bluuebunny/crossref_metadata_2025_split huggingface dataset:
A closer look at adipose tissue lymphatics and their markers
Authors: Lackman Madeleine H. , Subashi Yelin , Karaman Sinem 
Published: February 2022

Purpose of review
Lymphatic vessels are found in most tissues, with the exception of the cornea and the central nervous system. Tissues that have high exposure to antigens, such as the skin and the intestine, have especially extensive lymphatic vascular networks. Despite being densely vascularized with blood vessels, adipose tissue is poorly permeated with lymphatic vasculature. Here, we focus on the recent advances in the research on adipose tissue lymphatics and present a lymphatic-focused analysis of published single-cell and single-nucleus RNA sequencing datasets of adipose tissues.

Recent findings
Although lymphatic expansion in obesity may limit inflammation and promote glycerol efflux from adipose tissue, lymphatic endothelial cells (LECs) secrete factors that reduce brown adipocyte thermogenesis. Transcriptomic analyses of these cells show that they express common lymphatic markers such as Proxl, but datasets from different studies show great variation in gene expression values due to the low number of captured LECs, depot differences, and species-specific gene expression patterns.

Summary
As the importance of LECs in the homeostasis of adipose tissue has become evident, investigators want to shed light on the specific interactions of lymphatics with other cell types in adipose tissues. Extracting LECs from readily available transcriptomics datasets provides a standpoint for investigators for future research. However, systematic studies are needed to reveal unique identities according to depot and species-specific LEC signatures.
Impact of COVID-19 of oncology pharmacy services: Results of 8-months survey
Authors: Bienert Agnieszka , Meier Klaus , Kokisheva Antonina , Brambila Rodrigo A. Gama , Veraldi Marianna , Marques Nuno Vilaca , Kuzmanović Maja , Andreianu Dan Paul , Badibouidi Ferdinand , Vallespin Romina Morales 
Published: February 2022

Abstract

Introduction:
The SARS-CoV-2 pandemic stroke at the beginning of 2020, challenging the health systems worldwide. As hospitals became overwhelmed by the number of cases, and community pharmacies became one of the few non-stop operating services, and the work rhythm and workload of pharmacists changed importantly.

Methods:
To investigate which and how the changes occurred, especially among oncology pharmacists, the ESOP together with the EAHP developed a survey, translated to 9 languages, and distributed online. The questions were changed over the duration of the survey (August 2020 to March 2021), adapting to the global situation. The answers were analyzed with basic descriptive statistics.

Results:
Over 1000 health professionals, predominantly pharmacists (over 85%), from 64 countries participated in the monthly survey, providing information relevant to both the hospital and the community pharmacy. More than 50% of hospital pharmacists reported shortage of chemotherapeutics, while the availability of COVID-19 related medications had more fluctuations in the hospital pharmacy. Contrastingly, over 80% of community pharmacists reported medications shortages in April 2020. The survey showed the negative impact of the pandemic on chemotherapeutic preparations, with decreased productions during the first and second waves (February-May 2020, and November 2020 to January 2021). The survey also helped visualize the stress levels and workloads of pharmacists. More than 70% of participants reported in August 2020 to have needed to procure themselves with Personal Protective Equipment. Working hours increased for 43% of the respondents, and more than 60% reported to have felt emotionally stressed.

Conclusions:
Thus, the presented results give a broad, yet detailed overview of how the pandemic has affected health professionals both in the hospital and the community, how professionals and governments have reacted to the situation, and how the care of oncology patience and the practice of oncology pharmacy has changed and reacted during the first year of the SARS-CoV-2 pandemic.
Clinical Characteristics and Outcomes of Acute Childhood Encephalopathy in a Tertiary Pediatric Intensive Care Unit
Authors: Hui Wun Fung , Leung Karen Ka Yan , Au Cheuk Chung , Fung Cheuk Wing , Cheng Frankie W.T. , Kan Elaine , Hon Kam Lun Ellis 
Published: February 2022

Aim
Childhood encephalopathy comprises a wide range of etiologies with distinctive distribution in different age groups. We reviewed the pattern of encephalopathy admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital.

Methods
We reviewed the medical records and reported the etiologies, clinical features, and outcomes of children with encephalopathy.

Results
Twenty-four admissions to the PICU between April 2019 and May 2020 were reviewed. The median (interquartile range) age was 10.0 (14.7) years and 62.5% were boys. Confusion (66.7%) was the most common presentation. Adverse effects related to medications (33.3%) and metabolic disease (20.8%) were predominant causes of encephalopathies in our study cohort. Methotrexate was responsible for most of the medication-associated encephalopathy (37.5%), whereas Leigh syndrome, pyruvate dehydrogenase deficiency and Wernicke's encephalopathy accounted for those with metabolic disease. The median Glasgow Coma Scale (GCS) on admission was 12.5 (9.0). Antimicrobials (95.8%) and antiepileptic drugs (60.9%) were the most frequently given treatment. Children aged 2 years or younger were all boys (P = 0.022) and had a higher proportion of primary metabolic disease (P = 0.04). Intoxication or drug reaction only occurred in older children. The mortality was 8.3%, and over half of the survivors had residual neurological disability upon PICU discharge. Primary metabolic disease (P = 0.002), mechanical ventilation (P = 0.019), failure to regain GCS back to baseline level (P = 0.009), and abnormal cognitive function on admission (P = 0.03) were associated with cerebral function impairment on PICU discharge.

Conclusions
Primary metabolic encephalopathy was prevalent in younger children, whereas drug-induced toxic encephalopathy was common among older oncology patients. Survivors have significant neurologic morbidity. Failure to regain baseline GCS was a poor prognostic factor for neurological outcomes.
Nonutility of Diagnostic Testing in Ambulatory Patients With Supraventricular Tachycardia
Authors: Taylor Rachel A. , Thomas Ronald , Lawrence David 
Published: February 2022

Background
Supraventricular tachycardia (SVT) is the most common arrhythmia in the pediatric population. Patients often present to the emergency department and undergo extensive diagnostic assessment. The objective of this study is to determine the frequency of diagnostic studies obtained in such patients and to assess clinical significance of these results.

Methods
A retrospective study was performed from 2011 to 2018 in a single-center ED, including patients 21 years of age or younger presenting with SVT without shock.

Results
A total of 40 patients with 92 encounters were included for analysis. The mean age was 8.58 (±5.51) years; 55% female. A total of 67.4% underwent serologic laboratory evaluation, of which 8 (12.9%) had any abnormality. Only one was deemed clinically significant to warrant intervention. Nearly 30% of patients underwent chest radiography, with no clinically significant findings.

Conclusions
Patients undergoing ED management of uncomplicated SVT are likely to undergo laboratory investigation and unlikely to have abnormal studies impacting their care. Given the associated risk of false-positive studies, the discomfort to the patient and parent, and cost of these studies, routine laboratory or radiographic investigation in this population may be unwarranted.
Are We in Control of Our Demons?
Authors: Kong Kar Yee Catrin , Ganapathy Sashikumar 
Published: February 2022

Background
The medical profession, with its remarkable physical and emotional demands, predisposes physicians to compassion fatigue (CF) and burnout (BO). Although these conditions have been studied individually, little attention has been paid to how pediatric emergency physicians experience these conditions in the context of an Asian emergency setting especially during a global pandemic In our study, we aim to understand the experiences of individual physicians and describe the potential triggers or protective factors of compassion satisfaction, BO, and compassion satisfaction among physicians in an Asian pediatric emergency department during a pandemic.

Methods
A qualitative, individual interview methodology was used. From March to April 2020, we enrolled 20 physicians involved in frontline care during the coronavirus disease 2019 (COVID-19) pandemic in the pediatric emergency department to participate. Semistructured interviews were conducted, audiotaped, and transcribed in verbatim, with identifiers removed. Themes were identified, and data were analyzed using qualitative data analysis and iterative data analysis.

Results
We recruited 20 physicians. Three themes emerged from data analysis. First, we showed how workplace conditions are protective, including work morale, leadership and management, and social support received. Second, workload affected participants emotionally and in terms of its heavier quantity and longer hours. Finally, intrinsic factors that were protective in developing CF or BO include having professional autonomy, experience, work-life balance, and having emotional resilience to develop self-care. Cultural influences affect emotional regulation and can lead to negative coping with negative peer pressure. In general, participants quantified their levels of satisfaction at work as average to above average. However, they highlighted experiencing greater stress during COVID-19 with the underlying fear of contagion and infection.

Conclusions
Being a pediatric emergency physician puts one at greater risk of experiencing CF and BO because of work and nonwork stressors, especially during a global pandemic, influenced by sociocultural factors. A positive and supportive work environment should be created while providing culturally adapted strategies to improve individual physician resilience to maintain their well-being.
“Code Green Active” Curriculum
Authors: Kusulas Matthew P. , Drenis Anastasios , Cooper Alison , Fishbein Joanna , Crevi Diana , Stein Etess Melanie , Bullaro Francesca 
Published: February 2022

Background
There has been an increase in violent acts against hospital employees, including active shooter events. Emergency department (ED) staff must be able to respond to these events efficiently to ensure the safest possible outcome. However, few in our ED were aware of our hospital's active shooter protocol. We aimed to increase staff knowledge of and confidence in these guidelines.

Methods
We developed and implemented a 7-week spiral curriculum using the Kern model of curriculum development. Each week, a segment of the hospital active shooter protocol was featured. Multimodal instructional methods including posters, instruction at daily team huddles, descriptions in the weekly division newsletter, and email summaries were used.
A 10-question assessment was administered to ED staff both before and after the implementation of our curriculum. During both assessments, staff were asked to rate their confidence in both knowledge of and ability to follow hospital active shooter guidelines.

Results
There were 95 and 102 participants in the preintervention and postintervention periods, respectively.
The median proportion of correct answers on the knowledge assessment increased when comparing preintervention with postintervention performances (P < 0.05).
Staff confidence in both knowledge of and ability to follow active shooter protocols increased after the implementation of our curriculum (P < 0.05).

Conclusions
Our 7-week curriculum resulted in improved knowledge of and confidence in hospital active shooter protocols among ED staff. Given that our sample was an unpaired convenience sample, inferences from our analysis were limited. Tabletop simulations are currently underway to further reinforce and clarify concepts.
Oil Cyst Formation after Lower Blepharoplasty with Fat Grafts
Authors: Huang Chih-Wei , Yen Yu-Hsiu , Lu Shiuh-Yen , Pu Chi-Ming 
Published: February 2022

Background
Fat grafting is increasingly used as an adjuvant surgery to blepharoplasty to refill the volume loss of an aged face and promote cellular regeneration. Complications, such as hematoma, infection, seroma, and palpable mass, may occur. We collected the patients that underwent lower blepharoplasty combined with fat graft to evaluate the incidence of oil cyst formation in the lower eyelid and to identify risk factors.

Material and Methods
A retrospective review was performed of all patients who underwent lower or total blepharoplasty combined with fat graft at the authors' institution between January 2018 and June 2020. Complication rates were observed, and associations between preoperative variables and outcomes were assessed.

Results
A total of 119 patients were included in the series (all bilateral, 238 eyelids). The average patient age was 54.88 ± 11.94 years, and the average grafted fat was 1.88 ± 1.0 mL. On a per-eyelid basis for all patients, the complication rate of oil cyst formation was 6.72% (16 of 238 eyelids). The occurrence of oil cyst formation was associated with hypertension (P = 0.012; adjusted odds ratio, 9.27; 95% confidence interval, 1.62–52.99) and diabetes mellitus (P = 0.005; adjusted odds ratio, 14.02; 95% confidence interval, 2.22–88.45), but not associated with anticoagulants use (P = 0.931), age (P = 0.784), sex (P = 0.317), or fat volume (P = 0.215). The mean interval between the fat graft procedure and oil cyst noted was 236.5 ± 118.9 days.

Conclusions
Oil cyst in lower eyelid can be defined as a palpable, firm, and persistent subcutaneous cystic lesion found postoperatively in any size during physical examination. The complication rate of oil cyst formation occurring after lower blepharoplasty with autologous fat grafting is 6.72%. Hypertension and diabetes mellitus maybe are risk factors of oil cyst formation. Steroid injection, needle capsulotomy, liposuction, and excision are safe and effective treatments. Reduce surgical trauma by diminishing anterior lamina trauma and capsulopalpebral fascia repair might decrease the complication rate of oil cyst formation.
Transconjunctival lower blepharoplasty with fat graft or 2-stage surgery may be a choice to prevent oil cyst formation.
An In Vitro Study of the Effects of Mechanical and Enzymatic Isolation of Stromal Vascular Fraction on Wound Healing
Authors: Dai Lien-Guo , Huang Nien-Chi , Kang Lan-Ya , Fu Keng-Yen , Hsieh Pai-Shan , Dai Niann-Tzyy 
Published: February 2022

Abstract
The adipose-derived stromal vascular fraction (SVF) is considered to be an attractive source of stem cells in cell therapy. Besides stem cells, it also contains functional cells, such as macrophages, precursor cells, somatic stem cells, and pericytes. Collagenase digestion is the most frequently used method to isolate SVF, but it is time-consuming and costly and has some problems, such as infectious agents and immune reactions. In this research, we compared the yield, cell population ratios, and cell viability when isolating SVF by the ultrasonic physics (U-SVF) method and traditional enzymatic method (E-SVF). Then, we isolated exosomes from U-SVF and E-SVF, respectively, and cocultured them with fibroblasts to investigate the potential of applying this cell secretion in wound repair. The results showed that there was no significant difference between the ultrasonic method and enzymatic method in terms of cell viability, cell numbers, or the expression of CD markers of stem cells. However, exosome analysis identified a greater number and smaller size of exosome particles obtained by U-SVF. In terms of cell proliferation efficiency, although the proliferation efficiency of U-SVF was lower than that of E-SVF. Trilineage differentiation experiments revealed that both E-SVF and U-SVF had good differentiation ability, owing to high stem cell content. Finally, E-SVF and U-SVF exosomes were cocultured with fibroblasts. The efficiency of fibroblast migration increased in the SVF exosome treated groups, and the expression of related genes (integrin α5β1) was slightly upregulated; however, the expression of FAK, AKT, ERK, and RhoA was significantly upregulated at 24 hours. From the abovementioned experiments, we found that there was no significant difference in stem cell-related characteristics between SVF isolated by ultrasonic cavitation and SVF isolated by the enzymatic method. In addition, exosomes secreted by SVF may have excellent therapeutic effect on skin injuries, which provides a new viewpoint and therapeutic strategy for soft tissue repair.
The Effect of Biological Scaffold (Biodesign) in Postmastectomy Direct-to-Implant Breast Reconstruction
Authors: Sou Weng-Kit , Perng Cherng-Kang , Ma Hsu , Tseng Ling-Ming , Tsai Yi-Fang , Lin Yen-Shu , Lien Pei-Ju , Hsiao Fu-Yin , Feng Chin-Jung 
Published: February 2022

Background
Direct-to-implant (DTI) breast reconstruction is one of the immediate implant-based breast reconstruction methods. If the amount of soft tissue (eg, muscle or fascia) is insufficient to completely cover the implant, biological scaffold or acellular dermal matrix can be safely used for implant coverage. In this study, we used an acellular porcine small intestinal submucosa (SIS) mesh (Biodesign; Cook Medical Inc, Bloomington, IN) for DTI reconstruction to explore the impact of its use on breast reconstruction results.

Methods
We retrospectively assessed cases involving DTI reconstruction at Taipei Veterans General Hospital from 2015 to 2019. Women, 18 years or older, who underwent immediate DTI reconstruction after mastectomy were included in the study. Mastectomy may have been performed because of therapeutic or prophylactic reasons. Patients who did and did not use SIS mesh for reconstruction were studied separately, and the 2 groups were compared in terms of clinical outcomes and complications. The validated, self-administered BREAST-Q Reconstruction Module version 2.0 survey was used to evaluate health-related quality of life and satisfaction among patients who underwent breast reconstruction.

Results
A total of 30 DTI breast reconstructions were enrolled. The mean age was 49.2 years, and the mean body mass index was 22.3 kg/m2. The mean postoperative follow-up duration was 17.1 months. Nipple-sparing mastectomy was performed for 26 cases (86.7%), and DTI breast reconstructions using SIS mesh for implant coverage were done in 14 cases (46.7%). The overall complication rate was 53.3% in 30 reconstructions, with nipple complications being the most common complication. The non-SIS and SIS-using groups had a similar overall complication rate postoperatively. As for the quality-of-life assessment, the SIS group obtained a higher score on BREAST-Q than those for whom SIS was not used.

Conclusions
Porcine SIS mesh might be a safe and effective alternative to biological scaffolds in immediate 1-stage implant-based breast reconstruction to improve the quality of life after surgery.
Long-Term Complications and Patient-Reported Outcomes After Alloplastic Breast Reconstruction
Authors: Lee Chia-Chun , Perng Cherng-Kang , Ma Hsu , Wu Szu-Hsien , Hsiao Fu-Yin , Tseng Ling-Ming , Tsai Yi-Fang , Lin Yen-Shu , Lien Pei-Ju , Feng Chin-Jung 
Published: February 2022

Background
The most widely used method for breast reconstruction in Taiwan is alloplastic breast reconstruction, and traditionally, it can be categorized into immediate or delayed, single-stage or 2-stage procedures. We evaluated clinical outcomes and analyzed patients' self-reported satisfaction and quality of life after alloplastic breast reconstruction based on a previous preliminary study.

Patient and Methods
The patients who underwent primary alloplastic breast reconstruction after mastectomy were recruited in 2006 to 2020 at a single institute in Taiwan. The assessment of clinical outcomes was conducted by retrospective chart review and risk analysis. The patients also completed the BREAST-Q, a condition-specific patient-reported outcome measure, at least 6 months after treatment.

Results
A total of 237 patients with 247 reconstructed breasts were enrolled in this study. The demographics showed that 205 (83%) were reconstructed using a 2-stage tissue expander-based procedure and 42 (17%) were 1-stage direct-to-implant reconstructions. The mean follow-up time was 79.5 months. The clinical assessment revealed that the overall complication rate was 34%, with infection being the most common (21 patients; 8%). According to risk analysis, smoking (odds ratio, 7.626; 95% confidence interval, 1.56–37.30; P = 0.012), and nipple-sparing mastectomy (odds ratio, 3.281; 95% confidence interval, 1.54–6.99; P = 0.002) were significant risk factors for overall complications. The questionnaire response rate was 38% (94 of 247), at least 6 months after treatment. The total mean score was 69.78.

Conclusions
At a single institute in Taiwan from 2006 to 2020, alloplastic breast reconstruction, either single- or 2-stage, have acceptable complication rate and good postoperative satisfaction based on patient-reported outcomes. Both patient- and surgery-related factors presented as significant risk factors. Precise patient selection and comprehensive discussion between the patient and physician may play the important role to achieve optimal aesthetic outcomes.
Information-Content-Informed Kendall-tau Correlation: Utilizing Missing Values
Authors: Flight Robert M , Bhatt Praneeth S , Moseley Hunter NB 
Published: February 2022

AbstractAlmost all correlation measures currently available are unable to directly handle missing values. Typically, missing values are either ignored completely by removing them or are imputed and used in the calculation of the correlation coefficient. In both cases, the correlation value will be impacted based on a perspective that missing data represents no useful information. However, missing values occur in real data sets for a variety of reasons. In omics data sets that are derived from analytical measurements, the primary reason for missing values is that a specific measurable phenomenon falls below the detection limits of the analytical instrumentation. These missing data are not missing at random, but represent some information by virtue of their “missingness”. Therefore, we propose the information-content-informed Kendall-tau (ICI-Kt) correlation coefficient that allows missing values to carry explicit information in the determination of concordant and discordant pairs. With both simulated and real data sets from RNA-seq, metabolomics, and lipidomics experiments, we demonstrate that the ICI-Kt allows for the inclusion of missing data values as interpretable information, enabling both improved determination of outlier samples and improved feature-feature network construction, without explicitly using imputation. Moreover, our implementation of ICI-Kt uses a mergesort-like algorithm that provides O(nlog(n)) computational performance, a significant improvement over the Kendall-tau correlation available in base R.The ICI-Kt correlation calculation is available in an R package and Python module on GitHub athttps://github.com/moseleyBioinformaticsLab/ICIKendallTauandhttps://github.com/moseleyBioinformaticsLab/icikt, respectively.