdus endosymbionts, the role of other steinernematid-associated bacterial genera in the nematode lifecycle remains unclear. This genomic study aimed to determine the potential of Pseudomonaspiscis to contribute to the entomopathogenicity of its Steinernema host. Insect larvae were infected with three separate Steinernema cultures. From each of the three treatments, the prevalent bacteria in the haemocoel of cadavers, four days post-infection were isolated. These three bacterial isolates were morphologically characterised. DNA was extracted from each of three bacterial isolates and used for genome sequencing and assembly. Assemblies were used to delineate species and identify genes that encode insect toxins, antimicrobials, and confer antibiotic resistance. We assembled three complete genomes. Through digital DNA-DNA hybridisation analyses, we ascertained that the haemocoels of insect cadavers previously infected with Steinernema sp. Kalro, Steinernema sp. 75, and Steinernema sp. 97 were dominated by Xenorhabdus griffiniae Kalro, Pseudomonas piscis 75, and X. griffiniae 97, respectively. X. griffiniae Kalro and X. griffiniae 97 formed a subspecies with other X. griffiniae symbionts of steinernematids from Kenya. P. piscis 75 phylogenetically clustered with pseudomonads that are characterised by high insecticidal activity. The P. piscis 75 genome encoded the production pathway of insect toxins such as orfamides and rhizoxins, antifungals such as pyrrolnitrin and pyoluteorin, and the broad-spectrum antimicrobial 2,4-diacetyl phloroglucinol. Its genome encoded resistance to over ten classes of antibiotics, including cationic lipopeptides. Steinernematid-associated P. piscis bacteria hence have the biosynthetic potential to contribute to nematode entomopathogenicity.
Thymoquinone-Protoflavone Hybrid Molecules as Potential Antitumor Agents
Authors: Ahmed Sara H. H. , Tayeb Bizhar A. , Gonda Tímea , Girst Gábor , Szőri Kornél , Berkecz Róbert , Zupkó István , Minorics Renáta , Hunyadi Attila 
Published: September 2023

AbstractWe describe herein the synthesis of eight new ester-coupled hybrid compounds from thymoquinone and protoflavone building blocks, and their bioactivity testing against multiple cancer cell lines. Among the hybrids, compound 14 showed promising activities in all cell lines studied. The highest activities were recorded against breast cancer cell lines with higher selectivity to MDA-MB-231 as compared to MCF-7. Even though the hybrids were found to be completely hydrolysed in 24 h under cell culture conditions, compound 14 demonstrated a ca. three times stronger activity against U-87 glioblastoma cells than a 1:1 mixture of its fragments. Protoflavone-thymoquinone hybrids may therefore serve as potential new antitumor leads particularly against glioblastoma.
Larvicidal effect of some traditional Saudi Arabian herbs againstAedes aegyptilarvae, a vector of dengue fever
Authors: Sharawi Somia Eissa 
Published: September 2023

AbstractMosquitoes are effective disease vectors for human and veterinary health because they share a close environment with humans and represent a major public health problem. Saudi Arabia is home to the endemic dengue fever disease, carried by theAedes aegyptimosquito. Conventional insecticides based on organophosphates and insect growth regulators are the most effective short-term control methods for this vector. However, these insecticides are toxic to non-target organisms, the environment, and humans. This study, eight plant extracts (Ilex paraguariensis, Camellia sinensis, Cinnamomum zeylanicum, Elettaria cardamomum, Matricaria chamomilla, Allium sativum, Coffea arabica, andPiper nigrum) were assayed as an insecticide against the 3rdand 4thlarval stage ofAe. aegypti(L.), after 24 and 48 h of exposure in the duration between March and June 2023. After 48h, all plants extracted showed the highest mortality (100%), except forC. arabicawhich showed the lowest mortality rate (98.33%) at 30%.I. paraguariensisshowed the greatest effectiveness with an LC50=7.17 ppm, followed byP. nigrumwith an LC50= 5.66 ppm. Further investigation is needed to purify the active ingredients responsible for their toxicity to mosquito larvae and to investigate the mechanisms of action of plant extracts in water and other solvents.