bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clostridium difficile Infection in the Plastic Surgery Population: Lessons from the ACS NSQIP Database
Authors: Karamanos Efstathios , Wang Howard , Shah Amita R. 
Published: January 2021

Background:

Clostridium difficile–associated infections (CDI) have a significant impact on morbidity and mortality of hospitalized medical and surgical patients. There is a paucity of data regarding the incidence, impact, and modifiable risk factors in the plastic surgery population.

Methods:
The ACS NSQIP database was retrospectively queried for all cases performed by plastic surgeons during 2016. All plastic surgery cases, combined cases, demographics, and baseline clinical characteristics were extracted from the database. The study population was divided into 2 groups based on the development of CDI. Independent variables for development of CDI were identified.

Results:
During the study period, a total of 29,256 patients underwent a procedure by plastic surgery, with the most commonly performed procedures involving the breast (58%) and trunk (14%). Only 44 patients developed post-operative CDI (0.1%). Factors independently associated with development of CDI were wound classification at the end of the surgery, COPD, procedures involving the trunk, and surgery for reconstruction of pressure ulcers. Outpatient surgery was associated with decreased odds of developing CDI [AOR (95% CI):0.2 (0.1, 0.4), adj P < 0.001]. Staying overnight did not increase the odds of developing CDI; however, staying for >1 day in the hospital was associated with an increased risk of CDI development [AOR (95% CI): 1.03 (1.01, 1.13), adj P = 0.001]. Combined cases, ASA, body mass index, diabetes, and active smoking were not associated with CDI.

Conclusions:
CDI are rare in the plastic surgery population and are most associated with trunk/decubitus ulcer reconstructions, inpatient hospital stay, and contaminated wounds. The patients that usually fit in these categories have acutely or chronically infected wounds, which are often treated with systemic antibiotics. For patient with decubitus ulcers and other trunk reconstruction, the guidelines for pre and post-operative systemic antibiotic usage is not well defined. For patients who have had trunk reconstruction, development of evidence-based antibiotic stewardship guidelines may help these patients by limiting antibiotic usage and thereby reducing the incidence of CDI.
Distally-based Peroneus Brevis Turnover Muscle Flap in the Reconstruction of Soft Tissue Defects
Authors: Malahias Marco , Khalil Haitham , Abdalbary Sahar Ahmed , Abdelkader Rasha 
Published: January 2021

Background:
Reconstruction of the distal 3rd of the lower leg requires either local or free flap coverage if tendons or bones are exposed. The distally based, pedicled peroneus brevis (PB) flap has been shown to be a valid option in the management of distal 3rd lower limb injuries. Herein, we present 21 cases treated with distally-based PB muscle flaps between May 2017 and September 2019. The defect location varied, and included defects over the lateral and medial malleolar areas, distal tibia (middle and distal 3rd junction, and the distal 3rd), and Achilles tendon area.

Methods:
The PB was dissected from the lateral fibula and intermuscular septa in a cephalic to caudal direction, to a point no lower than 7 cm proximal to the lateral malleolus tip. This preserved most distal vascular perforators to the muscle, and afforded sufficient mobilization to allow successful turn-over of the muscle, with transposition into the defect within 30 minutes of tourniquet time. A meshed skin graft completed the intervention.

Results:
The metalwork was removed in all chronic cases (10/21), as bone union had occurred. All flaps survived completely. One patient partially lost the skin graft; the wound was healed by secondary intention. No major complications occurred and no significant patient discomfort was noted. All wounds healed completely by 9 weeks of follow-up.

Conclusion:
The PB turnover muscle flap is a versatile flap, ideally suited to manage up to moderately sized defects of the distal 3rd of the lower leg, with negligible postoperative morbidity.
Foot Web Space Transfer for Congenital Syndactyly
Authors: Tomioka Yoko Katsuragi , Narushima Mitsunaga , Yamashita Shuji , Ito Asuka , Okazaki Mutsumi 
Published: January 2021

Summary:
Syndactyly of the hand is commonly treated using local flaps with skin grafts; however, contractures and/or pigmentation pose a challenge, requiring repeated surgery. Here, we describe a case of a 1-year-old boy who underwent web transplantation for syndactyly. To the best of our knowledge, no “web for web” transplantations have been documented in pediatric literature. Because the patient had an “extra” web space, functional and aesthetic reconstruction was performed with careful preparation. The vascular pattern was assessed using high-resolution ultrasonography. The flap was harvested under a microscope, intravascular stenting was performed for secure anastomosis, and the adequacy of circulation in the flap was verified using the indocyanine green test. Each technique in the procedure used by us contributed to making the microsurgery safer. The present case suggests that “web for web” is a favorable treatment option for some cases, although these would be limited in number.
Computed Tomography Image Analysis in Abdominal Wall Reconstruction: A Systematic Review
Authors: Elfanagely Omar , Mellia Joseph A. , Othman Sammy , Basta Marten N. , Mauch Jaclyn T. , Fischer John P. 
Published: January 2021

Background:
Ventral hernias are a complex and costly burden to the health care system. Although preoperative radiologic imaging is commonly performed, the plethora of anatomic features present and available in routine imaging are seldomly quantified and integrated into patient selection, preoperative risk stratification, and perioperative planning. We herein aimed to critically examine the current state of computed tomography feature application in predicting surgical outcomes.

Methods:
A systematic review was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) checklist. PubMed, MEDLINE, and Embase databases were reviewed under search syntax “computed tomography imaging” and “abdominal hernia” for papers published between 2000 and 2020.

Results:
Of the initial 1922 studies, 12 papers met inclusion and exclusion criteria. The most frequently used radiologic features were hernia volume (n = 9), subcutaneous fat volume (n = 5), and defect size (n = 8). Outcomes included both complications and need for surgical intervention. Median area under the curve (AUC) and odds ratio were 0.68 (±0.16) and 1.12 (±0.39), respectively. The best predictive feature was hernia neck ratio > 2.5 (AUC 0.903).

Conclusions:
Computed tomography feature selection offers hernia surgeons an opportunity to identify, quantify, and integrate routinely available morphologic tissue features into preoperative decision-making. Despite being in its early stages, future surgeons and researchers will soon be able to integrate 3D volumetric analysis and complex machine learning and neural network models to improvement patient care.
The “Corset Repair” for Complex Hernia: A Proof-of-concept Report of an Innovative Approach
Authors: Byrnes Yasmeen M. , Othman Sammy , Elfanagely Omar , Card Elizabeth B. , Mellia Joseph A. , Llado-Farrulla Monica , Fischer John P. 
Published: January 2021

Summary:
Incisional hernias, especially those below the arcuate line, pose a unique challenge to reconstructive surgeons, as no consensus exists for repair strategy. An innovative approach is presented and illustrated. The “corset repair” involves placing an onlay mesh partially beneath released bilateral external obliques. A detailed technical review is provided to illustrate the benefits of this technique particularly in large defects and in hernia after abdominal flap harvest. Hernia recurrence and surgical site occurrence rates were reviewed and analyzed for a cohort of corset repair patients between December 2016 and January 2020. Twenty patients were included. All defects were successfully closed. Zero patients experienced hernia recurrence. Eight patients (40%) had a surgical site occurrence, of which 5 (63%) were either observed or managed non-operatively. Two of the surgical site occurrences were deep surgical site infections: 1 required surgical intervention for suspected mesh infection and the other did not. One patient (5%) developed hematoma 23 months post-operatively. The “corset repair” technique represents a modification to a classic technique for hernia repair. It is feasible and may be advantageous especially for large or challenging repairs below the arcuate line. It has promising results on early follow-up, and further research is needed to evaluate long-term efficacy.
Efficacy, Safety, and Durability of Response of Collagenase Clostridium Histolyticum-aaes for Treating Cellulite
Authors: Kaufman-Janette Joely A. , Bass Lawrence S. , Xiang Qinfang , McLane Michael P. , Kirby M. Todd , Vijayan Saji 
Published: January 2021

Background:
Collagenase clostridium histolyticum-aaes (CCH) enzymatically releases fibrous septa that contribute to the skin dimpling characteristic of cellulite. Long-term safety/duration of efficacy (durability) results from an open-label extension (OLE) of a randomized, double-blind, placebo-controlled trial (RCT) evaluating CCH efficacy/safety for moderate-to-severe cellulite of the buttocks or posterolateral thighs in women was assessed. Efficacy/safety of CCH treatment/retreatment during OLE was also evaluated.

Methods:
After RCT unblinding, women could enroll in OLE for assessment of long-term CCH durability (observation only, up to day 720) or CCH treatment/retreatment, the latter in women with moderate-to-severe buttock/posterolateral thigh cellulite [Clinician Reported Photonumeric Cellulite Severity Scale (CR-PCSS) and Patient Reported PCSS (PR-PCSS) scores of 3/4; Hexsel Cellulite Severity Scale score ≤13]. A treatment/retreatment course comprised 1 or 2 courses of 3 sessions (0.84-mg CCH injected at days 1, 22, and 43). CCH efficacy/safety was assessed at baseline, days 22, 43, 71, and quarterly at day 360.

Results:
Of the 259 OLE participants, 53 were observed for long-term CCH durability. For those who were ≥2-level composite responders during RCT (≥2-point CR-PCSS/PR-PCSS score improvements), CCH effect was durable (scores did not reach RCT baseline levels) in all women on days 180 (19/19), 360 (16/16), and 720 (7/7). Of the 200 women receiving CCH treatment/retreatment, more than 75% had ≥1-level improvement in patient and clinical assessments at day 71. The most common adverse events were injection-site bruising and pain.

Conclusions:
CCH treatment provided durable improvement in moderate-to-severe buttock/thigh cellulite and was generally well tolerated. Repeated CCH exposure did not increase adverse event risk or reduce efficacy.
Academics in the Pandemic: Early Impact of COVID-19 on Plastic Surgery Training Programs
Authors: Steele Thomas N. , Hemal Kshipra , Browne Donald T. , Balumuka Darius , Hansen Juliana E. , David Lisa R. 
Published: January 2021

Background:
The COVID-19 global pandemic has impacted plastic surgery training in the United States, requiring unprecedented measures to prepare for potential surges in critically ill patients. This study investigates how plastic surgery programs responded to this crisis, as well as how successful these changes were, through a survey of program directors and of residents at academic training programs in the United States.

Methods:
Two separate anonymous online surveys were conducted via REDCap between April 16 and June 4, 2020. The first survey was distributed to program directors, and the second was distributed to plastic surgery residents. Resident responses were then subdivided for an analysis between geographic regions.

Results:
Of the 59 program director responses (43.7%), the majority of programs implemented a platoon approach for resident coverage. A minority did the same for attending coverage. In total, 92% transitioned to virtual didactics only. Plastic surgery residents covered alternative services at 25% of responding institutions, and an additional 68% had a plan in place for responding to personnel shortages. Overall, residents were satisfied with their program’s response in a variety of categories. When subdivided based on geographic region, respondents in the Northeast and Northwest were less satisfied with resident wellness, personal and loved ones’ safety, and program communication.

Conclusions:
With the possibility of a “second wave,” successful methods of academic programs adapting to the pandemic should be communicated to reduce the future impact. Increased frequency of communications between program directors and residents can improve mental health and wellness of the resident population.
The etiology of menopause: not just ovarian dysfunction but also a role for the central nervous system
Authors: Perlman Barry , Kulak David , Goldsmith Laura T. , Weiss Gerson 
Published: January 2021

Background:
The hormonal changes which occur leading up to menopause have been described in multiple cross-sectional and longitudinal studies. Results from these studies document the occurrence of marked alterations in pituitary-hypothalamic function, along with the changes in the ovary, which play a role in the etiology of menopause. However, the role of pituitary-hypothalamic function in the menopausal transition (MT) has been generally overlooked.

Methods:
Literature searches were performed using PubMed, Scopus, and Medline, for articles with content related to menopause and the MT. The searches were restricted to English language observational studies and reviews of human studies and clinical trials.

Results:
During the MT, in addition to a reduction in the number of ovarian follicles, there is a marked reduction in the sensitivity of the central nervous system to both the positive and negative feedback effects of estrogen. These changes in sensitivity explain menstrual irregularities and systemic systems which are present in the time before the final menstrual period. Although the timing of menopause is difficult to predict, broad patterns in hormonal changes are seen, including a slow drop in inhibin B levels, followed by a monotropic rise in follicle-stimulating hormone during the late reproductive period. The MT is marked by irregular cycles with unpredictable luteinizing hormone levels and unpredictable ovulation. The levels of estrogen remain stable, or are even elevated through most of the MT, and levels of estrogen do not begin to decrease until late in the MT. The Stages of Reproductive Aging Workshop guidelines have improved the homogeneity of classifications in studies.

Conclusions:
On the basis of longitudinal hormone studies, it is clear that desensitization of the hypothalamic-pituitary-ovarian feedback loop plays an important role, in addition to a decrease in follicle number and insensitivity of remaining follicles to the positive feedback of estrogen, to trigger ovulation. Further studies in humans are needed to elucidate the mechanisms responsible for these perimenopausal changes if proper therapeutic modalities for the symptoms associated with menopause can be developed.
Reducing burnout among nurses: The role of high-involvement work practices and colleague support
Authors: Kilroy Steven , Bosak Janine , Chênevert Denis , Flood Patrick C. , Hill Kevin 
Published: January 2021

Background
The impact of human resource practices on nurses’ well-being, the underlying mechanisms involved, and the contextual factors that enhance or impede their success are not fully clear.

Purpose
The aim of this article was to examine a moderated mediation model whereby high-involvement work practices are purported to reduce nurses’ burnout via psychological empowerment, and colleague support is expected to moderate the mediating role of psychological empowerment in the high-involvement work practices–burnout link.

Methodology/Approach
Structural equation modeling was employed on cross-sectional survey data collected from a large sample of nurses in Canada (N = 2,174).

Results
The findings revealed that psychological empowerment partially mediated the association between high-involvement work practices and burnout, whereas colleague support was directly associated with lower burnout rather than exerting a moderating effect.

Conclusion
The study identifies the universality of high-involvement work practices in alleviating nurses’ burnout and highlights the important role of psychological empowerment as an explanatory variable. In addition, colleague support is an important yet independent predictor of nurses’ burnout.

Practical Implications
This study identifies a strategy that can be adopted by hospital managers to help protect against nurse burnout while offering insights into the underlying process involved.
Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review
Authors: Im David S. 
Published: January 2021

Abstract

Background
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by markedly impaired social interaction, impaired communication, and restricted/repetitive patterns of behavior, interests, and activities. In addition to challenges caused by core symptoms, maladaptive behaviors such as aggression can be associated with ASD and can further disrupt functioning and quality of life. For adults with ASD, these behaviors can portend adverse outcomes (e.g., harm to others or to the individual with ASD, hindering of employment opportunities, criminal justice system involvement). This article reviews the scientific literature to provide an update on evidence-based interventions for aggression in adults with ASD.

Method
A search of the electronic databases CINAHL, EMBASE, and PsycINFO was conducted using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 70 articles were identified and reviewed.

Results
The strongest (controlled trial) evidence suggests beneficial effects of risperidone, propranolol, fluvoxamine, vigorous aerobic exercise, and dextromethorphan/quinidine for treating aggression in adults with ASD, with lower levels of evidence supporting behavioral interventions, multisensory environments, yokukansan, and other treatments.

Conclusions
Additional randomized, controlled trials using consistent methodology that adequately addresses sources of bias are needed to determine which treatments are reliably effective in addressing aggression in adults with ASD. In the meantime, considering efficacy and adverse effect/long-term risk profiles, a practical approach could start with functional assessment–informed behavioral interventions along with encouragement of regular, vigorous aerobic exercise to target aggression in adults with ASD, with pharmacotherapy employed if these interventions are unavailable or inadequate based on symptom acuity.
CONCOMITANT MUTATIONS IN INHERITED RETINAL DYSTROPHIES
Authors: Rodríguez-Muñoz Ana , García-Bohórquez Belén , Udaondo Patricia , Hervás-Ontiveros Ana , Salom David , Aller Elena , Jaijo Teresa , García-García Gema , Millán José 
Published: January 2021

Purpose:
To highlight the challenge of correct reproductive and therapeutic counseling in complex pedigrees with different inherited retinal dystrophies (IRD).

Methods:
Two hundred eight patients diagnosed with nonsyndromic IRD underwent full ophthalmologic examination and molecular analysis using targeted next-generation sequencing.

Results:
Five families (4%) carried mutations in more than one gene that contribute to different IRD. Family fRPN-NB had a dominant mutation in SNRNP200, which was present in nine affected individuals and four unaffected, and a mutation in RP2 among 11 family members. Family fRPN-142 carried a mutation in RPGR that cosegregated with the disease in all affected individuals. In addition, the proband also harbored two disease-causing mutations in the genes BEST1 and SNRNP200. Family fRPN-169 beared compound heterozygous mutations in USH2A and a dominant mutation in RP1. Genetic testing of fRPN-194 determined compound heterozygous mutations in CNGA3 and a dominant mutation in PRPF8 only in the proband. Finally, fRPN-219 carried compound heterozygous mutations in the genes ABCA4 and TYR.

Conclusion:
These findings reinforce the complexity of IRD and underscore the need for the combination of high-throughput genetic testing and clinical characterization. Because of these features, the reproductive and therapeutic counseling for IRD must be approached with caution.
Incidence of and Risk Factors for Steroid Response After Cataract Surgery in Patients With and Without Glaucoma
Authors: Bojikian Karine D. , Nobrega Priscilla , Roldan Ashley , Forrest Samantha L. , Tsukikawa Mai , Chen Philip P. 
Published: January 2021

Precis:
Steroid response after cataract surgery was more frequent in glaucoma patients than nonglaucoma patients. Longer axial length and more preoperative medications were risk factors for steroid response in glaucoma patients.

Purpose:
The aim was to evaluate incidence and risk factors for topical steroid response after uneventful cataract surgery in patients with and without glaucoma.

Setting:
Academic glaucoma clinics.

Design:
This was a retrospective review.

Participants:
Consecutive patients with and without glaucoma and no prior incisional glaucoma surgery undergoing cataract surgery between March 2007 and September 2016. All patients routinely received topical prednisolone acetate 1% postoperatively.

Methods:
Pertinent clinical information was recorded. Steroid response was defined as intraocular pressure >50% above the baseline intraocular pressure measurement, occurring at or after the second postoperative week.

Results:
We included 472 eyes of 472 nonglaucoma patients and 191 eyes of 191 glaucoma patients. Ten (2.1%) nonglaucoma eyes and 16 (8.4%) glaucoma eyes were diagnosed as steroid responders (relative risk=3.72; 95% confidence interval: 1.71-8.07; P<0.001). Logistic regression showed that for nonglaucoma, longer axial length (AL) and younger age were associated with a higher incidence of steroid response (P≤0.003), while for glaucoma patients, longer AL and more preoperative medications were associated with steroid response (P≤0.030). An AL ≥26 mm was associated with steroid response for both groups (P≤0.024).

Conclusion:
Although glaucoma patients were 3.72 times more likely to have steroid response after uneventful cataract surgery, the incidence of steroid response with prednisolone acetate 1% was relatively low after phacoemulsification in both nonglaucoma and glaucoma eyes. Steroid response was associated with longer AL in both groups and with more preoperative medications in glaucoma patients.