bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients
Authors: Iyer Neena R. , Afshar Kamyar , Golts Eugene , Onaitis Mark W. , Kafi Aarya , Yung Gordon L. , Kunkel David C. 
Published: June 2022

Goals:
We aimed to evaluate a novel upper esophageal sphincter (UES) assist device loaner program for the prevention of acute cellular rejection and chronic lung allograft dysfunction among lung transplant (LTx) recipients.

Background:
Laryngopharyngeal reflux can lead to chronic microaspiration and LTx rejection. The UES assist device applies external pressure at the level of UES to decrease reflux.

Study:
We prospectively enrolled and issued UES assist devices to consecutive transplant patients referred for gastrointestinal motility testing from 2016 to 2020. Device tolerability was defined by successful utilization as a bridge to ambulatory pH monitoring and/or antireflux procedure, or as permanent therapy. Incidence of rejection was analyzed before, during, and after device implementation.

Results:
Twenty-six participants were issued devices (15 pathologic, 5 physiological, 6 unknown reflux status), none of whom developed acute rejection episodes or chronic lung allograft dysfunction while using the device. Thirteen adopted the device promptly after transplantation (mean 1.7 mo) and remained free of rejection episodes over a mean 24.7 months of follow-up. Among those with pathologic reflux, lag time to device adoption strongly correlated with the development of rejection (r=0.8, P=0.0006). There was no such correlation among those with physiological reflux. Five developed acute rejection after device return.

Conclusions:
The device was tolerated by a majority of LTx patients and appears feasible as a barrier measure in the prevention of rejection. Delayed treatment of laryngopharyngeal reflux may lead to early allograft failure; therefore, the UES assist device should be given important consideration in transplant protection.
Genetic and epigenetic nutritional interactions influencing obesity risk and adiposity outcomes
Authors: Ramos-Lopez Omar , Riezu-Boj Jose Ignacio , Milagro Fermin I. 
Published: June 2022

Purpose of review
This article aims to critically overview the current interplay of genetic/epigenetic factors and several nutritional aspects influencing obesity susceptibility and adiposity outcomes for obesity management and weight status monitoring.

Recent findings
Single nucleotide polymorphisms located in or near genes participating in energy homeostasis, fatty acid metabolism, appetite control, brain regulation, and thermogenesis have been associated with body composition measures (body weight, body mass index, waist circumference, body fat percentage, and visceral adipose tissue) depending on nutrient intakes, dietary patterns, and eating behaviors. Moreover, studies analyzing interactions between the epigenome and dietary intakes in relation to adiposity outcomes are reported. The main epigenetic mechanisms include methylation levels of promoter sequences, telomere length, and micro-ribonucleic acid expression profiles, whereas covalent histone modifications remain less studied.

Summary
Exploring potential interactions between the genetic/epigenetic background and nutritional features is improving the current understanding of the obesity physiopathogenesis and the usefulness of translating this precision information in the clinical setting for weight gain prediction, the design of personalized nutrition therapies as well as individual responsiveness estimation to dietary advice. The analysis of further relationships between the genotype, the epigenotype and other precision markers including the gut microbiota and the metabolome is warranted.
Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining Association With Early Sepsis*
Authors: Hou Sen-Kuang , Lin Hui-An , Tsai Hung-Wei , Lin Chiou-Feng , Lin Sheng-Feng 
Published: June 2022

OBJECTIVES:
To investigate the association between increased monocyte distribution width (MDW) and pediatric sepsis in the emergency department (ED).

DESIGN:
Retrospective cohort study.

SETTING:
A single academic hospital study.

PATIENTS:
Patients from birth to the age of 18 years who presented at the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were consecutively enrolled. Sepsis was diagnosed using the International Pediatric Surviving Sepsis Campaign criteria.

INTERVENTIONS:
Antibiotic treatment was administrated once infection was suspected.

MEASUREMENTS and MAIN RESULTS:
Routine complete blood cell count, neutrophil-to-lymphocyte ratio (NLR), and MDW, a new inflammatory biomarker, were evaluated in the ED. Logistic regression models were used to explore associations with early pediatric sepsis. We included 201 patients with sepsis and 1,050 without sepsis. In the multivariable model, MDW greater than 23 U (odds ratio [OR], 4.97; 95% CI, 3.42–7.22; p < 0.0001), NLR greater than 6 (OR, 2.06; 95% CI, 1.43–2.94; p = 0.0001), WBC greater than 11,000 cells/µL (OR, 6.52; 95% CI, 4.45–9.53; p < 0.0001), and the SIRS score (OR, 3.42; 95% CI, 2.57–4.55; p < 0.0001) were associated with pediatric sepsis. In subgroup analysis, MDW greater than 23 U remained significantly associated with sepsis for children 6–12 years old (OR, 6.76; 95% CI, 2.60–17.57; p = 0.0001) and 13–18 years (OR, 17.49; 95% CI, 7.69–39.76; p = 0.0001) with an area under the receiver operating curve of 0.8–0.9.

CONCLUSIONS:
MDW greater than 23 U at presentation is associated with the early diagnosis of sepsis in children greater than or equal to 6 years old. This parameter should be considered as a stratification variable in studies of pediatric sepsis.
What Do Patients and Their Carers Do to Support the Safety of Cancer Treatment and Care? A Scoping Review
Authors: Tillbrook Darci , Absolom Kate , Sheard Laura , Baxter Ruth , O’Hara Jane K. 
Published: June 2022

Background
Cancer patients and their carers face a multitude of challenges in the treatment journey; the full scope of how they are involved in promoting safety and supporting resilient healthcare is not known.

Objective
The study aimed to undertake a scoping review to explore, document, and understand existing research, which explores what cancer patients and their carers do to support the safety of their treatment and care.

Design
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Five online databases were searched from 2000 to 2021 to identify primary literature exploring perspectives on patient and caregiver involvement in maintaining their safety during cancer care. Narrative synthesis was then conducted on the included literature.

Results
Of the 1582 results generated from the initial search, 16 studies were included in the review. Most consisted of qualitative semistructured interviews with patients, as well as carers and healthcare professionals (HCP). Four narrative themes were identified: patient perception of safety and their involvement; patients take charge of their own care and well-being; safety as a dynamic collective responsibility; and carers are an undersupported asset. Patients and their carers involve themselves in a variety of behaviors in physical care, well-being, communication, and care coordination to ensure safety and support system resilience. This review adds a novel perspective on cancer patient and caregiver involvement in supporting resilient healthcare.

Conclusions
Patients and their carers play an important role in promoting safe cancer care and healthcare system resilience. Further research is recommended to realize the full extent of the system gaps encountered and mediated by patients and their carers.
Kynurenine/tryptophan ratio for detection of active tuberculosis in adults with HIV prior to antiretroviral therapy
Authors: Olsson Oskar , Skogmar Sten , Tesfaye Fregenet , Mulleta Daba , Jansson Marianne , Björkman Per 
Published: June 2022

Objective
The aim of this study was to assess the performance of kynurenine/tryptophan ratio for tuberculosis (TB) case-finding among antiretroviral therapy (ART)-naive people with HIV (PWH), and to investigate other factors associated with kynurenine/tryptophan ratio in this population.

Design
A nested case--control study based on a cohort of 812 ambulatory PWH in the Oromia region, Ethiopia.

Methods
At enrolment, all participants submitted sputum samples for bacteriological TB investigations. Concentrations of kynurenine and tryptophan in plasma were quantified using liquid chromatography-mass spectrometry. Receiver operator characteristic curves were constructed to assess diagnostic performance (area under the curve; AUC) for kynurenine, tryptophan, and kynurenine/tryptophan ratio. Sensitivity, specificity, and predictive values were calculated. Kynurenine/tryptophan ratios were correlated to plasma levels of nine inflammation mediators, plasma HIV RNA levels, CD4+ cell count, BMI, and mid-upper arm circumference (MUAC).

Results
We included 124 individuals with HIV-TB coinfection (HIV+/TB+) and 125 with HIV mono-infection (HIV+/TB-). Tryptophan levels were lower in HIV+/TB+ than in HIV+/TB- (median 19.5 vs. 29.8 μmol/l, P < 0.01), while kynurenine levels were similar between these groups (median 2.95 vs. 2.94 μmol/l, P = 0.62). Median kynurenine/tryptophan ratio was 0.15 in HIV+/TB+, significantly higher compared with HIV+/TB- (0.11; P < 0.01), with AUC 0.70 for TB detection. Kynurenine/tryptophan ratio was positively correlated to plasma HIV RNA levels, IP-10, IL-18, and IL-27, and negatively correlated to CD4+ cell count, BMI, and MUAC (all P < 0.01).

Conclusion
Among ART-naive PWH, kynurenine/tryptophan ratio has modest potential for TB discrimination, limiting its utility for TB case-finding in this population.
Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce
Authors: Rajabiun Serena , Killion Kate , Lennon-Dearing Robin , Williams Brandon Bernard , Hirschi Melissa 
Published: June 2022

Background:
Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV.

Setting:
Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi.

Methods:
Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders.

Results:
Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility.

Conclusion:
Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.
Multilevel Determinants of Rapid Antiretroviral Treatment Implementation and Demand in Miami-Dade County
Authors: Harkness Audrey , Wawrzyniak Andrew J. , Kolber Michael A. , Villamizar Kira , Botero Valeria , Rodriguez Jacqueline E. , Orr Jessica L. , Zukerberg Julia , Rodríguez Allan E. 
Published: June 2022

Background:
Rapidly linking newly diagnosed HIV patients to antiretroviral treatment (ART) is the best practice for achieving optimal treatment outcomes, including viral suppression. However, rapid ART implementation varies throughout the United States, highlighting the importance of identifying rapid ART implementation determinants in US HIV epicenters, such as Miami-Dade County (MDC).

Methods:
Clinic focus groups (N = 4 clinics) and patient interviews (N = 31 recently diagnosed patients) systematically and qualitatively assessed rapid ART implementation determinants in MDC. Independent coders analyzed focus groups and interviews using a directed content analysis approach guided by the Consolidated Framework for Implementation Research.

Results:
For clinic stakeholders, key rapid ART implementation determinants included the following: complexity and adaptability (innovation characteristics); networks between clinics and patient needs rooted in structural inequities (outer setting); leadership and available resources (inner setting); staff/provider flexibility (characteristics of individuals); and appointing patient navigators and champions (process). For patients, key determinants included complexity and relative advantage of rapid treatment (innovation characteristics); patient needs and clinic networks (outer setting); provider knowledge and skills (inner setting); provider warmth and affirmation (characteristics of individuals); and need for improved outreach (process).

Conclusions:
Multilevel factors impact clinic implementation and patient demand for rapid ART in MDC. Informed by these factors, we identified potential implementation strategies to enhance rapid ART implementation throughout MDC. These implementation strategies can be tested in an implementation trial, enhancing the toolkit of strategies to ensure that evidence-based tools, particularly rapid ART, are readily available to the most impacted communities.
Ultra-Low-Dose Photon-Counting CT Imaging of the Paranasal Sinus With Tin Prefiltration
Authors: Grunz Jan-Peter , Petritsch Bernhard , Luetkens Karsten Sebastian , Kunz Andreas Steven , Lennartz Simon , Ergün Süleyman , Bley Thorsten Alexander , Huflage Henner 
Published: June 2022

Objectives
In this study, we compared photon-counting detector computed tomography (PCD-CT) and energy-integrating detector computed tomography (EID-CT) for ultra-low-dose paranasal sinus examinations with employed tin prefiltration. The goal of our investigation was to define the most dose-effective scan protocols for diagnostic assessment of midface trauma, preoperative sinonasal anatomy, and acute rhinosinusitis.

Materials and Methods
Five cadaveric heads were examined with the standard-resolution scan mode of both CT systems using a tube potential of 100 kV and tin prefiltration for 7 dose-equivalent scan protocols (CTDIvol = 4.16–0.15 mGy) and 2 additional ultra-low-dose protocols exclusively feasible on the PCD-CT scanner (0.10 and 0.08 mGy). After applying comparable iterative reconstruction algorithms, image quality was subjectively assessed by 4 radiologists. The intraclass correlation coefficient was calculated to estimate the agreement among readers. Image noise was quantified in standardized regions of interest to establish an additional quantitative criterion of image quality.

Results
The most dose-effective scan protocols for diagnostic imaging of midface trauma (PCD-CT: 1.24 mGy; EID-CT: 2.05 mGy), preoperative sinonasal anatomy (PCD-CT: 0.20 mGy; EID-CT: 0.40 mGy), and acute rhinosinusitis (PCD-CT: 0.08 mGy; EID-CT: 0.15 mGy) required less radiation exposure on the PCD-CT system (P < 0.050). Despite higher image noise, ultra-low-dose PCD-CT studies (0.08 and 0.10 mGy) were considered suitable for inflammation-focused imaging, offering lower-dose penalties than EID-CT studies. Interobserver reliability for subjective image quality was excellent (intraclass correlation coefficient, 0.90; 95% confidence interval, 0.88–0.93; P < 0.001).

Conclusions
In paranasal sinus imaging with tin prefiltration, the PCD-CT allowed for superior image quality compared with high-end EID-CT. Assessment of paranasal sinuses with an ultra-low radiation exposure of 0.08 mGy was deemed adequate, suggesting substantial dose reduction potential for clinical routine, for example, in the diagnostic workup of patients with rhinosinusitis.
Finger Reconstruction With Distally Based Dorsal Metacarpal Flaps
Authors: Shimbo Keisuke , Kawamoto Haruka , Koshima Isao 
Published: June 2022

Background
Distally based dorsal metacarpal flaps for the reconstruction of finger soft-tissue defects are classified into 3 categories: dorsal metacarpal artery perforator flap, reverse dorsal metacarpal artery (RDMA) flap, and extended reverse dorsal metacarpal artery (ERDMA) flap. The present systematic review aimed to evaluate differences in the outcomes of commonly encountered defects and postoperative complications among these three flaps.

Methods
PubMed, Scopus, and Web of Science were systematically searched from when the flats were first reported to May 2021. Random-effects meta-analysis for each outcome was performed, and 24 studies were included in the analysis.

Results
Dorsal metacarpal artery perforator flaps were mainly used for defects extending to the proximal interphalangeal joint (n = 62 [29.1%]) and proximal phalanx (n = 85 [39.9%]). Conversely, defects extending to the distal phalanx (n = 24 [43.6%]) were mostly reconstructed using the ERDMA flap. The rate of venous congestion was highest for the ERDMA flap (29.3%; 95% confidence interval [CI], −17.2% to 65.1%; I
2 = 0%) and lowest for RDMA flap (8.1%; 95% CI, −5.9% to 21.7%; I
2 = 0%). The RDMA flap showed the lowest rate of any short-term complications, including partial and total necrosis (6.6%; 95% CI, −6.8% to 19.8%; I
2 = 0%).

Conclusions
This systematic review demonstrated that the dorsal metacarpal artery perforator flap was suitable for reconstruction proximal to the middle phalanx, and the ERDMA flap was suitable for reconstruction distal to the distal interphalangeal joint. Although the RDMA flap showed the lowest rate of short-term complications and limited analysis was secondary to limited data available, these occurred in 6.6% to 10.9% of distally based dorsal metacarpal flaps.
The 3-Dimensional “Croissant Mastopexy”
Authors: Handel Neal 
Published: June 2022

Abstract
Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in secondary breast revision cases. The key to achieving good results with this procedure lies in conceptualizing the operation in 3 dimensions rather than 2. Most publications about the surgical technique describe deepithelialization (or at most full-thickness skin resection) of a crescent-shaped area superior to the areola and a single-layer closure of the defect. Improved outcomes are achieved if a full-thickness composite segment of tissue—skin, subcutaneous fat, and a wedge of breast parenchyma—is resected and the resulting defect closed in multiple layers. A more fitting descriptive term for this procedure, one that conveys the 3-dimensional nature of the tissue resection, is “croissant mastopexy.” Croissant mastopexy has been used by the author in primary augmentation in women with mild to moderate ptosis, in patients with asymmetrical nipple position and in patients with tuberous breast deformity. The procedure is also applicable in secondary cases, but precautions must be taken to ensure that blood supply to the nipple is not compromised. When properly executed, croissant mastopexy yields good results without undue stretching of the superior half of the areola and with acceptable scars.
Breast Implant–Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures
Authors: Coombs Demetrius M. , Wu Shannon S. , Bernard Steven , Djohan Risal , Isakov Raymond , Schwarz Graham , Bassiri Gharb Bahar , Rampazzo Antonio 
Published: June 2022

Background
Outcomes related to preexisting breast implants after cardiothoracic procedures are poorly characterized. This study evaluated complications after minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP) in patients with preexisting breast implants.

Methods
A retrospective review of patients with prior breast implants who underwent MICS, MS, or EP from 1994 to 2019 was performed. Demographic, treatment, and outcome characteristics were recorded. χ2 Test and analysis of variance were used to perform statistical comparisons.

Results
In total, 78 patients (37 MICS, 21 MS, and 20 EP) were identified. Mean breast implant age was 13.3, 11.7, and 10.2 years, respectively (P = 0.235). Intraoperative plastic surgeon involvement was present in 26 (70.3%) MICS cases, compared with 2 (9.5%) MS and 0% EP (P < 0.001). Intraoperative rupture occurred in 5 (13.5%) MICS cases and no MS or EP cases (P < 0.001). Postoperative implant complications occurred in 6 (16.2%) MICS, 8 (38.1%) MS, and 5 (25.0%) EP (P = 0.350) cases, with median time to complication of 5.9, 5.4, and 38.9 months, respectively (P = 0.596). Revision surgery was performed in 5 (13.5%) MICS, 7 (33.3%) MS, and 5 (25.0%) EP (P = 0.246) cases. On multivariate analysis, lack of intraoperative plastic surgeon involvement (P = 0.034) and breast implant age (P = 0.001) were significant predictors of postoperative complications.

Conclusions
Long-term complication rates are highest among patients with breast implants undergoing MS. Plastic surgeon involvement was significantly associated with fewer postoperative complications. Our results support a multidisciplinary approach to managing breast implants during cardiothoracic procedures.