bluuebunny/crossref_metadata_2025_split huggingface dataset:
Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas
Authors: Stierman Elizabeth K. , O'Brien Barbara T. , Stagg Julie , Ouk Elizabeth , Alon Natanya , Engineer Lilly D. , Fabiyi Camille A. , Liu Tasnuva M. , Chew Emily , Benishek Lauren E. , Harding Brenda , Terhorst Raymond G. , Latif Asad , Berenholtz Sean M. , Mistry Kamila B. , Creanga Andreea A. 
Published: March 2023

Background and Objective:
The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas.

Methods:
In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation.

Results:
Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001).

Conclusions:
Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.
Promoting Publications Through Plastic Surgery Journal Instagram Accounts
Authors: Maisner Rose S. , Goydos Christopher , Ong Melody , Jain Shona , Shah Payal , Kim Brian , Wright Jack , Patel Nidhi , Kapadia Kailash , Lee Edward S. 
Published: March 2023

Purpose
Journals are increasingly using social media to increase article engagement. We aim to determine the impact of Instagram promotion on, and identify social media tools that effectively enhance, plastic surgery article engagement and impact.

Methods
Instagram accounts for Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Aesthetic Surgery Journal, and Aesthetic Plastic Surgery were reviewed for posts published by February 8, 2022. Open access journal articles were excluded. Post caption word count and number of likes, tagged accounts, and hashtags were recorded. Inclusion of videos, article links, or author introductions was noted. All articles from journal issues published between the dates of the first and last posts promoting articles were reviewed. Altmetric data approximated article engagement. Citation numbers from the National Institutes of Health iCite tool approximated impact. Differences in engagement and impact of articles with and without Instagram promotion were compared by Mann-Whitney U tests. Univariate and multivariable regressions identified factors predictive of more engagement (Altmetric Attention Score, ≥5) and citations (≥7).

Results
A total of 5037 articles were included, with 675 (13.4%) promoted on Instagram. Of posts featuring articles, 274 (40.6%) included videos, 469 (69.5%) included article links, and 123 included (18.2%) author introductions. Promoted articles had higher median Altmetric Attention Scores and citations (P < 0.001). On multivariable analysis, using more hashtags predicted higher article Altmetric Attention Scores (odds ratio [OR], 1.85; P = 0.002) and more citations (OR, 1.90; P < 0.001). Including article links (OR, 3.52; P < 0.001) and tagging more accounts (OR, 1.64; P = 0.022) predicted higher Altmetric Attention Scores. Including author introductions negatively predicted Altmetric Attention Scores (OR, 0.46; P < 0.001) and citations (OR, 0.65; P = 0.047). Caption word count had no significant impact on article engagement or impact.

Conclusions
Instagram promotion increases plastic surgery article engagement and impact. Journals should use more hashtags, tag more accounts, and include manuscript links to increase article metrics. We recommend that authors promote on journal social media to maximize article reach, engagement, and citations, which positively impacts research productivity with minimal additional effort in designing Instagram content.
Posterior Circumflex Humeral Artery Perforator Flap: A Cadaveric Study and Case Series
Authors: Garieri Pietro , Gatto Arianna , Brambilla Leonardo , Cavalli Erica , Codazzi Denis , Marchesi Andrea 
Published: March 2023

Background
Reconstruction of soft tissue defects of the acromioclavicular region represents a relatively uncommon but challenging event. Many muscular, fasciocutaneous, and perforator flaps have been described, including the posterior circumflex humeral artery perforator (PCHAP) flap based on the direct cutaneous perforator of the PCHA. This study aims to describe a variant of the PCHAP flap, based on a constant musculocutaneous perforator, by means of a cadaveric study and a case series.

Methods
A cadaveric study was conducted using 11 upper limbs. The perforator vessels originating from the PCHA were dissected and the musculocutaneous ones were identified and measured in their length and distance from the deltoid tuberosity. Besides, we retrospectively analyzed the posterior shoulder reconstruction conducted among 2 plastic surgery department (San Gerardo Hospital, Monza and Hospital Papa Giovanni XXIII, Bergamo) using the musculocutaneous perforators of the PCHA.

Results
The cadaver dissection showed the presence of a constant musculocutaneous perforator arising from the PCHA. The mean pedicle length is 6.10 ± 1.18 cm, and the musculocutaneous perforator pierces the fascia at a mean distance of 10.4 ± 2.06 cm from the deltoid tuberosity. In all the cadaver dissected, the perforator of interest divided into 2 terminal branches, anterior and posterior, nourishing the skin paddle.
In our case series, the mean age of the patients was 66.7 years, the mean size of the defect was 46 cm2, the mean operating time was 79.3 minutes, the mean length of hospital stay was 2.7 days, and the complication rate was 28.6%.

Conclusions
According to this preliminary data, the PCHAP flap based on the musculocutaneous perforator seems to be a reliable alternative in posterior shoulder region reconstruction.
Efficacy Analysis of Extended Uvulopalatopharyngoplasty Combined With the Simultaneous Multiplane Operation to Treat Obstructive Sleep Apnea
Authors: Yuan FoLiang , Wu ShuXian , Tang JiaHui , Yuan HongYan , Zhang Song 
Published: March 2023

Purpose:
The purpose of this study was to discuss the safety and long-term efficacy of extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation to treat obstructive sleep apnea (OSA).

Materials and Methods:
Sixty-two patients confirmed with OSA by polysomnography received physical examinations, determination of nasal resistance, Muller’s maneuver under electronic laryngoscope, and upper airway computed tomography scan to locate the obstruction planes. Then the patients received extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation of the nasal cavity and/or tongue root under general anesthesia. Body mass index, Epworth Sleepiness Scale (ESS) score, apnea-hypopnea index (AHI), and lowest arterial oxygen saturation (LSaO2) were compared before and after surgery. Postoperative complications were recorded. All patients were followed up for 12 to 24 months after surgery. The above-mentioned indicators were determined.

Results:
Fourteen patients (22.58%) achieved a cure, 20 patients (32.26%) marked effectiveness, 20 patients (32.26%) moderate effectiveness, and 8 patients (12.90%) ineffectiveness. The overall response rate was 87.10%. AHI and ESS score decreased, and LSaO2 increased after surgery than before, all in a significant manner (P<0.05). There was no significant difference in body mass index before and after surgery. No severe complications occurred in any patients.

Conclusions:
Extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation had a good safety for OSA, improving ESS, AHI, and LSaO2 significantly. The patients enjoyed an improved life quality after surgery.
Application of a Modified Perforator Flap of the Transverse Facial Artery for Zygomaticofacial Skin Defect Repair After Tumor Resection
Authors: Zhang Shuo , Zhao Shuhan , Song Peijun , Xu Jing 
Published: March 2023

Background:
The transverse facial artery is an important source of zygomaticofacial blood, but its perforator flap is rarely reported. The aim of this study was to investigate the utility of a modified perforator flap based on facial aesthetic units and previous anatomic studies of transverse facial arteries.

Methods:
All 18 elderly patients with zygomatic facial tumors underwent Mohs surgery. The V-Y and propeller flaps were designed according to the aesthetic unit of the defect site. Only a small portion of the fascia and fat surrounding the blood vessel are left, the rest of the flap is pruned to a thickness closer to the surrounding tissues. The surgical effect was comprehensively evaluated by an expert group. To assess the patient’s postoperative quality of life, we administered the FACT-H & N (v 4.0) scale before and after surgery.

Results:
Among the 18 flaps, 10 were V-Y flaps and 8 were propeller flaps. The flaps of 18 patients survived, with adequate cheek, facial symmetry, and proper mouth opening. The flaps worked well and looked good at both the recipient and donor sites. According to the scale survey, the postoperative patients had a higher quality of life in terms of physiology, psychology, function, and other areas than the preoperative patients (P<0.05).

Conclusion:
A modified flap of the transverse facial artery can rotate flexibly and repair a larger area, as the blood flow is relatively constant near the zygomatic arch. It has a high clinical value in the treatment of zygomaticofacial tumors.
Ultrapulse Fractional CO2 Laser With Different Fluences and Densities in the Prevention of Periorbital Laceration Scars: A Split-Scar, Evaluator-Blinded Study
Authors: Wang Jue , Wu Jiang , Chen Baoguo , Gao Quanwen 
Published: March 2023

Background:
Periorbital laceration can result in complex, permanent scars, and even lead to serious complications such as cicatricial ectropion. Early intervention with laser devices has been suggested as a novel modality to reduce scar formation. However, no consensus exists regarding the optimal treatment parameters for scar management. This study evaluated the efficacy and safety of ultrapulse fractional CO2 laser (UFCL) with different fluences and densities in preventing periorbital surgical scars.

Objective:
To assess the efficacy and safety of UFCL with different fluences and densities in the prevention of periorbital laceration scars.

Methods:
A prospective, randomized, blinded study was conducted on 90 patients with periorbital laceration scars of 2 weeks old. Four treatment sessions of UFCL were administered to each half of the scar at 4-week intervals, with halves treated with high fluences with low density versus low fluences with low-density treatment. Vancouver Scar Scale was used to assess the 2 portions of each individual scar at baseline, final treatment, and 6 months. The patient’s 4-point satisfaction scale was used to evaluate the patient’s satisfaction at baseline and 6 months. Safety was evaluated by registration of adverse events.

Results:
Eighty-two of 90 patients completed the clinical trial and follow-up. There was no significant difference in Vancouver Scar Scale and satisfaction score between different laser settings between the two groups (P > 0.05). Adverse events were minor and no long-term side effects were noted.

Conclusions:
Early application of UFCL is a safe, strategy to significantly improve the final traumatic periorbital scar appearance. Objective evaluation of scars did not identify differences in scar appearance between high fluences with low density versus low fluences with low density of UFCL treatment.

Level of Evidence:
Level III.
Lifestyle Optimization Leads to Superior Liver Regeneration in Live Liver Donors and Decreases Early Allograft Dysfunction in Recipients
Authors: Gupta Anish , Patil Nilesh Sadashiv , Mohapatra Nihar , Benjamin Jaya , Thapar Shalini , Kumar Anupam , Rastogi Archana , Pamecha Viniyendra 
Published: March 2023

Introduction:
The aim of the current randomized control trial was to assess the efficacy of donor lifestyle optimization on liver regeneration and outcome following live donor liver transplantation.

Methods:
Live liver donors (LLDs) who were fit with no or minimal steatosis were randomized to receive either a customized low-calorie diet with calorie intake equalling their basal requirement along with exercise for 2 weeks before surgery versus to continue their normal routine lifestyle. Primary objectives were the difference in the day of normalization of serum bilirubin and PT-International normalized ratio and the percentage growth of the liver at postoperative day 7 and 14. Secondary objectives were differences in intraoperative liver biopsy, liver-regeneration markers, blood loss, hospital stay, the complication rate in LLDs, and rates of early graft dysfunction (EGD) in recipients.

Results:
Sixty-two consecutive LLDs were randomized (28 in intervention vs. 34 in control). Baseline parameters and graft parameters were similar in both groups. LLDs in the intervention arm had significantly decreased calorie intake (P<0.005), abdominal girth (P<0.005), BMI (P=0.05), and weight (P<0.0005). The mean blood loss (P=0.038), day of normalization of bilirubin (P=0.005) and International normalized ratio (P=0.061), postoperative peak aspartate transaminase (P=0.003), Alanine transaminase (P=0.025), and steatosis (P<0.005) were significantly less in the intervention group. There was significantly higher volume regeneration (P=0.03) in donors in the intervention arm. The levels of TNF-α, IL-6, and IL-10 levels were significantly higher, while the TGF-β level was lower in donors in the intervention group. The rate of EGD was significantly higher in recipients in the control group (P=0.043).

Conclusion:
Lifestyle optimization of LLD is simple to comply with, improves liver regeneration in LLDs, and decreases EGD in recipients, thus can enhance donor safety and outcomes in live donor liver transplantation.
Effects of selfing on the evolution of sexual reproduction
Authors: Xu Kuangyi 
Published: March 2023

AbstractPlants exhibit diverse breeding systems, with populations capable of outcrossing, selfing, and/or asexual reproduction. However, interactions between the three reproductive pathways remain not fully clear. Sexual reproduction introduces segregation and recombination, but incurs several costs. Selfing can affect the relative costs and benefits of sexual vs. asexual reproduction. Building population genetic models, I explore how selfing affects the evolution of a sexual reproduction rate modifier via (1) indirect selection due to segregation, (2) indirect selection from changes in recombination rates, and (3) selection from the cost of meiosis and mate limitation. The dominant selective force mediating the evolution of sex is found to vary with the rate of sexual reproduction and selfing, but selective force (1) and (3) are generally stronger than selective force (2). A modifier enhancing sexual reproduction tends to be favored by indirect selection generated by partially recessive, small-effect deleterious mutations, while hindered by highly recessive lethal mutations. Overall, evolution towards higher sexual reproduction is hindered at low sexual reproduction rates and intermediate selfing rates, but favored under high selfing rates. The results suggest that asexual reproduction may precede the evolution of selfing, and offer insights into the evolution of mechanisms reducing geitonogamy in partially clonal populations.
Evolution of flowering time through the asynchrony of pollen dispersal
Authors: Xu Kuangyi 
Published: March 2023

AbstractThe evolution of flowering time is often attributed to variation of pollinator rates over time. This study proposes that flowering time can evolve through siring success variation among individuals caused by differential pollen dispersal timing (a result of flowering time variation itself). Quantitative genetic models show that earlier flowering evolves under low pollen removal rates, high pollen deposition rates, and a slow decline in the fertilization ability of removed pollen. Variations in pollen dispersal timing also select for a stable variance in flowering time, which is larger when pollen removal rates are either very low or high, pollen deposition rates are moderate, and the fertilization ability of removed pollen declines more rapidly. Also, a model on the coevolution of flower longevity and flowering time predicts that under constant pollination rates, non-random mating results in a weak correlation between late flowering and longer-lived flowers. This baseline finding suggests that the observed correlation between late flowering and shorter flowering duration in nature is influenced by other factors, such as declining pollination rates during late-stage flowering. I discuss the role of altered pollination rates under climate change during flowering time evolution and the importance of distinguishing between pollen removal and deposition rates.
Impact and characterization of serial structural variations across humans and great apes
Authors: Höps Wolfram , Rausch Tobias , Ebert Peter ,   Human Genome Structural Variation Consortium (HGSVC), Korbel Jan O. , Sedlazeck Fritz J. 
Published: March 2023

AbstractModern sequencing technology enables the detection of complex structural variation (SV) across genomes. However, extensive DNA rearrangements arising through series of mutations, a phenomenon we term serial SV (sSV), remain understudied since their complexity poses a challenge for SV discovery. Here, we present NAHRwhals (https://github.com/WHops/NAHRwhals), a method to infer repeat-mediated series of SVs in long-read genomic assemblies. Applying NAHRwhals to 58 haplotype-resolved human genomes reveals 37 sSV loci of various length and complexity. These sSVs explain otherwise cryptic variation in medically relevant regions such as theTPSAB1gene, 8p23.1 and the DiGeorge and Sotos syndrome regions. Comparisons with great ape assemblies indicate that most human sSVs formed recently and involved non-repeat-mediated processes. NAHRwhals reliably discovers and characterizes sSVs at scale and independent of species, uncovering their genomic abundance and revealing broader implications for disease than prior studies suggested.
Senescence during early differentiation reduced chondrogenic differentiation capacity of mesenchymal progenitor cells
Authors: Voskamp Chantal , Koevoet Wendy J. L. M. , van Osch Gerjo J.V.M. , Narcisi Roberto 
Published: March 2023

AbstractMesenchymal stromal/progenitor cells (MSCs) are promising for cartilage cell-based therapies due to their differentiation capacity. However, MSCs can become senescent duringin vitroexpansion, a state characterized by stable cell cycle arrest, metabolic alterations, and substantial changes in the gene expression and secretory profile of the cell. In this study, we aimed to investigate how senescence and the senescence associated secretory phenotype (SASP) affect chondrogenic differentiation of MSCs. To study the effect of senescence, we exposed MSCs to gamma irradiation during expansion or during chondrogenic differentiation (pellet culture). When senescence was induced during expansion or at day-7 of chondrogenic differentiation, we observed a significant reduction in cartilage matrix. Interestingly, when senescence was induced at day-14 of differentiation, chondrogenesis was not significantly altered. Moreover, exposing chondrogenic pellets to medium conditioned by senescent pellets had no significant effect on the expression of anabolic or catabolic cartilage markers, suggesting a neglectable paracrine effect of senescence on cartilage generation in our model. Finally, we show that senescent MSCs had lower phosphorylated SMAD2 levels after TGFβ1stimulation compared to control MSCs. Overall, these results suggest that the occurrence of senescence in MSCs during expansion or early differentiation could be detrimental for cartilage tissue engineering.
Sodium channel subpopulations with distinct biophysical properties and subcellular localization enhance cardiac conduction
Authors: Weinberg Seth H. 
Published: March 2023

AbstractSodium (Na+) current is responsible for the rapid depolarization of cardiac myocytes that triggers the cardiac action potential upstroke. Recent studies have illustrated the presence of multiple “pools” of Na+channels with distinct biophysical properties and subcellular localization, including clustering of channels at the intercalated disk and along the lateral membrane. Computational studies predict that Na+channel clusters at the intercalated disk can regulate cardiac conduction via modulation of the narrow intercellular cleft between electrically coupled myocytes. However, these studies have primarily focused on the redistribution of Na+channels between intercalated disk and lateral membranes and not considered the distinct biophysical properties of the Na+channel subpopulations. In this study, we simulate computational models of single cardiac cells and one-dimensional cardiac tissues to predict the functional consequence of distinct Na+channel subpopulations. Single cell simulations predict that a subpopulation of Na+channels with shifted steady-state activation and inactivation voltage-dependency promote an earlier action potential upstroke. In cardiac tissues that account for distinct subcellular spatial localization, simulations predict that “shifted” Na+channels contribute to faster and more robust conduction, with regards to sensitivity to tissue structural changes (i.e., cleft width), gap junctional coupling, and rapid pacing rates. Simulations predict that the intercalated disk-localized shifted Na+channels provide a disproportionally larger contribution to total Na+charge, relative to lateral membrane-localized Na+channels. Importantly, our work supports the hypothesis that Na+channel redistribution may be a critical mechanism by which cells can rapidly respond to perturbations to support fast and robust conduction.SummarySodium channels are organized in multiple “pools” with distinct biophysical properties and subcellular localization, but the role of these subpopulations is not well-understood. Computational modeling predicts that intercalated disk-localized sodium channels with shifted steady-state activation and inactivation voltage-dependence promote faster cardiac conduction.