bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aesthetic Outcomes of the Adipofascial Turnover Flap for Nasal Defects
Authors: Canzoneri Christina N. , Capito Anthony E. 
Published: April 2023

Background:
The single-stage adipofascial turnover (AFT) flap with full-thickness skin grafting is a novel technique that has been demonstrated as a safe, reliable, and cost-effective alternative to forehead flaps for nasal tip reconstruction. The purpose of this study was to compare aesthetic outcomes of these reconstructive techniques.

Methods:
A retrospective review was conducted of patients who underwent either a forehead flap or an AFT flap for nasal reconstruction between January 2016 and January 2021. Aesthetic outcomes were compared via patient surveys and photographic analysis by plastic surgeons. All photographs were standardized and masked to conceal which reconstructive technique was utilized. Wilcoxon rank-sum tests and t-tests were performed to determine significance.

Results:
Ten forehead flaps and 22 AFT flaps were performed between January 2016 and January 2021. Seven forehead flap patients and 18 AFT flap patients participated in the aesthetic outcome survey. Seven forehead flap postoperative photographs and 20 AFT flap postoperative photographs were available for analysis. Patients who underwent forehead flap reconstruction reported higher satisfaction for color match of the reconstruction to the surrounding nasal skin (P = 0.005). Otherwise, there was no statistical significance between the two patient groups. There was no statistical difference in the photographic analysis of the two groups.

Conclusion:
The single-stage AFT flap with full thickness skin grafting provides similar aesthetic outcomes compared with the two-stage forehead flap when reconstructing large defects of the nasal tip, which is supported by both patient-reported outcome measures and standardized photographic analysis by a panel of plastic surgeons.
Optic Disc Measurements in Children by Optical Coherence Tomography
Authors: Hashemi Hassan , Khabazkhoob Mehdi , Heydarian Samira , Emamian Mohammad Hassan , Fotouhi Akbar 
Published: April 2023

Précis:This study showed the distribution of optic disc indices in a population-based sample of Iranian children in detail. Refractive errors and biometric components are among the ocular factors that are related to these indices.Purpose:To determine the normative value of optic nerve indices in children and their association with ocular and demographic factors.Methods:A cross-sectional study was conducted in 2018. Biometry was done using the Allegro Biograph, and macular indices were measured by OCT imaging.Results:After applying the exclusion criteria, 9051 eyes of 4784 children were analyzed. The mean±SD and 95% confidence intervals (in parentheses) of vertical cup-to-disc ratio, average cup-to-disc ratio, rim area, disc area, and cup volume were 0.45±0.15(0.45–0.46) mm, 0.43±0.14 (0.42–0.43) mm, 1.46±0.25 (1.45–1.47) mm2, 1.92±0.35 (1.91–1.93) mm2, and 0.14±0.14 (0.14–0.15) mm3, respectively. Vertical cup-to-disc ratio and average cup-to-disc ratio had a positive association with intraocular pressure (IOP) (both βs=0.003), and a negative association with retinal nerve fiber layer thickness (both βs=−0.001), central corneal thickness (CCT) (both βs=−0.001), anterior chamber depth (β=−0.025 and β=−0.027, respectively), lens thickness (β=−0.034 and β=−0.032, respectively), and mean keratometry (MK) (both βs=−0.015). The average cup-to-disc ratio had a positive association with height (β=0.001). Rim area had a negative association with increased age (β=−0.008), axial length (β=−0.065), IOP (β=−0.009), and MK (β=−0.014) and a positive association with macular volume (β=0.021), retinal nerve fiber layer thickness (β=0.004), and CCT (β=0.001). Disc area had a positive association with macular volume (β=0.031) and a negative association with female sex (β=−0.037), axial length (β=−0.087), anterior chamber depth (β=−0.112), lens thickness (β=−0.059), and MK (β=−0.048). The results of generalized estimating equations showed that cup volume was smaller in girls (β=−0.009), and had a positive association with height (β=0.001), IOP (β=0.003) and negative association with CCT (β=−0.0001) and MK (β=−0.012).Conclusion:The results provided the normative values of optic disc indices in children. Demographic factors, biometric components, IOP, SBP, and retinal parameters had a significant association with optic disc indices.
Acceptance and Benefit of Electroacoustic Stimulation in Children
Authors: Spitzer Emily R. , Kay-Rivest Emily , Waltzman Susan B. , O'Brien Colleen A. , Santacatterina Michele , Roland J. Thomas , Landsberger David M. , Friedmann David R 
Published: April 2023

Objective
Children with high-frequency severe-to-profound hearing loss and low-frequency residual hearing who do not derive significant benefit from hearing aids are now being considered for cochlear implantation. Previous research shows that hearing preservation is possible and may be desirable for the use of electroacoustic stimulation (EAS) in adults, but this topic remains underexplored in children. The goal of this study was to explore factors relating to hearing preservation, acceptance, and benefits of EAS for children.

Study Design
Retrospective review.

Setting
Tertiary academic medical center.

Patients
Forty children (48 ears) with preoperative low-frequency pure-tone averages of 75 dB HL or less at 250 and 500 Hz (n = 48).

Intervention
All patients underwent cochlear implantation with a standard-length electrode.

Main Outcome Measure
Low-frequency audiometric thresholds, speech perception, and EAS usage were measured at initial stimulation, and 3 and 12 months postoperatively. Outcomes were compared between children with and without hearing preservation, and between EAS users and nonusers.

Results
Hearing was preserved at similar rates as adults but worse for children with an enlarged vestibular aqueduct. Fewer than half of children who qualified to use EAS chose to do so, citing a variety of audiologic and nonaudiologic reasons. No differences were detected in speech perception scores across the groups for words, sentences, or sentences in noise tests.

Conclusions
Neither hearing preservation nor EAS use resulted in superior speech perception in children with preoperative residual hearing; rather, all children performed well after implantation.
Racial and Ethnic Disparities in Opioid Prescriptions in Benign and Malignant Pancreatic Disease in the United States
Authors: McHenry Nicole , Ahmed Awais , Shah Ishani , Freedman Steven D. , Nee Judy , Lembo Anthony , Sheth Sunil G. 
Published: April 2023

Objectives
Racial-ethnic disparities in pain management are common but not known among pancreatic disease patients. We sought to evaluate racial-ethnic disparities in opioid prescriptions for pancreatitis and pancreatic cancer patients.

Methods
Data from the National Ambulatory Medical Care Survey were used to examine racial-ethnic and sex differences in opioid prescriptions for ambulatory visits by adult pancreatic disease patients.

Results
We identified 207 pancreatitis and 196 pancreatic cancer patient visits, representing 9.8 million visits, but weights were repealed for analysis. No sex differences in opioid prescriptions were found among pancreatitis (P = 0.78) or pancreatic cancer patient visits (P = 0.57). Opioids were prescribed at 58% of Black, 37% of White, and 19% of Hispanic pancreatitis patient visits (P = 0.05). Opioid prescriptions were less common in Hispanic versus non-Hispanic pancreatitis patients (odds ratio, 0.35; 95% confidence interval, 0.14–0.91; P = 0.03). We found no racial-ethnic differences in opioid prescriptions among pancreatic cancer patient visits.

Conclusions
Racial-ethnic disparities in opioid prescriptions were observed in pancreatitis, but not pancreatic cancer patient visits, suggesting possible racial-ethnic bias in opioid prescription practices for patients with benign pancreatic disease. However, there is a lower threshold for opioid provision in the treatment of malignant, terminal disease.
Preoperative Rapid Weight Loss as a Prognostic Predictor After Surgical Resection for Pancreatic Cancer
Authors: Nishikawa Makoto , Yamamoto Junji , Einama Takahiro , Hoshikawa Mayumi , Iwasaki Toshimitsu , Nakazawa Akiko , Takihara Yasuhiro , Tsunenari Takazumi , Kishi Yoji 
Published: April 2023

Objective
The aim of the study is to evaluate the influence of cachexia at the time of diagnosis of pancreatic ductal adenocarcinoma (PDAC) on prognosis in patients undergoing surgical resection.

Methods
Patients with data on preoperative body weight (BW) change followed by surgical resection during 2008–2017 were selected. Large BW loss was defined as weight loss >5% or >2% in individuals with body mass index less than 20 kg/m2 within 1 year preoperatively. Influence of large BW loss, ΔBW defined as preoperative BW change (%) per month, prognostic nutrition index, and indices of sarcopenia.

Results
We evaluated 165 patients with PDAC. Preoperatively, 78 patients were categorized as having large BW loss. ΔBW was ≤ −1.34% per month (rapid) and > −1.34% per month (slow) in 95 and 70 patients, respectively. The median postoperative overall survival of rapid and slow ΔBW groups was 1.4 and 4.4 years, respectively (P < 0.001). In multivariate analyses rapid ΔBW (hazard ratio [HR], 3.88); intraoperative blood loss ≥430 mL (HR, 1.89); tumor size ≥2.9 cm (HR, 1.74); and R1/2 resection (HR, 1.77) were independent predictors of worse survival.

Conclusions
Preoperative rapid BW loss ≥1.34% per month was an independent predictor of worse survival of patients with PDAC.
A Subset of Pancreatoblastomas May Arise From an Adenomatous Precursor
Authors: Slack Jonathan C. , Bründler Marie-Anne , Box Adrian , Koro Konstantin 
Published: April 2023

Abstract
Pancreatoblastomas are rare pediatric tumors. In adults, they are exceedingly rare and seem to have a worse prognosis. Most are sporadic, though rare, cases occur in patients with familial adenomatous polyposis. Unlike pancreatic ductal adenocarcinomas, pancreatoblastomas are not believed to arise from dysplastic precursor lesions. Clinical history, along with endoscopic, pathological, and molecular findings, was reviewed for a 57-year-old male patient with an ampullary mass who presented with obstructive jaundice. Microscopic examination showed a pancreatoblastoma subjacent to an adenomatous polyp with intestinal differentiation and low-grade dysplasia. Both tumors had abnormal p53 (complete loss) and nuclear β-catenin immunostaining. Mutational panel analysis showed an identical CTNNB1 (p.S45P) mutation in both. This case adds to our understanding of the pathogenesis of these rare tumors and suggests that a subset may arise from an adenomatous precursor. In addition, this case is just the second pancreatoblastoma to originate in the duodenal ampulla, and the preceding case suggests that an ampullary location leads to earlier diagnosis. Moreover, this case highlights the difficulty in diagnosing pancreatoblastoma on limited tissue specimens and illustrates the need to include pancreatoblastoma in the differential diagnosis in all tumors in and around the pancreas, including those in adult patients.
Pancreatic Neuroendocrine Tumor: Rationale for Centralization in an Integrated Health Care System
Authors: Kwak Hyunjee V. , Hsu Diana S. , Le Sidney T. , Chang Alex L. , Spitzer Austin L. , Kazantsev George B. , Peng Peter D. , Chang Ching-Kuo 
Published: April 2023

Objectives
Given the complex surgical management and infrequency of pancreatic neuroendocrine tumor, we hypothesized that treatment at a center of excellence improves survival.

Methods
Retrospective review identified 354 patients with pancreatic neuroendocrine tumor treated between 2010 and 2018. Four hepatopancreatobiliary centers of excellence were created from 21 hospitals throughout Northern California. Univariate and multivariate analyses were performed. The χ2 test of clinicopathologic factors determined which were predictive for overall survival (OS).

Results
Localized disease was seen in 51% of patients, and metastatic disease was seen in 32% of patients with mean OS of 93 and 37 months, respectively (P < 0.001). On multivariate survival analysis, stage, tumor location, and surgical resection were significant for OS (P < 0.001). All stage OS for patients treated at designated centers was 80 and 60 months for noncenters (P < 0.001). Surgery was more common across stages at the centers of excellence versus noncenters at 70% and 40%, respectively (P < 0.001).

Conclusions
Pancreatic neuroendocrine tumors are indolent but have malignant potential at any size with management often requiring complex surgeries. We showed survival was improved for patients treated at a center of excellence, where surgery was more frequently utilized.
Overwork Among ICU Nurses
Authors: Xie Tian , He Wenhao , Jiu Zhaohua , Li Qixia , Huang Changyang , Liu Jiali , Sun Zhongwen , Zhang Huiting 
Published: April 2023

OBJECTIVE
This study aimed to describe the current situation and explore overwork predictors among ICU nurses in China.

BACKGROUND
Overwork is a comprehensive condition of labor where employees work for extended periods with high intensity and high pressure, which can negatively affect their health. Limited literature exists regarding the prevalence, characteristics, professional identity, and environment of overwork among ICU nurses.

METHODS
A cross-sectional design study was conducted. The Professional Identification Scale for Nurses, the Practice Environment Scale of the Nursing Work Index, and the Overwork Related Fatigue Scale (ORFS) were used. To explore relationships between variables, univariate analysis or bivariate correlations were used. Multiple regression was used to identify predictors of overwork.

RESULTS
Almost 85% of nurses were categorized as overworked, of which, 30% were moderately to severely overworked. Gender, form of employment, stress related to ICU nursing technology and equipment updates, nurses' professional identity, and nurse working environment accounted for 36.6% in the ORFS.

CONCLUSIONS
Overwork is common among ICU nurses. Nurse managers need to develop and implement strategies to better support nurses to prevent overwork.
Ability of a polygenic risk score to refine colorectal cancer risk in Lynch syndrome
Authors: Dueñas Nuria , Klinkhammer Hannah , Bonifaci Nuria , Spier Isabel , Mayr Andreas , Hassanin Emadeldin , Díez-Villanueva Anna , Moreno Victor , Pineda Marta , Maj Carlo , Capellá Gabriel , Aretz Stefan , Brunet Joan 
Published: April 2023

ABSTRACTBackgroundPolygenic risk scores (PRS) have been used to stratify colorectal cancer (CRC) risk in the general population, whereas its role in Lynch syndrome (LS), the most common type of hereditary CRC, is still conflicting. We aimed to assess the ability of PRS to refine CRC risk prediction in European-descendant LS individuals.Methods1,465 LS individuals (557MLH1, 517MSH2/EPCAM, 299MSH6, and 92PMS2)and 5,656 CRC-free population-based controls from two independent cohorts were included. A 91-Single Nucleotide Polymorphism PRS was applied. A Cox proportional hazard regression model with “family” as a random effect and a logistic regression analysis, followed by a meta-analysis combining both cohorts were conducted.ResultsOverall, we did not observe a statistically significant association between PRS and CRC risk in the entire cohort. Nevertheless, PRS was significantly associated with a slightly increased risk of CRC or advanced adenoma (AA), in those with CRC diagnosed < 50 years, and in individuals with multiple CRCs or AAs diagnosed < 60 years.ConclusionThe PRS may slightly influence CRC risk in LS individuals, in particular in more extreme phenotypes such as early-onset disease. However, the study design and recruitment strategy strongly influence the results of PRS studies. A separate analysis by genes and its combination with other genetic and non-genetic risk factors will help refine its role as a risk modifier in LS.KEY MESSAGESWHAT IS ALREADY KNOWN ON THIS TOPIC?-Great variability in the incidence of CRC has been described in LS individuals, even within the same family.-Polygenic risk scores (PRS) can help stratify colorectal cancer risk and, thus, adjust surveillance or treatment procedures.WHAT THIS STUDY ADDS-PRS performed on family-based registries slightly influences CRC risk in subgroups of LS individuals, even though with weak effects.-Our study showed a weak association of PRS with multiple and young CRC cases, pointing to a possible risk-modifying role in extreme phenotypes.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY-Gene-based PRS analysis and its combination with other genetic and non-genetic factors may contribute to refining cancer risk in LS patients.
ChatGPT as a medical doctor? A diagnostic accuracy study on common and rare diseases
Authors: Mehnen Lars , Gruarin Stefanie , Vasileva Mina , Knapp Bernhard 
Published: April 2023

AbstractSeeking medical advice online has become popular in the recent past. Therefore a growing number of people might ask the recently hyped ChatGPT for medical information regarding their conditions, symptoms and differential diagnosis. In this paper we tested ChatGPT for its diagnostic accuracy on a total of 50 clinical case vignettes including 10 rare case presentations. We found that ChatGPT 4 solves all common cases within 2 suggested diagnoses. For rare disease conditions ChatGPT 4 needs 8 or more suggestions to solve 90% of all cases. The performance of ChatGPT 3.5 is consistently lower than the performance of ChatGPT 4. We also compared the performance between ChatGPT and human medical doctors. We conclude that ChatGPT might be a good tool to assist human medical doctors in diagnosing difficult cases, but despite the good diagnostic accuracy, ChatGPT should be used with caution by non-professionals.
Deviation from Nash Mixed Equilibrium in Repeated Rock-Scissors-Paper Reflect Individual Personality Traits
Authors: Arai Kensuke , Jacob Suma , Widge Alik S. , Yousefi Ali 
Published: April 2023

AbstractQuantification of human behavior in a social context can reveal behavioral variations in a population that can be used to improve screening and targeting accuracy in the development of interventions and biomedical treatments for psychiatric disorders. However, social interaction is difficult to study and quantify in a controlled, reproducible environment. In this research, we describe an experimental framework that utilizes a zero-sum game of repeated Rock-Paper-Scissors played against an artificial intelligence agent to probe social interaction. Human deviation from the Nash Mixed Equilibrium strategy of play, the only guaranteed way to avoid exploitation, can be seen in the sequential dependence of hands. We hypothesize that this deviation represents humans mimicing randomness through constant adjustments of behavior, which we analyze in terms of a set of switching heuristic lag-1 conditional response rules. We quantify and interpret the set of rules subjects are able to utilize as mirroring individual personality traits of the subjects. Subjects in the study also completed the Autism Quotient Abridged survey, and subscores of the social, imagination and routine dimensions were found to be predicted by a combination of behavioral features derived from game play. This work proposes a new approach to quantifying social behavioral traits in individuals affected by psychiatric disorders that manifest in social functioning.
Ebola Virus Sequesters IRF3 in Viral Inclusion Bodies to Evade Host Antiviral Immunity
Authors: Zhu Lin , Jin Jing , Wang Tingting , Hu Yong , Liu Hainan , Gao Ting , Dong Qincai , Jin Yanwen , Li Ping , Liu Zijing , Huang Yi , Liu Xuan , Cao Cheng 
Published: April 2023

AbstractViral inclusion bodies (IBs) commonly form during the replication of Ebola virus (EBOV) in infected cells, but their role in viral immune evasion has rarely been explored. Here, we found that interferon regulatory factor 3 (IRF3), but not TANK-binding kinase 1 (TBK-1) or IκB kinase epsilon (IKKε), was recruited and sequestered in viral IBs when the cells were infected by EBOV transcription- and replication-competent virus-like particles (trVLPs). NP/VP35-induced IBs formation was critical for IRF3 recruitment and sequestration, probably through interaction with STING. Consequently, the association of TBK1 and IRF3, which plays a vital role in type I interferon (IFN-I) induction, was blocked by EBOV trVLPs infection. Additionally, IRF3 phosphorylation and nuclear translocation induced by Sendai virus (SeV) or poly(I:C) stimulation were suppressed by EBOV trVLPs. Furthermore, downregulation of STING significantly attenuated VP35-induced IRF3 accumulation in IBs. Coexpression of the viral proteins by which IBs-like structures formed was much more potent in antagonizing IFN-I than expression of the IFN-I antagonist VP35 alone. These results suggested a novel immune evasion mechanism by which EBOV evades host innate immunity.Impact statementEbola virus VP35 protein evades host antiviral immunity by interacting with STING to sequester IRF3 into inclusion bodies and inhibit type-I interferon production.
Systematic evaluation of the two main blood-based RNA-seq approaches for Mendelian disease diagnosis
Authors: Yang Ziying , Yang Xiaoru , Chen Yunmei , Wang Zhonghua , Song Lijie , Sun Jun , Peng Huanhuan , Yang Xunzhe , Peng Zhiyu , Dai Yi 
Published: April 2023

AbstractBackgroundAs an adjunct to diagnostic exome sequencing and whole-genome sequencing, RNA sequencing (RNA-seq) has been demonstrated to improve diagnostic yield for Mendelian diseases. However, systematic evaluation of the associated experimental and computational processes and the establishment of robust and efficient practices for RNA diagnostics implemented in the clinic to analyse readily accessible whole blood samples are still required.MethodsWe simulated clinical conditions in which each patient’s sample is tested only once, and we evaluated the two typical experimental protocols (polyA-selection and rRNA depletion) by comparing the expression profiles, aberrant splicing events and monoallelic expression (MAE) identified from 11 patients in clinical settings with different bioinformatics software.ResultsWe demonstrated that a higher proportion of unique reads from polyA-selection than rRNA depletion were mapped to exons or exon – intron junction regions (84.54% vs. 40.14%), resulting in more detectable OMIM genes (TPM > 1) in the blood (65.29% vs. 59.79%); thus, the rRNA depletion method requires a median of 258 more valid reads per gene to achieve the same level of gene quantification. Moreover, although the transcriptome profiling of protein-coding genes in the two methods is highly correlated, polyA-selection offers more sensitive detection of MAE variants and aberrant splicing under common filtering conditions in combination with DROP.ConclusionsA combination of polyA+ and DROP is recommended when implementing blood-based RNA-seq for the diagnosis of Mendelian diseases in clinical practice, and filtering criteria for aberrant expression, aberrant splicing and MAE variants are suggested for reference.