bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coverage of Big Toe Defects After Wraparound Flap Transfer With a Second-Toe Medial-Side Adjacent Toe Flap
Authors: Wang Yang , Yuan Chaoqun , Gu Jiaxiang , Pan Junbo , Liu Hongjun 
Published: June 2022

Purpose
In finger reconstruction, big-toe wraparound flap (WAF) transfer provides excellent results. However, difficulty in healing and impaired function at the donor site are common. We aimed to explore an ideal method to address these complications.

Methods
This retrospective study involved 22 patients who were treated with big toe WAF transfer for finger reconstruction between 2016 and 2020. Patients were categorized into cohorts by donor site repair method: second-toe medial-side adjacent toe flap and skin graft (cohort 1) and skin graft alone (cohort 2). Functional outcomes, aesthetic appearance, and complications at the donor site were compared. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) for hallux metatarsophalangeal-interphalangeal score, Foot Function Index–Verbal Rating Scales (FFI-5 pt), and visual analog scale for pain. Aesthetic appearance was evaluated according to the adjusted question 28 in the Michigan Hand Outcome Questionnaire.

Results
The mean pain scores in AOFAS and FFI-5 pt were 38.00 ± 4.22 and 3.75 ± 2.37, and 32.50 ± 4.52 and 6.60 ± 2.14 in cohorts 1 and 2, respectively, which showed no significant differences. The method in cohort 1 can reduce the level of pain. This was further confirmed by visual analog scale scores of 3.40 ± 0.84 and 6.42 ± 7.93 in cohorts 1 and 2, respectively. The mean functional scores in AOFAS and FFI-5 pt were 38.40 ± 2.37 and 1.25 ± 1.62, and 37.92 ± 2.15 and 1.56 ± 2.11 in cohorts 1 and 2, respectively, which showed no significant differences. Eight patients developed complications: 1 patient (1/10 [10%]) in cohort 1 developed a superficial infection, and in cohort 2, 7 patients (7/12, 58.30%) developed complications, including 2 short-term complications with partial necrosis and 1 delayed healing. Long-term complications included the following: scar discomfort (2 cases), pain discomfort (1 case), and skin ulceration due to repeated wear and tear (1 case). Cohort 2 had significantly more complications than cohort 1.

Conclusions
Second-toe medial-side adjacent toe flap combined with skin graft had better aesthetic appearance, less complications, and less pain compared with skin graft alone. Hence, it can be a reliable technique for repairing the donor site after big-toe WAF transfer.
Correlation of Macular Sparing and Homonymous Paracentral Scotomas With MRI Lesions in Posterior Cerebral Artery Infarction
Authors: Cho Juno , Liao Eric , Trobe Jonathan D. 
Published: June 2022

Background:
The concepts of the representation of visual field in primary visual cortex are based on studies of war wounds and correlations with brain imaging in small cohorts. Because of the difficulty of judging brain lesion extent and the small number of studied patients, there is lingering controversy as to whether the central 15° of visual field are mapped onto the posterior 25% of primary visual cortex or onto a larger area. To improve the delineation of MRI lesion extent, we have studied only patients with posterior cerebral artery (PCA) ischemic strokes.

Methods:
We accrued a cohort of 92 patients with PCA strokes from an electronic medical records search between 2009 and 2020 at a single tertiary care academic institution. Patients had reliable static perimetry demonstrating homonymous hemianopias and high-definition reviewable brain imaging. We divided the primary visual cortex on the MRI T1 sagittal sequence into 8 equal segments in right and left cerebral hemispheres and located lesions according to the segments they occupied. We correlated lesion locations with 3 visual field defects (VFDs): macular-sparing homonymous quadrantanopias, macular-splitting homonymous quadrantanopias, and homonymous paracentral scotomas.

Results:
Among 25 cases with macular sparing, 13 had lesion-sparing confined to the posterior 25% of visual cortex. Among 6 cases with homonymous paracentral scotomas, 2 had lesions confined to the posterior 25% of visual cortex. Macular-splitting quadrantanopia did not occur in any patients with lesions confined to the posterior 25% of visual cortex, but did occur in 3 patients with lesions confined to the posterior 50% of visual cortex. These phenomena would not be expected if the central 15° of visual field were mapped onto a region extending beyond the posterior 25% of visual cortex. In patients with PCA strokes that involved the retrogeniculate visual pathway proximal to visual cortex, the visual cortex lesions were often less extensive than predicted by the VFDs, perhaps because of widespread damage to axons before they reached their destination in visual cortex.

Conclusions:
These results support the concept that the central 15° of the visual field are represented in the posterior 25% of visual cortex. Although this study contributes a larger cohort of patients with better-defined lesion borders than in past reports, its conclusions must be tempered by the variability of patient attention during visual field testing, the subjectivity in the interpretation of the defect patterns, and the difficulty in judging MRI lesion extent even on diffusion-weighted and precontrast T1 sagittal sequences.
Proxy Detection of Resident Burnout by Program Directors and Domestic Partners
Authors: Esposito Andrew C , White Erin M , Coppersmith Nathan A , Huot Stephen J , Asnes Andrea G , Yoo Peter S , Solomon Daniel G 
Published: June 2022

BACKGROUND:
Resident burnout is associated with increased incidence of depression, suicide, and poor patient outcomes, yet identification of it is difficult. This study was designed to compare how well program directors (directors) and a resident’s spouse or domestic partner (partner) can serve as a proxy to identify burnout in the resident.

STUDY DESIGN:
An electronic survey, including the Maslach Burnout Inventory, was distributed to residents, their partners, and directors of all ACGME-accredited residencies at a single university-affiliated hospital. Burnout rates were compared with McNemar’s test. Emotional exhaustion and depersonalization rates were compared with Spearman’s correlation.

RESULTS:
The response rate by respondent type was 33% (292 of 876) for residents, 48% (55 of 114) for partners, and 57% (13 of 23) for directors. Residents’ self-reported burnout rate was 51% (148 of 292), while partners’ proxy predicted burnout rate was 25% (14 of 55), and directors’ was 5% (9 of 174). There was moderate correlation of partners’ prediction of resident emotional exhaustion (ρ = 0.537, p < 0.01), depersonalization (ρ = 0.501, p < 0.01), and personal accomplishment (ρ = 0.416, p < 0.01). There was poor correlation of directors’ prediction of residents’ emotional exhaustion (ρ = 0.361, p < 0.01) and depersonalization (ρ = 0.223, p < 0.01). Partners had a 50% sensitivity, 94% specificity, 86% positive predictive value, and 71% negative predictive value in predicting resident burnout. Directors had a 6% sensitivity, 96% specificity, 56% positive predictive value, and 54% negative predictive value in predicting resident burnout.

CONCLUSIONS:
Directors are not skilled in detecting burnout in their trainees. Partners are an underused group for detecting burnout and may represent an important target audience for awareness of available resources to benefit residents.
Round Ligament Management in Female Patients Undergoing Inguinal Hernia Repair: Should We Divide or Preserve?
Authors: Renshaw Savannah , Collins Courtney , Gupta Anand , Poulose Benjamin , Haisley Kelly R 
Published: June 2022

BACKGROUND:
Although inguinal hernia repair in female patients is less common than in male patients, it remains a frequent procedure. The decision to divide or preserve the round ligament has largely been left to surgeon preference, but little data exists about its impact on outcomes. This study aimed to describe current practices for round ligament management and identify the impact of division on surgical and patient-reported outcomes.

STUDY DESIGN:
The 2013 to 2021 Abdominal Core Health Quality Collaborative database was queried for all female patients undergoing inguinal hernia repair with 30-day patient-reported outcome data available. Comparison groups were created based on round ligament management: round ligament division (RLD) or round ligament preservation (RLP).

RESULTS:
We identified 1365 female patients who underwent open (36.3%), laparoscopic (34.5%), or robotic (28.2%) repair. Most were non-recurrent (93%) and unilateral (82.6%). The round ligament was divided in 868 (63.6%) and preserved in 497 (36.4%) cases. There were no significant differences in overall complications (RLD 7.1%, RLP 5.2%, p = 0.17), reoperation (RLD 0.5%, RLP 0.2%, p = 0.4), or recurrence (RLD 0.1%, RLP 0.4%, p = 0.28). Mean European Registry for Abdominal Wall Hernias quality of life summary scores were not significantly different at 30 days (RLD 27.2, RLP 27.8) or 6 months (RLD 12.8, RLP 17.1). However, a significant difference was found in terms of mean pain-specific scores at 6 months, with lower pain scores in the RLD group (3 vs 4.7, p < 0.01), which persisted on multivariable analysis (p = 0.02).

CONCLUSIONS:
RLD is a common practice and is not associated with increased complications or recurrence. Although there is some evidence that RLD may result in decreased pain at 6 months, this must be balanced with potential functional complications of division that are not fully studied in this paper.
Colorectal Liver Micrometastases: Association with RAS/TP53 Co-Mutation and Prognosis after Surgery
Authors: Chun Yun Shin , Passot Guillaume , Nishioka Yujiro , Katkhuda Riham , Arvide Elsa M , Benzerdjeb Nazim , Lopez Jonathan , Kopetz Scott E , Maru Dipen M , Vauthey Jean-Nicolas 
Published: June 2022

BACKGROUND:
Micrometastases, defined as microscopic cancer cells spatially separated from the macroscopically evident metastasis, are identified in 24% to 56% of resected colorectal liver metastases (CLMs). Somatic gene mutations have emerged as independent prognostic factors in CLM. This study aimed to determine the prognostic impact and risk factors for the presence of micrometastases, including somatic gene mutations.

STUDY DESIGN:
Prospective evaluation for micrometastases was performed at 2 centers in the US and France from 2015 to 2019. CLM specimens were cut radially from the tumor margin to surrounding grossly normal liver for a distance of 2 cm. Depending on CLM size, 3 to 8 specimens per patient were submitted for microscopic analysis. Somatic gene mutations were detected by next-generation sequencing.

RESULTS:
Among 140 patients undergoing CLM resection in the US (n = 84) and France (n = 56), 36 (26%) patients were found to have micrometastases. Five-year overall and recurrence-free survival rates with micrometastases were 39% and 0%, respectively, compared with 61% and 20% without micrometastases (both p < 0.05). In multivariable analyses, the presence of micrometastases was an independent risk factor for worse overall survival (hazard ratio 2.88, 95% CI 1.46 to 5.70, p = 0.002) and recurrence-free survival (hazard ratio 1.56, 95% CI 1.01 to 2.41, p = 0.046). In binary logistic regression analysis, RAS/TP53 co-mutation was found to significantly increase the risk of micrometastases (odds ratio 2.77, 95% CI 1.15 to 6.71, p = 0.024).

CONCLUSIONS:
Micrometastases are associated with significantly worse survival after CLM resection. RAS/TP53 co-mutation correlated with increased risk of micrometastases. Further studies are needed to determine strategies to eradicate micrometastases.
A Rising Tide Lifts All Boats: Impact of Combined Volume of Complex Cancer Operations on Surgical Outcomes in a Low-Volume Setting
Authors: de Geus Susanna WL , Papageorge Marianna V , Woods Alison P , Wilson Spencer , Ng Sing Chau , Merrill Andrea , Cassidy Michael , McAneny David , Tseng Jennifer F , Sachs Teviah E 
Published: June 2022

BACKGROUND:
Centralization for complex cancer surgery may not always be feasible owing to socioeconomic disparities, geographic constraints, or patient preference. The present study investigates how the combined volume of complex cancer operations impacts postoperative outcomes at hospitals that are low-volume for a specific high-risk cancer operation.

STUDY DESIGN:
Patients who underwent pneumonectomy, esophagectomy, gastrectomy, hepatectomy, pancreatectomy, or proctectomy were identified from the National Cancer Database (2004–2017). For every operation, 3 separate cohorts were created: low-volume hospitals (LVH) for both the individual cancer operation and the total number of those complex operations, mixed-volume hospital (MVH) with low volume for the individual cancer operation but high volume for total number of complex operations, and high-volume hospitals (HVH) for each specific operation.

RESULTS:
LVH was significantly (all p ≤ 0.01) predictive for 30-day mortality compared with HVH across all operations: pneumonectomy (9.5% vs 7.9%), esophagectomy (5.6% vs 3.2%), gastrectomy (6.8% vs 3.6%), hepatectomy (5.9% vs 3.2%), pancreatectomy (4.7% vs 2.3%), and proctectomy (2.4% vs 1.3%). Patients who underwent surgery at MVH and HVH demonstrated similar 30-day mortality: esophagectomy (3.2 vs 3.2%; p = 0.993), gastrectomy (3.2% vs 3.6%; p = 0.637), hepatectomy (3.8% vs 3.2%; p = 0.233), pancreatectomy (2.8% vs 2.3%; p = 0.293), and proctectomy (1.2% vs 1.3%; p = 0.843). Patients who underwent pneumonectomy at MVH demonstrated lower 30-day mortality compared with HVH (5.4% vs 7.9%; p = 0.045).

CONCLUSION:
Patients who underwent complex operations at MVH had similar postoperative outcomes to those at HVH. MVH provide a model for the centralization of complex cancer surgery for patients who do not receive their care at HVH.
Effect of Delay and Disruption in Venous Thromboembolism Prophylaxis in Trauma Patients: Case-Control Study
Authors: Falksen Jessica A , Duby Jeremiah J , Wilson Machelle D , Fine Jeffrey R , Cocanour Christine S 
Published: June 2022

BACKGROUND:
Trauma patients are at high risk for venous thromboembolism (VTE) and bleeding. The purpose of this study was to characterize percentage of VTE chemoprophylaxis given to trauma patients with and without a VTE.

STUDY DESIGN:
This retrospective case–control study evaluated trauma patients admitted to a Level I trauma center. Adult patients were included when hospitalized at least 2 days and had a head abbreviated injury score of 1 or less. Non-VTE patients were matched by decade of life and injury severity score (ISS). The primary outcome was percentage of VTE chemoprophylaxis received over the first 14 days of admission. Descriptive statistics, chi-squared test, Student’s t-test, and Cox proportional hazard were used for analysis.

RESULTS:
A total of 44 VTE patients were included with 125 matched non-VTE patients. Baseline demographics included age in years (50.7 ± 19.6 vs 49.6 ± 19.4), ISS (18.9 ± 11.3 vs 19 ± 11.6), and lower extremity fracture (54.5% vs 40%), for VTE and non-VTE groups, respectively. The primary outcome of VTE chemoprophylaxis doses given was significantly lower for VTE patients than non-VTE patients (49.3% vs 59.3%, p = 0.0069). Significant predictors of VTE were percentage of VTE chemoprophylaxis doses given (p < 0.0001) and weight (p = 0.0042) based on regression analysis. Notably, there was a 7% decrease in the hazard for VTE for every 1% increase in VTE chemoprophylaxis given.

CONCLUSIONS:
Patients who developed VTE were more likely to have delays and disruptions in VTE chemoprophylaxis, even after controlling for age, sex, ISS, lower extremity fractures, and number of operations.
Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments
Authors: Röhr Susanne , Kivipelto Miia , Mangialasche Francesca , Ngandu Tiia , Riedel-Heller Steffi G. 
Published: June 2022

Purpose of review
The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence.

Recent findings
Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions.

Summary
Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.
Electroconvulsive Therapy in Children and Adolescents in Germany—A Case Series From 3 University Hospitals
Authors: Karl Sebastian , Methfessel Isabel , Weirich Steffen , Rothermel Boris , Crozier Jesse , Besse Matthias , Reinhardt Martin , Buchmann Johannes , Dück Alexander , Schulz Jan , Zilles-Wegner David , Häßler Frank , Kölch Michael , Uebel von Sandersleben Henrik , Poustka Luise , Sartorius Alexander 
Published: June 2022

Objective
Electroconvulsive therapy (ECT) is a well-established, safe, and efficacious treatment for severe psychiatric disorders. In children and adolescents, it is used much less frequently than in adults, likely because of a lack of knowledge.

Methods
We retrospectively analyzed all patients aged 12 to 17 years who completed a course of ECT at 3 psychiatric university hospitals in Germany between 2010 and 2020. Clinical Global Impression Severity (CGI-S) scores were assessed based on electronic medical records. Changes in CGI-S scores were assessed using a paired samples t test. Predictors for response and remission were assessed using binomial logistic regression.

Results
We included 32 patients. The CGI-S scores improved significantly from before to after ECT treatment (6.9 vs 3.9, t = 10.0, P < 0.01). A total of 40.6% of patients responded (CGI ≤ 3) and 21.9% remitted (CGI ≤ 2). The number of ineffective medication trials in the 6 months before ECT treatment was significantly associated with response (odds ratio, 0.54; P = 0.028) and remission (odds ratio, 0.31; P = 0.048). Five patients reported subjective cognitive adverse effects, 2 patients exhibited a prolonged seizure, 1 patient reported headaches, and 1 patient experienced a mild allergic reaction after anesthesia with etomidate. A total of 65.6% of patients experienced no adverse effects at all.

Conclusions
This retrospective analysis found ECT to be effective and safe in children and adolescents irrespective of their main diagnosis. The reported data point to the importance of an early use of ECT for severe psychiatric diseases in child and adolescent psychiatry.
Codon optimization, not gene content, predicts XYLose metabolism in budding yeasts
Authors: Nalabothu Rishitha L. , Fisher Kaitlin J. , LaBella Abigail Leavitt , Meyer Taylor A. , Opulente Dana A. , Wolters John F. , Rokas Antonis , Hittinger Chris Todd 
Published: June 2022

AbstractXylose is the second most abundant monomeric sugar in plant biomass. Consequently, xylose catabolism is an ecologically important trait for saprotrophic organisms, as well as a fundamentally important trait for industries that hope to convert plant mass to renewable fuels and other bioproducts using microbial metabolism. Although common across fungi, xylose catabolism is rare within Saccharomycotina, the subphylum that contains most industrially relevant fermentative yeast species. Several yeasts unable to consume xylose have been previously reported to possess complete predicted xylolytic metabolic pathways, suggesting the absence of a gene-trait correlation for xylose metabolism. Here, we measured growth on xylose and systematically identify XYL pathway orthologs across the genomes of 332 budding yeast species. We found that most yeast species possess complete predicted xylolytic pathways, but pathway presence did not correlate with xylose catabolism. We then quantified codon usage bias of XYL genes and found that codon optimization was higher in species able to consume xylose. Finally, we showed that codon optimization of XYL2, which encodes xylitol dehydrogenase, positively correlated with growth rates in xylose medium. We conclude that gene content cannot predict xylose metabolism; instead, codon optimization is now the best predictor of xylose metabolism from yeast genome sequence data.Significance StatementIn the genomic era, strategies are needed for the prediction of metabolic traits from genomic data. Xylose metabolism is an industrially important trait, but it is not found in most yeast species heavily used in industry. Because xylose metabolism appears rare across budding yeasts, we sought to identify a computational means of predicting which species are capable of xylose catabolism. We did not find a relationship between gene content and xylose metabolism traits. Rather, we found that codon optimization of xylolytic genes was higher in species that can metabolize xylose, and that optimization of one specific gene correlated with xylose-specific growth rates. Thus, codon optimization is currently the only means of accurately predicting xylose metabolism from genome sequence data.
Distance-based global analysis of consistentcis-bonds in protein backbones
Authors: Okada Tetsuji , Tomoike Fumiaki 
Published: June 2022

AbstractBiological polypeptides are known to containcis-linkage in their main chain as a minor but important feature. Such anomalous connection of amino acids has different structural and functional effects on proteins. Experimental evidence ofcis-bonds in proteins is mainly obtained using X-ray crystallography and other methods in the field of structural biology. To date, extensive analyses have been carried out on the experimentally foundcis-bonds using the Protein Data Bank entry bases and/or residue bases; however, their consistency in each protein has not been examined on a global scale. Data accumulation and advances in methodology enable the use of new approaches from a proteomic point of view. Here, we sought to describe a simple procedure for the detection and confirmation ofcis-bonds from a set of experimental coordinates for a protein to discriminate this type of bond from isomerizable and/or misassigned bonds. The resulting set of consistentcisbonds provides unprecedented insights into the trend of “highciscontent” proteins and the upper limit of consistentcisbonds per polypeptide length. Recognizing such limit would not only be important for a practical check of upcoming structures, but also for the design of novel protein folds beyond the evolutionally-acquired repertoire.