bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Case Series on Free Flap Reconstruction for Ischemic Diabetic Foot: The Nutrient Flap Further Explained
Authors: Kwon Jin Geun , Cho Min-Jeong , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio 
Published: April 2022

Background:
This retrospective case series compares the outcomes and postoperative oxygen levels in patients who underwent free flap versus primary closure/local flap reconstruction for ischemic diabetic foot wounds to determine the influence of free flap on the surrounding ischemic tissues. The authors hypothesized that the free flap would benefit the surrounding ischemic tissue as a nutrient flap by increasing the tissue oxygen content.

Methods:
The patients were divided into two groups: group 1 underwent free flap reconstruction, and group 2 underwent partial foot amputation with primary closure/local flap. Patient demographics, endovascular intervention, surgical outcome, postreconstruction intervention, and prereconstruction and postreconstruction transcutaneous oximetry were analyzed.

Results:
Among 54 patients, 36 were in group 1 and 18 were in group 2. There were no differences in patient demographics between the two groups. All patients had successful angioplasty. Statistical significance was noted in postreconstruction intervention in which group 2 required 2.8 ± 2.9 débridements (versus 1.2 ± 2.5 for group 1) and seven of 18 below-knee amputations (versus three of 36 for group 1) (p < 0.05). Transcutaneous partial pressure of oxygen levels were significantly higher in group 1 at 6 months after reconstruction (61.6 ± 7.5 versus 32.6 ± 5.8 mmHg) (p < 0.01).

Conclusion:
This study shows that the role of the free flap in ischemic diabetic limb may expand beyond that of providing coverage over the vital structures, and it supports the use of the free flap as a nutrient to increase oxygen content in the ischemic diabetic foot.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Comparing forefoot and heel stiffnesses across commercial prosthetic feet manufactured for individuals with varying body weights and foot sizes
Authors: Ruxin Talia R. , Halsne Elizabeth G. , Turner Anne T. , Curran Carl S. , Caputo Joshua M. , Hansen Andrew H. , Hafner Brian J. , Morgenroth David C. 
Published: April 2022

Background:
Despite the effects of prosthetic foot mechanical properties on gait of people with lower limb amputation, scant forefoot and heel stiffness data exist to help guide prosthetic foot prescription.

Objective:
To measure forefoot and heel linear stiffness properties across commonly prescribed commercial prosthetic foot models and to describe variations in stiffness across feet targeted for users with different body weights and foot sizes.

Study design:
Mechanical testing of five types of commercial prosthetic feet across nine user body weight and foot size combinations.

Methods:
Linear forefoot and heel stiffness (force vs. displacement) data were collected for 41 prosthetic feet. Quasistatic testing was conducted at −15 and +20 degrees to isolate loading of the heel and forefoot, respectively.

Results:
Overall, there was a significant relationship between user body weight and both forefoot and heel stiffness, when adjusted for foot size and type (P < 0.001). However, there were a substantial number of inconsistencies across foot type within example user body weight and foot sizes combination. Furthermore, the relative order of forefoot stiffness across foot type differed from the relative order of heel stiffness across foot type.

Conclusions:
The inconsistencies and differences in relative order of forefoot and heel stiffness across commercial foot type suggest the importance of publishing objective stiffness and other mechanical properties of prosthetic feet. These data can aid clinicians in better matching mechanical properties of prosthetic feet with the functional goals and abilities of prosthesis users.
Feasibility of reconstructing the glenohumeral center of rotation with a single camera setup
Authors: Haarman Claudia J.W. , Hekman Edsko E.G. , Rietman Johan S. , van der Kooij Herman 
Published: April 2022

Background:
An accurate estimation of the glenohumeral joint center of rotation (CoR) is important during alignment of braces and exoskeletons, as a misalignment will introduce undesired forces on the human body. The aim of this research was to develop a new method to estimate the glenohumeral CoR and register the location to the body using a single camera and two printed markers.

Methods:
During shoulder anteflexion, the arm roughly describes an arc in the sagittal plane, with the glenohumeral joint in the center. Two binary square-fiducial ArUco markers were secured to the upper arm and the scapula, their position and orientation were obtained, and a sphere was fitted to the coordinates of the arm marker. The sphere center position was then registered on the skin. The accuracy was assessed with a test bench with a known rotational center. The repeatability was assessed in vivo with five healthy participants.

Results:
The mean absolute offset between the true CoR of the test bench and the fitted sphere centers across multiple trials was 2.7 mm at a velocity of 30 degrees/s, and 2.5 mm at 60 degrees/s. The root mean squared distance from the estimated sphere centers after each trial to the mean sphere center across all trials per participant was 5.1 mm on average for the novice examiner and 5.2 mm for the expert examiner.

Conclusions:
The proposed method is able to accurately and precisely estimate the glenohumeral CoR.
FDG PET/CT and Bone Scintigraphy in Desmoplastic Fibroma of the Bone
Authors: Zhang Jun , Nian Shensheng , Bai Yushu , Dong Aisheng 
Published: April 2022

Abstract
Desmoplastic fibroma is a very rare benign bone tumor with local aggressiveness. We describe imaging findings in 2 cases with desmoplastic fibroma of the bone. One case had a desmoplastic fibroma in the right distal femur, showing bone destruction with sclerotic margins and inhomogeneous FDG uptake. The other case had a desmoplastic fibroma in the left ninth rib, showing progressive peripheral enhancement and increased 99mTc-MDP uptake.
Contrast-Enhanced Ultrasound as a Problem-Solving Modality
Authors: Kim Solomon , Chughtai Komal , Brahmbhatt Akshaar , Rubens Deborah , Dogra Vikram 
Published: April 2022

Abstract
Contrast-enhanced ultrasound (CEUS) continues to be an ever-growing tool in radiation-free imaging. While it has been widely used in cardiac imaging, CEUS has only recently become an Food and Drug Administration–approved and viable modality for evaluation of abdominal structures. Ultrasound contrast agents are nontoxic, microbubble-based vascular agents and can be used to reliably assess enhancement patterns of various lesions in real time. In particular, it's non nephrotoxic nature makes CEUS a particularly important tool in renal failure patients requiring serial follow-up. This review provides a comprehensive discussion on the utility of CEUS agents, imaging techniques, comparison with traditional cross-sectional imaging modalities, and its application in diagnosing kidney and liver lesions. This pictorial review is illustrated with cases of renal and hepatic lesions that the practicing radiologist should become familiar with as CEUS becomes increasingly popular.
Long-Term Visual Prognosis in Patients With Aquaporin-4-Immunoglobulin G–Positive Neuromyelitis Optica Spectrum Disorder
Authors: Moon Yeji , Jang Yeonji , Lee Haeng-Jin , Kim Sung-Min , Kim Seong-Joon , Jung Jae Ho 
Published: April 2022

Background:
To identify the factors associated with visual prognosis for functional and structural outcomes of optic neuritis (ON) in patients with aquaporin-4-immunoglobulin (AQP4-IgG)–positive neuromyelitis optica spectrum disorder (NMOSD).

Methods:
We included the eyes that experienced at least 1 episode of ON and were followed for at least 2 years after the first attack of ON in patients with AQP4-IgG–positive NMOSD. We performed a retrospective review of clinical data, including ophthalmological examination and orbital MRI, of 34 eyes of 22 patients. Functional outcomes were measured as final visual acuity, visual field index, and mean deviation and structural outcomes as final retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (GCIPL) thickness.

Results:
The mean age at onset of the first ON was 42.7 ± 13.7, and all patients were female. The poor visual acuity was significantly associated with the worse final visual acuity and thinner RNFL and GCIPL. Older age also showed a negative correlation with RNFL thickness. The number of attacks was not statistically significant for functional and structural outcomes. The lesion involving the intracanalicular optic nerve to the chiasm on orbital MRI showed worse visual acuity and a thinner GCIPL. Rapid high-dose intravenous methylprednisolone pulse therapy within 3 days was statistically significant, with better visual acuity and more preserved GCIPL thickness.

Conclusions:
Our results indicate that the severity of ON rather than the number of recurrences might be critical for the visual prognosis of patients with AQP4-IgG–positive NMOSD. Rapid treatment within 3 days may improve visual outcomes, and a younger age at onset may have better visual outcomes.
Laparoscopic Ultrasound for Bile Duct Imaging during Cholecystectomy: Clinical Impact in 785 Consecutive Cases
Authors: Deziel Daniel J 
Published: April 2022

BACKGROUND:
The influence of laparoscopic ultrasonography (LUS) on the operative management of patients during laparoscopic cholecystectomy (LC) has not been examined in a large unselected series.

STUDY DESIGN:
Seven hundred eight-five consecutive LC operations were reviewed to determine whether the findings of LUS for bile duct imaging altered operative management. Patients were analyzed according to the primary indication for imaging: anatomic identification (group I), possible common bile duct stones (group II), and routine use absent other indications (group III).

RESULTS:
LUS demonstrated the cystic duct–common bile duct junction, the common hepatic duct, the common bile duct to the ampulla, and the right hepatic artery in 95.8% of cases. Among 56 of 111 (50%) patients in group I for whom initial dissection failed to result in adequate anatomic identification, subsequent LUS provided sufficient anatomic identification to allow completion of a laparoscopic operation in 87.5%. Group I patients were more likely to have acute cholecystitis (p < 0.0001) and Tokyo Guidelines 2018 grade II or III acute cholecystitis (p < 0.001). LUS changed operative management for 19 of 256 (7.5%) group II patients and 10 of 361 (2.8%) group III patients by demonstrating common bile duct stones that resulted in common bile duct exploration with stone clearance. Five patients had common bile duct stones that were not detected by LUS. There were no major bile duct or vascular injuries.

CONCLUSIONS:
The primary value of LUS during LC is for anatomic identification when there are severe local inflammatory conditions. In this setting, LUS imaging can facilitate safe completion of LC or an early decision for an alternate operative strategy. When performed primarily for common bile duct stones or as routine practice, LUS results in CBDE for a limited proportion of patients.
Longitudinal Durability of Patient-Reported Pain Outcomes after Targeted Muscle Reinnervation at the Time of Major Limb Amputation
Authors: O’Brien Andrew L , West Julie M , Gokun Yevgeniya , Janse Sarah , Schulz Steven A , Valerio Ian L , Moore Amy M 
Published: April 2022

BACKGROUND:
Phantom limb pain (PLP) and residual limb pain (RLP) are debilitating sequelae of major limb amputation. Targeted muscle reinnervation (TMR), when performed at the time of amputation, has been shown to be effective for management of this pain; however, its long-term effects and the longitudinal trend of patient-reported outcomes is unknown. The purpose of this study was to characterize the longitudinal patient-reported outcomes of pain and quality of life following TMR at the time of initial amputation.

STUDY DESIGN:
A prospective case series of patients undergoing major limb amputation with TMR performed at the time of amputation were followed from October 2015 to December 2020 with outcomes measured 3, 6, 12, and 18 months or longer after amputation and TMR. Outcomes included patient-reported severity of PLP and RLP as measured by the numeric rating scale (NRS). Secondary outcomes included the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Behavior Questionnaires.

RESULTS:
Eighty-one patients with 83 treated limbs were included in the study, and 23 patients completed surveys at 18 months or later, with an average follow-up time of 2.4 years. By 3 months after operation, all patient-reported outcomes for PLP and RLP were consistent with previously reported data that demonstrated superiority to non-TMR amputees. Mixed-model linear regression analysis showed that PLP NRS severity scores continued to improve over the study period (p = 0.022). The remaining outcomes for RLP severity and PROMIS quality-of-life measures demonstrated that these scores remained stable over the study period (p > 0.05).

CONCLUSION:
TMR is an effective surgical procedure that improves the chances of having reduced RLP and PLP when performed at the time of amputation, and our study demonstrates the long-term durability of its efficacy.
Analysis of Intraoperative Frozen Pancreatic Resection Margin and Prediction of Postoperative Pancreatic Fistula Risk During Pancreatoduodenectomy
Authors: Brunner Maximilian , Kovacevic Jasna , Krautz Christian , Merkel Susanne , Hartmann Arndt , Grützmann Robert , Haller Florian , Weber Georg F 
Published: April 2022

BACKGROUND:
Pancreatic duct diameter and pancreatic texture are important predictive factors for a postoperative pancreatic fistula (POPF) and are assessed intraoperatively by the surgeon. However, surgical evaluation is arbitrary and difficult to objectify, especially in minimally invasive approaches in pancreatic surgery.

STUDY DESIGN:
We conducted a retrospective analysis of 275 patients that underwent pancreatoduodenectomy from 2012 to 2019 at our institution. Pancreatic duct diameter and pancreatic fibrosis were assessed by histopathologic examination of the pancreatic resection margin using intraoperative frozen sections and correlated with the occurrence of POPF and clinically relevant POPF (CR-POPF).

RESULTS:
The POPF and CR-POPF rates were 27% and 19%, respectively. Univariate analysis indicated that the indication for surgery, the surgically determined pancreatic duct diameter, and pancreatic texture, as well as the histopathologically determined pancreatic duct diameter and pancreatic fibrosis were significant predictive factors for POPF and CR-POPF. A multivariate analysis revealed histopathologically determined pancreatic duct diameter and pancreatic fibrosis as independent risk factors for POPF (OR [odds ratio] 2.3 [1.1 to 4.5], p = 0.022 and OR 2.4 [1.1 to 5.1], p = 0.023, respectively) and CR-POPF (OR 2.2 [1.1 to 4.8], p = 0.037 and OR 2.6 [1.1 to 6.1], p = 0.036).

CONCLUSIONS:
Histopathologically determined pancreatic duct diameter and pancreatic fibrosis are quantitatively measurable independent risk factors for POPF and CR-POPF. An intraoperative objective histopathologic evaluation of these parameters using frozen sections could support the surgical assessment of the pancreatic duct diameter and the pancreatic texture.
Racial and Ethnic Disparities in Surgical Outcomes after Postmastectomy Breast Reconstruction
Authors: Sarver Melissa M , Rames Jess D , Ren Yi , Greenup Rachel A , Shammas Ronnie L , Hwang E Shelley , Hollenbeck Scott T , Hyslop Terry , Butler Paris D , Fayanju Oluwadamilola M ,   for the Duke Breast and Plastic Surgery Workgroup
Published: April 2022

BACKGROUND:
Women of color with breast cancer are less likely to undergo post-mastectomy reconstruction compared with White women, but it is unclear whether their perioperative outcomes are worse. The goal of this study was to investigate differences in preoperative comorbidities and postoperative complications by race/ethnicity among women with breast cancer undergoing postmastectomy reconstruction.

STUDY DESIGN:
Data were collected from the National Inpatient Sample database of the Healthcare Cost and Utilization Project from 2012 to 2016. Patient demographics, types of reconstruction, comorbid conditions, Charlson-Deyo Combined Comorbidity (CDCC) scores, length of stay (LOS), and perioperative complications were abstracted. Multivariate linear and logistic regression were performed to model LOS and likelihood of postoperative complications, respectively.

RESULTS:
Compared with White women (n = 19,730), Black women (n = 3,201) underwent autologous reconstruction more frequently (40.7% vs 28.3%), had more perioperative comorbidities (eg diabetes: 12.9% vs 5.8%), higher CDCC scores (% CDCC ≥ 4: 5.5% vs 2.7%), and longer LOS (median 3 vs 2 days, all p < 0.001). Being Black (vs White: +0.13 adjusted days, 95% CI 0.06 to 0.19) was also associated with longer LOS and an increased likelihood of surgical complications (vs White: odds ratio 1.24, 95% CI 1.09 to 1.42, both p < 0.01), but this association did not persist when outcomes were limited to microsurgical complications.

CONCLUSION:
Disparities in postmastectomy breast reconstruction between Black and White women extend beyond access to care and include perioperative factors and outcomes. These findings suggest an important opportunity to mitigate inequities in reconstruction through perioperative health optimization and improved access to and co-management with primary care.
Avian H7N9 influenza viruses are evolutionarily constrained by stochastic processes during replication and transmission in mammals
Authors: Braun Katarina M. , Haddock Luis A. , Crooks Chelsea M. , Barry Gabrielle L. , Lalli Joseph , Neumann Gabriele , Watanabe Tokiko , Imai Masaki , Yamayoshi Seiya , Ito Mutsumi , Kawaoka Yoshihiro , Friedrich Thomas C. 
Published: April 2022

AbstractH7N9 avian influenza viruses (AIV) have caused over 1,500 documented human infections since emerging in 2013. Although wild type H7N9 AIV can transmit by respiratory droplets in ferrets, they have not yet caused widespread outbreaks in humans. Previous studies have revealed molecular determinants of H7N9 AIV virus host-switching, but little is known about potential evolutionary constraints on this process. Here we compare patterns of sequence evolution for H7N9 AIV and mammalian H1N1 viruses during replication and transmission in ferrets. We show that three main factors – purifying selection, stochasticity, and very narrow transmission bottlenecks – combine to severely constrain the ability of H7N9 AIV to effectively adapt to mammalian hosts in isolated, acute spillover events. We find rare evidence of natural selection favoring new or mammalian-adapting mutations within ferrets, but no evidence of natural selection acting during transmission. We conclude that human-adapted H7N9 viruses are unlikely to emerge during typical spillover infections. Our findings are instead consistent with a model in which the emergence of a human-transmissible virus would be a rare and unpredictable, though highly consequential, “jackpot” event. Strategies to limit the total number of spillover infections will limit opportunities for the virus to win this evolutionary lottery.
Multiple waves of viral invasions in Symbiodiniaceae algal genomes
Authors: Benites L. Felipe , Stephens Timothy G. , Bhattacharya Debashish 
Published: April 2022

AbstractDinoflagellates from the family Symbiodiniaceae are phototrophic marine protists that engage in symbiosis with diverse hosts. Their large and distinct genomes show pervasive gene duplication and large-scale retroposition events. However, little is known about the role and scale of horizontal gene transfer (HGT) in the genomic evolution of this algal family. In other dinoflagellates, higher levels of HGTs have been observed, linked to major genomic transitions, such as the appearance of a viral acquired nucleoprotein that originated via HGT from a large DNA algal virus. Previous work showed Symbiodiniaceae from different hosts being actively infected by several viral groups, such as giant DNA viruses and ssRNA viruses, that may play an important role in coral health. This includes a hypothetical latent viral infection, whereby viruses could persist in the cytoplasm or integrate into the host genome as a provirus. This hypothesis received some experimental support however, the cellular localization of putative latent viruses and their taxonomic affiliation are still unknown. In addition, despite the finding of viral sequences in some genomes of Symbiodiniaceae, viral origin, taxonomic breadth, and metabolic potential have not been explored. To address these questions, we searched for evidence of protein sequences of putative viral origin in 13 Symbiodiniaceae genomes. We found 59 candidate viral-derived HGTs that give rise to 12 phylogenies across 10 genomes. We also describe the taxonomic affiliation of these virus-related sequences, their structure, and genomic context. These results lead us to propose a model to explain the origin and fate of Symbiodiniaceae viral acquisitions.
Autism-associated mutation in Hevin/Sparcl1 induces endoplasmic reticulum stress through structural instability
Authors: Taketomi Takumi , Yasuda Takunori , Morita Rikuri , Kim Jaehyun , Shigeta Yasuteru , Eroglu Cagla , Harada Ryuhei , Tsuruta Fuminori 
Published: April 2022

AbstractHevin is a secreted extracellular matrix protein that is encoded by SPARCL1 gene. Recent studies show that Hevin plays an important role in regulating synaptogenesis and synaptic plasticity. Mutations in SPARCL1 gene increase the risk of autism spectrum disorder (ASD). However, the molecular basis of how mutations in SPARCL1 increase the risk of ASD has not been fully understood. In this study, we show that one of SPARCL1 mutations associated with ASD impairs normal Hevin secretion. We identified Hevin mutants lacking the EF-hand motif through analyzing ASD-related mice with vulnerable spliceosome functions. Hevin deletion mutants accumulate in the ER, leading to the activation of unfolded protein responses. We also found that a single amino acid substitution of Trp647 with Arg in the EF-hand motif associated with a familial case of ASD causes a similar phenotype with the EF-hand deletion mutant. Importantly, molecular dynamics (MD) simulation revealed that this single amino acid substitution triggers exposure of hydrophobic amino acid to the surface, increasing the binding of Hevin with a molecular chaperon, BIP. Taken together, these data suggest that the integrity of EF-hand motif in Hevin is crucial for proper folding and ASD-related mutation impairs an export of Hevin from the endoplasmic reticulum (ER). Our data provide a novel mechanism linking a point mutation in SPARCL1 gene to the molecular and cellular characteristics involved in ASD.