bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drowning in Children and Predictive Parameters
Authors: Peri Francesca , De Nardi Laura , Canuto Arianna , Gaiero Alberto , Noli Serena , Ferretti Marta , Vergine Gianluca , Falcioni Alice , Copponi Elisabetta , Tagliabue Bruna , Massart Francesco , Fabiani Elisabetta , Stringhi Carlo , Rubini Monica , Zamagni Giulia , Amaddeo Alessandro , Genovese Maria Rita , Norbedo Stefania 
Published: June 2023

Background
Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors.

Methods
This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning.

Results
One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3–10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel (P = 0.388 vs 0.390).

Conclusions
This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention.
Modifiable Post-Mastectomy Radiation Therapy Factors and Impact on Implant-Based Breast Reconstruction Outcomes
Authors: Barnes Laura L. , Chew Jessica , Lem Melinda , Park Catherine , Yang Joanna C. , Prionas Nicolas , Piper Merisa 
Published: June 2023

Introduction:
Intensity modulated radiation therapy (IMRT) and other modifiable radiation factors have been associated with decreased radiation toxicity. These factors could allow for improved reconstructive outcomes in patients requiring post-mastectomy radiation therapy (PMRT). However, they have not yet been well-studied in implant-based breast reconstruction (IBBR).

Methods:
We performed a retrospective chart review of patients who underwent mastectomy with immediate tissue expander placement followed by PMRT. Radiation characteristics were collected, including radiation technique, bolus regimen, X-ray energy, fractionation, maximum radiation hot spot (DMax), and tissue volume receiving >105% (V105%) or >107% (V107%) of the prescription dose. Reconstructive complications occurring after initiation of PMRT were analyzed with respect to these radiation characteristics.

Results:
68 patients (70 breasts) were included in this study. The overall complication rate was 28.6%, with infection being the most common complication (24.3%), requiring removal of the tissue expander or implant in greater than half of infections (15.7%). DMax was greater in patients who required explant after PMRT, and this approached statistical significance (114.5+/-7.2% v. 111.4+/-4.4%, p=0.059). V105% and V107% were also greater in patients who required explant after PMRT (42.1+/-17.1% v. 33.0+/-20.9% and 16.4+/-14.5% v. 11.3+/-14.6%, respectively), however this was not statistically significant (p=0.176 and p=0.313, respectively). There were no significant differences in complication rates between patients with respect to radiation technique or other radiation characteristics studied.

Conclusions:
Minimizing the radiation hot spots and volumes of tissue receiving greater than the prescription dose of radiation may improve reconstructive outcomes in patients undergoing IBBR followed by PMRT.
A Novel Method Using the Petal Pattern for Contouring a Domed Nipple in Tuberous Breasts
Authors: Go Ju Young , Lee Youngdae , Lee Won 
Published: June 2023

Summary:
The main cause of domed nipples is increased pressure, which causes the breast tissue to herniate toward the nipple-areola complex. It appears as a characteristic of a tuberous breast rather than occurring alone, and the boundary between the nipple and areolar region is unclear. The authors present a method using petal patterns for single-stage aesthetic correction of domed nipples. The method is designed by placing the left and right corners of each petal at the desired position as the edge boundary of the nipple. The number and width of petals are adjusted so that the obtuse angle between the nipple and areola is 90 to 100 degrees. The areolar and soft tissues in the designed patterns are excised together with the skin and collected using a barbed suture in a specially designed suture technique. Surgery is completed after the skin is sutured using nylon. Case examples are presented to illustrate the appropriate candidate selection and results. Overall, the aesthetic results are positive in terms of shape and patient satisfaction. This method is useful for contouring domed nipples. This new design is simple, leaves minimal scars, and provides the surgeon with an additional option for treating tuberous breasts. It can be used alone or along with breast augmentation.
Endoscopic Concurrent Gastrocnemius Muscle Resection and Soleus Muscle Neurectomy for Severe Muscular Calf Hypertrophy
Authors: Hsu Honda , Lee Jiunn-Tat 
Published: June 2023

Background:
Selective neurectomy or muscle resection techniques for calf reduction conventionally focus on the gastrocnemius muscle. However, the underlying soleus muscle plays an important role in muscular calf hypertrophy. In the authors’ experience, the results of calf reduction have been suboptimal in patients with severe muscular calf hypertrophy who underwent gastrocnemius muscle resection only. This article describes a new calf reduction method that uses concurrent gastrocnemius muscle resection and soleus muscle neurectomy using an endoscope-assisted single-incision approach in patients with severe muscular calf hypertrophy.

Methods:
A total of 139 patients who underwent simultaneous gastrocnemius muscle resection and soleus muscle neurectomy for severe calf hypertrophy from March of 2017 to June of 2020 were retrospectively analyzed.

Results:
After combined gastrocnemius resection (mean weight per calf, 349 g) and soleus neurectomy, about 3.8 to 8.2 cm (mean, 6.4 cm) or 12.8% to 24.3% (mean, 16.6%) of the calf was reduced. Complications included cellulitis, hematoma, seroma, and mild depression (n = 1 each). Two patients had traction injury to the sural nerve. One patient developed Achilles tendon rupture at 2 months postoperatively. No patient complained of functional impairment with respect to easy fatigability, stability, gait, or sport activities at 6 months postoperatively.

Conclusion:
This study is the first to combine gastrocnemius muscle resection with selective soleus muscle neurectomy to achieve the most efficient calf reduction for severe muscular calf hypertrophy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Increased 68Ga-FAPI Uptake in Benign Metastasizing Leiomyoma
Authors: Wu Simin , Cai Jiayu , Chen Qi , Wu Jing , Chen Haojun 
Published: June 2023

Abstract
Benign metastasizing leiomyomas (BMLs) are benign disseminated extrauterine tumors in patients with prior history of uterine leiomyomas and may occur years after hysterectomy. In this case, we presented 18F-FDG and 68Ga-FAPI PET/CT findings in a 37-year-old woman with benign leiomyoma metastasizing to lung and pelvis. The metastatic lesions demonstrated faint 18F-FDG but elevated 68Ga-FAPI activity, indicating the low level of glucose metabolism but excessive accumulation of activated fibroblasts in the BMLs. This case demonstrated that 68Ga-FAPI PET/CT may be potentially useful in the evaluation of BMLs.
Unexpected Solitary Subcutaneous Metastasis From Esophageal Carcinoma Revealed by MDP Bone Scintigraphy
Authors: Liu Huipan , Xiang Feifan , Xie Yang , Liu Lin , Chen Yue 
Published: June 2023

Abstract
A 60-year-old man with back pain underwent 99mTc-MDP to evaluate bone metastases from newly esophageal carcinoma. No bone metastasis was found on the whole-body bone scan. Unexpectedly, subcutaneous metastasis revealed increased 99mTc-MDP activity.
The Impact of Postoperative Antibiotic and Duration After Implant-Based Breast Reconstruction on Resistance Among Cultured Species
Authors: Driscoll Cassandra R. , Grosser Joshua A. , Davidson Amelia L. , Lloyd Kelsey M. , Prabhu Shamit S. , Katz Adam J. 
Published: June 2023

Background
There is a growing presence of literature within plastic surgery that establishes best practice for postoperative antibiotics after implant-based breast reconstruction (IBBR), although it has not been widely adopted or translated into clinical practice. This study aims to determine how antibiotic and duration affects patient outcomes. We hypothesize that IBBR patients who receive a longer duration of postoperative antibiotics will demonstrate higher rates of antibiotic resistance as compared with the institutional antibiogram.

Methods
A retrospective chart review included patients who underwent IBBR between 2015 and 2020 at a single institution. Variables of interest included patient demographics, comorbidities, surgical techniques, infectious complications, and antibiograms. Groups were classified by antibiotic (cephalexin, clindamycin, or trimethoprim/sulfamethoxazole) and duration (≤7 days, 8–14 days, and >14 days).

Results
There were a total of 70 patients who experienced infections included in this study. Onset of infection did not differ based on antibiotic during either device implantation (postexpander P = 0.391; postimplant P = 0.234). Antibiotic and duration did not have an established relationship with explantation rate either (P = 0.154). In patients who had Staphylococcus aureus isolated, there was significantly increased resistance to clindamycin when compared with the institutional antibiogram (sensitivities of 43% and 68%, respectively).

Conclusions
Neither antibiotic nor duration displayed a difference in overall patient outcomes, including explantation rates. In this cohort, S. aureus strains isolated in association with IBBR infections demonstrated a higher level of resistance to clindamycin compared with strains isolated and tested within the broader institution.
Reliable Location of Upper Extremity Lymphatic Channels for Use in Immediate Lymphatic Reconstruction
Authors: Wainwright D’Arcy , Weinstein Brielle , Le Nicole K. , Parikh Jeegan , Panetta Nicholas J. 
Published: June 2023

Background
Breast cancer–related lymphedema (BCRL) is a limiting sequelae of breast cancer treatment that may negatively impact 30% to 50% of high-risk breast cancer survivors. Risk factors for development of BCRL include axillary lymph node dissection (ALND), and recently, axillary reverse lymphatic mapping and immediate lymphovenous reconstruction (ILR) at time of ALND have been implemented to prevent BCRL. Reliable anatomy of neighboring venules has been commented on in the literature; however, little information exists about anatomical location of local lymphatic channels amenable for bypass.

Methods
After institutional review board approval, patients who underwent ALND with axillary reverse lymphatic mapping and ILR at a tertiary cancer center from November 2021 to August 2022 were applicable for this study. The location and number of lymphatic channels used for ILR were identified and measured intraoperatively with the arm abducted to 90 degrees and soft tissue under no tension. Four measurements were taken to localize each lymphatic and were based on relationship with reliable anatomic landmarks including 4th rib, anterior axillary line, and lower border of the pectoralis major muscle. Demographics, oncologic treatments, intraoperative factors, and outcomes were prospectively maintained.

Results
Twenty-seven patients met inclusion for this study by August 2022 with a total of 86 lymphatic channels identified. Patients were on average 50 ± 12 years old with a body mass index of 30 ± 6 and had an average of 1 vein and 3 identifiable lymphatic channels amenable to bypass. Seventy percent of lymphatic channels were found in a cluster of 2 or more channels. The average horizontal location was 4.5 ± 1.4 cm lateral to the 4th rib. The average vertical location was 1.3 ± 0.9 cm from the superior border of the 4th rib.

Conclusions
These data comment upon intraoperatively identified and consistent location of upper extremity lymphatic channels used for ILR. These lymphatic channels are often found in clusters with 2 or more lymphatic channels at the same location. Such insight may aid in easier intraoperative identification of amenable vessels for the unexperienced surgeon, decrease in intraoperative time, and higher success of ILR.
Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare
Authors: Perloff Jennifer , Hasley Rebecca , Kumar Senthil Subbiah , Chapman John , Coffron Matt , Opelka Frank 
Published: June 2023

Objective:
This proof-of-concept explores the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example.

Summary /background data:
Price transparency is an important policy issue that will require surgeons to better understand the components and cost of care.

Methods:
This study uses the Episode Grouper for Medicare (EGM) business logic to construct colectomy surgical episodes of care for cancer using Medicare claims data for the Boston Hospital Referral Region (HRR) from 2012-2015. Descriptive statistics show the mean reimbursement based on patient severity and stage of surgery along with the number of unique clinicians billing for care and the mix of services provided.

Results:
The EGM episode grouper identified 3,182 colectomies in Boston between 2012 and 2015 with 1,607 done for cancer. The mean Medicare allowed amount per case is $29,954 and varies from $26,605 to $36,850 as you move from low to high severity cases. The intra-facility stage is the most expensive ($23,175 on average) compared to the pre ($780) and post ($6,479) facility stages. There is tremendous heterogeneity in service mix.

Conclusion:
Episode groupers are a potentially valuable tool for identifying variation in service mix and teaming patterns that correlate with total price. By looking at patient care holistically, stakeholders can identify opportunities for price transparency and care redesign that have heretofore been hidden.
Omics Signatures of Tissue Injury and Hemorrhagic Shock in Swine
Authors: LaCroix Ian S. , Cralley Alexis , Moore Ernest E. , Cendali Francesca I. , Dzieciatkowska Monika , Hom Patrick , Mitra Sanchayita , Cohen Mitchell , Silliman Christopher , Sauaia Angela , Hansen Kirk C. , D’Alessandro Angelo 
Published: June 2023

Objective:
Advanced mass spectrometry methods were leveraged to analyze both proteomics and metabolomics signatures in plasma upon controlled tissue injury and hemorrhagic shock – isolated or combined - in a swine model, followed by correlation to viscoelastic measurements of coagulopathy via thrombelastography.

Summary Background Data:
TI and HS cause distinct molecular changes in plasma in both animal models and trauma patients. However, the contribution to coagulopathy of trauma, the leading cause of preventable mortality in this patient population remains unclear. The recent development of a swine model for isolated or combined TI + HS facilitated the current study.

Methods:
Male swine (n=17) were randomized to either isolated or combined tissue injury and hemorrhagic shock. Coagulation status was analyzed by thrombelastography during the monitored time course. The plasma fractions of the blood draws (at baseline, end of shock and at 30 min, 1, 2 and 4h after shock) were analyzed by mass spectrometry-based proteomics and metabolomics workflows.

Results:
HS– isolated or combined with TI - caused the most severe omic alterations during the monitored time course. While isolated TI delayed the activation of coagulation cascades. Correlation to TEG parameters of clot strength (MA) and breakdown (LY30) revealed signatures of coagulopathy which were supported by analysis of gene ontology enriched biological pathways.

Conclusion:
The current study provides a comprehensive characterization of proteomic and metabolomic alterations to combined or isolated TI and HS in a swine model, and identifies early and late omics correlates to viscoelastic measurements in this system.
Restoring Microcirculatory Perfusion in a Preclinical Model of Severe Hemorrhagic Shock: The Role of Microcirculatory Function
Authors: Kang Hae Sung , Khoraki Jad , Li Ru , Xu Haoxuan , Archambault Caitlin , Liebrecht Loren K. , Mangino Martin J. 
Published: June 2023

Abstract

Background
No reflow in capillaries (no reflow) is the lack of tissue perfusion that occurs once central hemodynamics are restored. This prevents oxygen transfer and debt repayment to vital tissues after shock resuscitation. Since metabolic swelling of cells and tissues can cause no reflow, it is a target for study in shock. We hypothesize no reflow secondary to metabolic cell swelling causes the problem not addressed by current strategies that increase central hemodynamics alone.

Methods
Anesthetized swine were bled until plasma lactate reached 7.5-9 mM. Intravenous low volume resuscitation (LVR) solutions were administered (6.8 ml/kg over 5 min) consisting of; 1.) LR, 2.) Autologous whole blood (WB), 3.) High dose Vitamin C (VC, 200 mg/kg), or 4.) 10% PEG-20 k, a polymer-based cell impermeant that corrects metabolic cell swelling. Outcomes were macro-hemodynamics (MAP), plasma lactate, capillary flow in the gut and tongue mucosa using orthogonal polarization spectral imaging (OPSI), and survival to 4 hours.

Results
All PEG-20 k resuscitated swine survived 240 min with MAP above 60 mmHg compared to 50% and 0% of the WB and LR groups, respectively. The VC group died at just over 2 hours with MAPs below 40 and high lactate. The LR swine only survived 30 min and died with low MAP and high lactate. Capillary flow positively correlated (P < 0.05) with survival and MAP. Sublingual OPSI correlated with intestinal OPSI and OPSI was validated with a histological technique.

Discussion
Targeting micro-hemodynamics in resuscitation may be more important than macro-hemodynamics. Fixing both is optimal. Sublingual OPSI is clinically achievable to assess micro-hemodynamic status. Targeting tissue cell swelling that occurs during ATP depletion in shock using optimized osmotically active cell impermeants in crystalloid LVR solutions improves perfusion in shocked tissues, which leverages a primary mechanism of injury.
High positive end-expiratory pressure ventilation mitigates the progression from unilateral pulmonary contusion to ARDS: An animal study
Authors: Landeck Tobias , Schwarz Henrike , Hammermüller Sören , Noreikat Katharina , Reske Stefan , Gottschaldt Udo , Nestler Christian , Wolf Samuel Johannes , Ramm Jan , Lange Mirko , Wrigge Hermann , Girrbach Felix , Brehm Walter , Reske Andreas Wolfgang 
Published: June 2023

BACKGROUNDPulmonary contusion (PC) is common in severely traumatized patients and can lead to respiratory failure requiring mechanical ventilation (MV). Ventilator-induced lung injury (VILI) might aggravate lung damage. Despite underrepresentation of trauma patients in trials on lung-protective MV, results are extrapolated to these patients, potentially disregarding important pathophysiological differences.METHODSThree MV protocols with different positive end-expiratory pressure (PEEP) levels: ARDSnetwork lower PEEP (ARDSnet-low), ARDSnetwork higher PEEP (ARDSnet-high), and open lung concept (OLC) were applied in swine for 24 hours following PC. Gas exchange, lung mechanics, quantitative computed tomography, and diffuse alveolar damage (DAD) score were analyzed. Results are given as median (interquartile range) at 24 hours. Statistical testing was performed using general linear models (group effect) over all measurement points and pairwise Mann-WhitneyUtests for DAD.RESULTSThere were significant differences between groups: PEEP (p< 0.0001) ARDSnet-low (8 [8–10] cmH2O), ARDSnet-high (12 [12–12] cmH2O), OLC (21 [20–22] cmH2O). The fraction of arterial partial pressure of oxygen and inspired oxygen fraction (p= 0.0016) was lowest in ARDSnet-low (78 (73–111) mm Hg) compared with ARDSnet-high (375 (365–423) mm Hg) and OLC (499 (430–523) mm Hg). The end-expiratory lung volume (EELV) differed significantly (p< 0.0001), with highest values in OLC (64% [60–70%]) and lowest in ARDSnet-low (34% [24–37%]). Costa's surrogate for mechanical power differed significantly (p< 0.0001), with lowest values for ARDSnet-high (73 [58–76]) compared with OLC (105 [108–116]). Diffuse alveolar damage was lower in ARDSnet-high compared with ARDSnet-low (0.0007).CONCLUSIONProgression to ARDS, 24 hours after PC, was mitigated by OLC and ARDSnet-high. Both concepts restored EELV. ARDSnet-high had the lowest mechanical power surrogate and DAD. Our data suggest, that ARDSnet-high restored oxygenation and functional lung volume and reduced physiological and histological surrogates for VILI. ARDSnet-low generated unfavorable outcomes, such as loss of EELV, increased mechanical power and DAD after PC in swine. The high respiratory rate in the OLC may blunt favorable effects of lung recruitment.
Inflammation Markers Among Schizophrenia Patients Who Use Cannabis
Authors: Fridman Jonathan , Bloemhof-Bris Esther , Weizman Shira , Kessler Tal , Porat Dorit , Ivry Amos , Wolf Aviva , Stryjer Rafael , Shelef Assaf 
Published: June 2023

Objectives
The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without.

Methods
In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use.

Results
No differences were found in the NLR and MPV values between the groups.

Conclusion
The results were contrary to our expectations. These results may be explained by the presentation of a “pseudo-balanced” picture created when multiple processes affect inflammatory indices.