bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic-assisted Nipple-sparing Mastectomy with Direct-to-Implant Subpectoral Breast Reconstruction in the Management of Breast Cancer
Authors: Zhang Songbo , Xie Yanyan , Liang Faqing , Wang Yao , Lv Qing , Du Zhenggui 
Published: December 2021

Summary:
Endoscopic-assisted or robotic nipple-sparing mastectomy (E-NSM or R-NSM) with direct-to-implant breast reconstruction is becoming an increasingly popular surgical treatment for breast cancer patients. However, existing surgical methods such as traditional two-dimensional endoscopic-assisted or robot-assisted surgery are time-consuming and expensive. A new innovative three-dimensional videoscope system is efficient but needs special instruments; additionally, the incision over the extramammary region near the anterior axillary line is still too invisible. This study took place from May 2020 to April 2021. This technique is suitable for patients with small- to moderate-sized breasts (C cup size and below; grade 0 to grade I ptotic breasts). We have now performed 30 procedures, including eight bilateral reconstructions. The average operative time (including axillary operation) of a unilateral reconstruction is 179 ± 40.96 minutes, and for bilateral reconstruction, it was 271 ± 45.29 minutes. The median follow-up time was 9.93 months. For the complications, only one patient presented with a mild depigmentation of the nipple and one patient presented with local cellulitis but recovered after oral administration of antibiotics. All patients were satisfied with their postoperative aesthetic outcome. We present a new surgical technique of E-NSM with direct-to-implant subpectoral breast reconstruction to achieve better results.
The Plastic Surgery Learning Module: Improving Plastic Surgery Education for Medical Students
Authors: Reghunathan Meera , Segal Rachel M. , Reid Chris M. , Gosman Amanda A. 
Published: December 2021

Background:
Medical students receive limited exposure to the field of plastic surgery because most students will not rotate in plastic surgery, especially those at schools without dedicated plastic surgery residency programs. This study aimed to create and validate a plastic surgery learning module for medical students to dispel media-propagated myths and misrepresentation of the breadth of plastic surgery and equip students with referral-making capabilities.

Methods:
The plastic surgery learning module was created using Articulate Storyline 360 (New York, N.Y.). Student participants were recruited from a single medical school across all four classes. Pre- and postmodule surveys were administered via Qualtrics (Provo, Utah). Scores were computed for the general surgical knowledge section and for each specialty referral question.

Results:
Twelve students completed usability testing and edits were subsequently made to optimize the module. The module took on average 66 minutes to complete. Sixty-five students (19 MS1, 16 MS2, 15 MS3, 15 MS4) completed efficacy testing. In the premodule survey, students were nearly 100% accurate in identifying breast-related referrals, unlike pediatric/craniofacial (avg: 68%), reconstruction/microsurgery (avg: 64%), and hand/upper extremity (avg: 30%) referrals. Students of all classes exhibited significant improvement in all testing categories except for the breast category, with the most improvement in the hand referrals category. Prior exposure to plastic surgery (57%) correlated with higher premodule hand (P = 0.003) and breast/cosmetic (P = 0.01) referral scores.

Conclusion:
The plastic surgery learning module shows promise to be a comprehensive yet affordable and time-efficient tool for medical students to learn about basic surgical principles and the scope of plastic surgery.
Pulp De-epithelialization for Venous Outflow Augmentation after Digital Replantation
Authors: Smearman Erica , Chan Patricia , Ghareeb Paul A. 
Published: December 2021

Summary:
Traumatic amputation injuries account for a substantial portion of emergency department visits. This includes digital amputations that may be considered for replantation. Following surgery, venous congestion is the most common cause of replant failure. To address this, several methods have been proposed to augment venous outflow. In this article, a simple and straightforward method that can be utilized to establish or augment venous outflow in cases of venous insufficiency is described. This method entails de-epithelization of the replanted digit pulp skin with use of postoperative anticoagulation. The area can be further expanded or stimulated to increase bleeding as needed and is allowed to heal by secondary intention. This method allows for reliable venous outflow with relative ease of implementation.
Does severe subacute noise exposure increase risk of new onset hypertension beyond conventional risk factors? A 30 000 person-years cohort study
Authors: Yun Byungyoon , Sim Juho , Jeong Inchul , Lee Seunghyun , Kim Seunghan , Cho Ara , Yoon Jin-Ha 
Published: December 2021

Objectives:
Previous studies mostly focused on the relationship between chronic environmental noise exposure and hypertension but the effects of subacute (under 4 years) exposure with severe (>85 dB) noise exposure on clinical level hypertension have not been explored. This study aimed to reveal the association between severe noise exposure and hypertension.

Methods:
The severe noise exposure group was recruited from a Common Data Model conducted for the Korean Participants Health Examination from January 2014 to December 2017. The use of antihypertensive drug and/or blood pressure of at least 140/90 mmHg was defined as new onset clinical hypertension. A multivariate Cox proportional hazard model was implemented to estimate hazard ratios and 95% confidence intervals (CI) by adjusting covariates including demographic, lifestyle, and other chemical exposure factors. Time-dependent Cox analysis and Landmark analysis were further performed as a sensitivity analysis.

Results:
During the 29 332 person-years follow-up with 12 412 participants of the entire cohort, new onset hypertension occurred in 1222 participants. The findings showed that severe noise exposure was associated with an increased risk of hypertension incidence in the entire cohort [final model hazard ratio 1.28 (95% CI 1.11–1.47)]. Other covariates did not attenuate the association after adjusting age and sex. Time-dependent Cox and Landmark analysis also showed significant results [hazard ratio 1.60 (95% CI 1.38–1.85) and hazard ratio 1.33 (95% CI 1.13–1.57)].

Conclusion:
Severe noise with subacute exposure is significantly associated with hypertension development. Further studies should be implemented to clarify whether severe exposure to noise could be an important risk factor for hypertension.
Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients
Authors: Gori Mauro , Berzuini Carlo , D’Elia Emilia , Ghirardi Arianna , Bernardinelli Luisa , Gavazzi Antonello , Balestrieri Giulio , Giammarresi Andrea , Trevisan Roberto , Di Marco Fabiano , Bellasi Antonio , Amoroso Mariangela , Raimondi Federico , Novelli Luca , Magro Bianca , Mangia Gianpaolo , Lorini Ferdinando L. , Guagliumi Giulio , Fagiuoli Stefano , Parati Gianfranco , Senni Michele 
Published: December 2021

Objectives:
The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age.

Methods and results:
Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36--0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29--0.82, P = 0.006).

Conclusion:
In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.
Adverse Events Associated With Ossicular Prostheses: Utility of a Federal Database
Authors: Tong Jane Y. , Pasick Luke J. , Benito Daniel A. , Monfared Ashkan , Sataloff Robert T. 
Published: December 2021

Objectives:
Ossicular prostheses have demonstrated utility in ossicular chain reconstruction, but their use also is associated with complications. This study aims to explore the utility of the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database for the systematic analysis of complications associated with ossicular prostheses. It also summarizes adverse events to patients (AEPs) and device malfunctions (DMs) reported in the MAUDE database, and attempts to examine the consequences brought about by these events and to identify likely root causes.

Study Design:
Retrospective analysis of the MAUDE database.

Methods:
The MAUDE database was queried for reports from January 2010 to May 2020. Data were extracted from reports involving the use of ossicular prostheses.

Results:
Seventy-three medical device reports, reports submitted to the Food and Drug Administration detailing suspected device-associated malfunctions, injuries, and deaths, involved ossicular prostheses and were included for analysis, from which 126 adverse events were extracted. Of these, 50 (39.7%) were AEPs, while 76 (60.3%) were DMs. The most common AEPs were foreign body and hearing loss, while the DMs reported most commonly were broken prosthesis and displaced prosthesis. Of the 76 DMs, 19 (25%) were attributed to mishandling by the operator, while 6 (7.9%) were due to a defective device. Broken prosthesis was the DM most commonly attributed to mishandling by the operator in 16 (32.7%) cases.

Conclusion:
Ossicular prostheses are used extensively for ossicular chain reconstruction, but also are associated with adverse events. The MAUDE database in its current form does not appear sufficient for the systematic review of adverse events associated with ossicular prostheses. A more standardized reporting format with clearly defined categories and inclusion of relevant variables might improve the quality of information provided by the MAUDE database.
Ultrasound-Guided Placement of Percutaneous Abutments for Bone Conduction Hearing Devices
Authors: Breen Joseph T. , Nader Marc-Elie , Gidley Paul W. 
Published: December 2021

Objective:
To introduce a minimally invasive and image-guided technique for staged placement of a percutaneous abutment after osseointegrated implantation.

Patients:
Adults undergoing temporal bone resection at two academic medical centers.

Interventions:
Ultrasound-guided percutaneous installation of a bone conduction hearing device abutment. All patients had lateral temporal bone resection with osseointegrated implantation. Abutment placement followed as a planned staged procedure 3 to 6 months later depending on the use of radiotherapy.

Main Outcome Measures:
Ability to use a bone conduction hearing device and occurrence of skin reactions or wound complications.

Results:
Twelve patients successfully underwent abutment installation through a 5 mm skin biopsy punch incision, nine of which had minimal to no skin reaction surrounding the abutment. Two patients developed Holgers grade 1 skin reaction (redness with slight swelling). One patient experienced an osseointegration failure 152 days after abutment placement.

Conclusions:
Ultrasound is a widely available imaging modality that can be used to precisely localize subcutaneous osseointegrated implants, allowing for minimally invasive percutaneous placement of an abutment under local or general anesthesia.
Vision-Based Augmented Reality System for Middle Ear Surgery: Evaluation in Operating Room Environment
Authors: Hussain Raabid , Guigou Caroline , Lalande Alain , Bozorg Grayeli Alexis 
Published: December 2021

Hypothesis:
Augmented reality (AR) solely based on image features is achievable in operating room conditions and its precision is compatible with otological surgery.

Background:
The objective of this work was to evaluate the performance of a vision-based AR system for middle ear surgery in the operating room conditions.

Methods:
Nine adult patients undergoing ossicular procedures were included in this prospective study. AR was obtained by combining real-time video from the operating microscope with the virtual image obtained from the preoperative computed tomography (CT)-scan. Initial registration between the video and the virtual CT image was achieved using manual selection of six points on the tympanic sulcus. Patient-microscope movements during the procedure were tracked using image-feature matching algorithm. The microscope was randomly moved at an approximated speed of 5 mm/s in the three axes of space and rotation for 180 seconds. The accuracy of the system was assessed by calculating the distance between each fiducial point selected on the video image and its corresponding point on the scanner.

Results:
AR could be obtained for at least 3 minutes in seven out of nine patients. The overlay fiducial and target registration errors were 0.38 ± 0.23 mm (n = 7) and 0.36 ± 0.15 mm (n = 5) respectively, with a drift error of 1.2 ± 0.5 μm/s. The system was stable throughout the procedure and achieved a refresh rate of 12 fps. Moderate bleeding and introduction of surgical instruments did not compromise the performance of the system.

Conclusion:
The AR system yielded sub-millimetric accuracy and remained stable throughout the experimental study despite patient-microscope movements and field of view obtrusions.
Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device
Authors: Caspers Coosje Jacoba Isabella , Nelissen Rik Chrétien , Groenewoud Hans J. M. M. , Hol Myrthe Karianne Sophie 
Published: December 2021

Objective:
To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time.

Study design:
Prospective questionnaire survey.

Setting:
Tertiary referral center.

Patients:
Seventy-five patients with a percutaneous BCD.

Main outcome measures:
Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications.

Results:
After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median −6.4 h/day, p = 0.009).

Conclusion:
The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.
Multiseptate gallbladder
Authors: Hsieh Yu-Min , Hsieh Yuli Lily , Wang Nien-Lu , Wu Pao-Shu , Weng Shu-Chao 
Published: December 2021

Abstract

Rationale:
Multiseptate gallbladder (MSG) is a rare congenital gallbladder anomaly. Between 1963 and June 2021, only 56 cases were reported. There is currently no treatment guideline for pediatric or adult cases of MSG.

Patient concerns:
A 14-year-old woman visited our out-patient clinic in September 2020 for epigastric pain that last for 6 months. Honeycomb appearance of the gallbladder was noted under ultrasonography.

Diagnosis:
The patient was diagnosed with MSG. The diagnosis was confirmed through computed tomography and magnetic resonance cholangiopancreatography.

Interventions:
Cholecystectomy was performed.

Outcomes:
Epigastric pain showed limited improvement after the surgery. Since she was diagnosed with gastritis at the same time, a proton-pump inhibitor was prescribed. Epigastric pain was eventually resolved.

Lessons:
MSG cases can undergo cholecystectomy and show good recovery without complications. However, concomitant treatment may be required to resolve in the presence of other symptoms such as epigastric pain.
Knowledge, attitudes, and practices regarding venous thromboembolism prophylaxis
Authors: Feng Shangpeng , Li Minhui , Wang Kai , Hang Cheng , Xu Dongmei , Jiang Ye , Jia Zhongzhi 
Published: December 2021

Abstract
To assess the knowledge, attitudes, and practices regarding venous thromboembolism (VTE) prophylaxis among medical staff at a tertiary hospital in China.
A self-administered web-based survey was completed by medical staff, and data about respondent knowledge, attitudes, and practices regarding VTE prophylaxis were gathered and analyzed with chi-square tests, using a 95% significance level.
Of the 2079 medical staff invited to participate in the survey, a total of 2042 (including 921 clinicians and 1121 nurses) responded. The overall rate of correct responses to knowledge items was 57.6%; the rate was 60.1% for clinicians and 55.4% for nurses (P < .001). The median affirmative (“strongly agree”/“agree”) rate for attitude items was 99.0% (range, 83.2%-99.4%). Medical staff members were most commonly concerned about the possibility of a financial penalty when a patient could not be treated with VTE prophylaxis (49.4%). Low levels of knowledge and participation of medical staff were identified most commonly as difficulties involved in VTE prophylaxis (48.5%). The median affirmative response rate for practice items was 58.2% (range, 51.1%-68.3%). All affirmative response rates for practice items were significantly higher for nurses than for clinicians (all P < .001).
Although the overall attitude toward VTE prophylaxis was positive, the knowledge level was poor, especially among nurses, and the rate of affirmative responses regarding practices was low, especially among clinicians. Medical institutions should improve staff training regarding VTE prophylaxis, and medical staff should be encouraged to actively engage in VTE prophylaxis.
Cost-effectiveness and clinical outcomes of intermittent/continuous proton pump inhibitors infusion in high bleeding risk of ulcers
Authors: Hsieh Hui-Hsia , Wu Tien-Yuan , Chen Chi-Hua , Hour Mann-Jen 
Published: December 2021

Abstract
The purpose of this study was to evaluate the clinical outcomes, including patient prognosis and medication expense, of proton pump inhibitors administered by high-dose continuous infusion (HDC, 80 mg loading dose, then 8 mg/h for 72 hours) or non-high-dose intermittent infusion (NHDI, 40 mg qd or 40 mg q12 h, for 3 days) regimens in high-risk patients with bleeding peptic ulcers.
In this retrospective cohort study, patients with peptic ulcers and endoscopic hemostasis between January, 2013 and December, 2015 were included. The primary endpoints were rebleeding and mortality rates within 7 days. The secondary endpoints were length of stay (LOS), transfusion units of packed red blood cells (PRBCs), and the number needed to treat.
A total of 335 patients met the inclusion criteria during the 3-year follow-up period. The cumulative incidence of rebleeding within 7 days was 20.4% and 11.2% in the HDC and NHDI groups, respectively, with a significant difference (P = .021). The mortality rate was 12.1% and 7.3% in the HDC and NHDI groups, respectively, with no significant difference (P = .136). Univariate Cox proportional hazards model analysis showed that the risk of rebleeding within 7 days in the HDC group was higher than that in the NHDI group. The hazard ratio for HDC vs. NHDI was 1.93 (P = .021). There were significant differences in LOS (P = .034) and PRBC units (P = .005) for risk of rebleeding within 7 days, as well as in transfusion units of PRBCs for mortality rate analysis (p < 0.001), between the HDC and NHDI groups. The results showed that the NHDI regimen could reduce the risk of rebleeding within 7 days in 1 of 11 patients (number needed to treat = 11) and could reduce medication cost by US$ 400 to 800.
The NHDI regimen showed a lower risk of rebleeding within 7 days, shorter LOS, and fewer PRBC units than that of the HDC regimen. Receiving NHDI has better cost-effective outcomes than that of HDC for patients with high-risk bleeding peptic ulcers.
Human herpesvirus 8-associated multicentric Castleman disease in a patient with advanced HIV infection
Authors: Guayboon Theerajet , Chinthammitr Yingyong , Sukpanichnant Sanya , Horthongkham Navin , Angkasekwinai Nasikarn 
Published: December 2021

Abstract

Rational:
Multicentric Castleman disease (MCD) is a nonclonal lymphoproliferative disorder that is rarely reported from Southeast Asian countries. Here, we report a case of human herpesvirus 8 (HHV-8)-associated MCD in a patient with advanced human immunodeficiency virus (HIV) infection who presented with prolonged intermittent fever, urticarial rash, hepatosplenomegaly, and generalized lymphadenopathy.

Patient concerns:
A 34-year-old man with advanced HIV infection who was in good compliance with his antiretroviral treatment regimen presented with intermittent fever, weight loss, marked hepatosplenomegaly, and generalized lymphadenopathy. Recurrent symptoms of high-grade fever, abdominal discomfort, pancytopenia, and high C-reactive protein level occurred for 16 months.

Diagnoses:
Histopathological findings of left inguinal lymph node revealed diffuse effacement of lymph node architecture with coexpression of HHV-8 latency-associated nuclear antigen 1 from immunohistochemical staining. The HHV-8 viral load was 335,391 copies/mL.

Interventions:
The patient was treated initially with one dose of intravenous rituximab (375 mg/m2) followed by subcutaneous rituximab (1400 mg) weekly for 5 weeks.

Outcomes:
The patient's recurrent systemic symptoms subsided dramatically, and he has now been in remission for almost two years.

Lessons:
HHV8-associated MCD remains a diagnostic challenge in advanced HIV disease and should be suspected in those with recurrent flares of systemic inflammatory symptoms. Lymph node histopathology is essential for diagnosis and for excluding clonal malignancy. HHV-8 viral load is also useful for diagnosis and for monitoring disease activity.