bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Cerclage in Patients With Preterm Prelabor Rupture of Membranes
Authors: Wu Jenny , Denoble Anna E. , Kuller Jeffrey A. , Dotters-Katz Sarah K. 
Published: December 2021

Importance
Women undergoing cerclage placement remain at high risk for preterm labor and preterm prelabor rupture of membranes (PPROMs). The management of cervical cerclage after PPROM is controversial given the potential for prolonged latency when the cerclage is kept in place balanced with a potential increased risk of maternal infectious morbidity.

Objective
In this review, we compared studies that examined maternal, fetal, and neonatal outcomes in women with cerclage at the time of PPROM. We evaluated latency after PPROM and maternal and neonatal complications in the setting of PPROM with cervical cerclage.

Evidence Acquisition
Original research articles, review articles, and guidelines on cerclage removal were reviewed.

Results
Nine studies comparing cerclage retention versus removal were examined with mixed results, in particular between studies before the routine use of latency antibiotics and corticosteroid administration. There was an associated increase in latency to delivery with retention of cerclage, with a potential increase in maternal infectious morbidity. No significant differences were noted for neonatal mortality, neonatal sepsis, or other neonatal morbidity outcomes. The majority of studies were limited by their retrospective nature and small sample sizes.

Conclusions and Relevance
Cerclage removal at the time of diagnosis of PPROM can be considered due to the concern for increased risk of maternal morbidity without definitive benefit in latency to delivery or neonatal outcomes. However, data are limited, and clinicians should engage in shared decision-making with patients in this setting.

Target Audience
Obstetricians and gynecologists, pediatricians

Learning Objectives
After participating in this activity, the provider should be better able to summarize the current evidence regarding maternal, obstetric, and neonatal outcomes for women with PPROM in the setting of cervical cerclage; describe clinical evaluation for women who present with cerclage at the time of PPROM; and evaluate management considerations for women who present with cerclage at the time of PPROM.
Negative-Pressure Wound Therapy Application in Fingertip Replantations and a Systematic Review
Authors: Hu Ching-Wei , Chang Tommy Nai-Jen , Chen Yi-Chieh , Hu Ching-Hsuan 
Published: December 2021

Background:
Fingertip replantation is technically challenging. Venous congestion is one of the most common causes of replantation failure. Therefore, various venous drainage procedures and salvage techniques have been used in venous congestion. Negative-pressure wound therapy has proven beneficial in limb injuries, yet limited studies of fingertip replantation exist. This study aims to analyze risk factors in fingertip replantation and to evaluate the feasibility and clinical benefits of negative-pressure wound therapy compared with other salvage techniques.

Methods:
From January of 2015 to December of 2019, 27 patients (27 digits) who experienced fingertip amputation over Tamai zone I or II underwent replantation. Salvage negative-pressure wound therapy was applied for venous congestion postoperatively. Replantation data were collected for further analysis.

Results:
The overall survival rate of digit replantation with salvage negative-pressure wound therapy was 92.6 percent (25 of 27). The blood transfusion rate was 11.1 percent (three of 27). The average hospitalization time was 8.04 ± 1.43 days and the median duration of negative-pressure wound therapy was 6 days (range, 4 to 8 days; interquartile range, 2 days). There is no significant difference between the survival and failure groups for all risk factors evaluated.

Conclusion:
Negative-pressure wound therapy is a simple and effective salvage option to relieve venous congestion in fingertip replantation with a satisfactory survival rate, low blood transfusion rate, and short inpatient stay.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data
Authors: Vu Giap H. , Warden Clara , Zimmerman Carrie E. , Kalmar Christopher L. , Humphries Laura S. , McDonald-McGinn Donna M. , Jackson Oksana A. , Low David W. , Taylor Jesse A. , Swanson Jordan W. 
Published: December 2021

Background:The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors.Methods:The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics.Results:Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor’s degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively;p< 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25;p= 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively;p< 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively;p< 0.05).Conclusions:Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate.CLIINCAL QUESTION/LEVEL OF EVIDENCE:Risk, III.
Microvascular Free Tissue Transfer for Reconstruction of Complex Abdominal Wall Defects
Authors: Bauder Andrew , Othman Sammy , Asaad Malke , Butler Charles E. , Kovach Stephen J. 
Published: December 2021

Summary:
Patients with significant loss of abdominal wall soft tissue represent a reconstructive challenge. The purpose of this study was to describe the authors’ experience using microvascular free tissue transfer to repair complex abdominal wall defects with insufficient overlying soft tissue. In this report, the authors highlight their techniques and experiences in performing microvascular free tissue transfer to the abdominal wall for these massive, complex defects. In total, 14 patients who underwent 16 free-flap reconstructions were included in the series. The patients’ mean age was 50 ± 14 years, and mean body mass index was 27 ± 5 kg/m2. The mean hernia defect size was 412 ± 149 cm2. Ten flaps were fasciocutaneous anterolateral thigh flaps, one myocutaneous anterolateral thigh flap, two subtotal thigh flaps, one myocutaneous latissimus dorsi flap, one parascapular/latissimus dorsi flap, and one free filet of the lower leg. Five cases (36 percent) developed hernia recurrence, and seven developed surgical site complications. All flaps survived, with no total flap loss. This report highlights that microsurgical free tissue transfer in combination with mesh repair is a safe and reliable method for restoring complex, large, full-thickness abdominal wall defects. This case series illustrates a number of techniques and considerations that are of importance to achieve a favorable outcome when faced with these complex defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection
Authors: Hammond Dennis C. , Kim Kuylhee , Bageris Matthew H. , Chaudhry Arif 
Published: December 2021

Background:
In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume.

Methods:
A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method.

Results:
Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size.

Conclusion:
Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Pushing the Limits in Extremity Reconstruction Using Virtual Surgical Planning: A Case Series Study
Authors: Pereira Nicolás , Kufeke Matías , Roa Ricardo 
Published: December 2021

Summary:
Technology is advancing in benefit to solving complex problems. Preoperative planning is essential in any reconstructive process given the importance of achieving good results. New technologies facilitate the process to anticipate intraoperative findings. Virtual surgical planning has contributed in the evolution of craniomaxillofacial surgery. However, limited reports have been published regarding its usefulness in extremity reconstruction. The aim of this study was to push the limits and evaluate the use of virtual surgical planning with three-dimensional images for reconstruction of complex extremity defects using a free, open-source software. Patient candidates for upper or lower extremity microsurgical reconstruction with multiple defects or defects requiring reconstruction of various tissue components were included. Computed tomography angiography images were analyzed for virtual surgical planning using Horos software (Horos, Annapolis, Md.). Two upper and eight lower extremities were reconstructed with free flaps using virtual surgical planning; six cases had multiple defects, and four cases underwent different tissue components reconstruction. The postoperative period was uneventful, and there was no flap failure. A didactic video of the process and examples of some cases are presented. Virtual surgical planning is a powerful planning method, and the authors propose its use in complex extremity defects reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Severity of Flare Reactions in Diethylenetriamine Pentaacetate Chelations
Authors: Semelka Richard C. , Castro Pereira José F. , Ramalho Miguel 
Published: December 2021

Purpose
The aim of this study was to report early clinical experience with various forms of immune dampening to mitigate the expected flare reaction in patients suffering from gadolinium deposition disease (GDD) receiving DTPA chelation.

Materials and Methods
All patients were clinical subjects, and no prospective research was performed on them. The study included 31 consecutive patients (21 women; age, 46.2 ± 12.5 years). The diagnosis of GDD was clinically made. The severity of the flare over the week after each chelation session was rated on a scale from 1 to 10 (where 1 is negligible, 10 is intolerably severe). Patients were followed for up to 5 chelation sessions. Four immune dampening strategies were used: (1) no concurrent treatment; (2) antihistamine plus montelukast (AH); (3) steroid/antihistamine taper postchelation (SAHT); and (4) steroid/antihistamine extending from prechelation to 5 days postchelation (extended hypersensitivity medication regimen; EHMR). The data were analyzed with generalized linear mixed models and with linear regression.

Results
A total of 102 flare scores were obtained at different time points. Ten patients underwent 5 chelations. The severity of the flare after the first chelation was significantly higher in cases of no concurrent therapy (8.4 ± 2.6) and AH (7 ± 1.4) compared with SAHT (6 ± 1.3) and EHMR (5 ± 1.1). Patients who underwent SAHT and EHMR experienced less severity of flare after the first chelation (P = 0.0049 and P = 0.0005, respectively). Considering all time points, the results were also significantly better with SAHT and EHMR.

Conclusion
Based on early clinical experience, EHMR seems to manage flare reactions in DTPA chelation well. This strategy may represent the first standard therapy in patients with GDD.
Clinical and Ultrasonographic Features of Papillary Thyroid Carcinoma Located in the Isthmus
Authors: Fan Jinfang , Zhou Wei , Zhan Weiwei , Tao Lingling , Li Weiwei , Kuang Lijun 
Published: December 2021

Abstract
The aim of this research was to investigate the clinical and ultrasonographic features of papillary thyroid carcinoma (PTC) in the isthmus. A total of 823 patients with 823 PTCs including 133 in the isthmus and 690 in the lateral lobe were included in our study. All patients were confirmed by postoperative pathology. The clinical and ultrasonographic characteristics were retrospectively analyzed and compared. Univariate analysis and multivariate logistic regression analysis were performed. Multifactor analyses showed that PTC in the isthmus was significantly different from PTC originating from the lateral lobe in aspect ratio, microcalcification, extrathyroid extension, lymph node metastases, and lymph node density (P < 0.05, for all). There were no significant differences in age, sex, tumor size, margin, halo, echogenicity, and homogeneity (P > 0.05, for all). The results indicated that the sonographic appearances of PTC in the isthmus were relatively atypical; however, it had a higher incidence of extrathyroidal extension, central lymph node metastasis, and a tendency of higher lymph node density. Therefore, more careful ultrasound evaluation should be performed for these nodules.
Process Modeling of ABCDE Primary Survey in Trauma Resuscitations
Authors: Lodemann Tobias , Akçalı Elif , Fernandez Rosemarie 
Published: December 2021

Introduction
Trauma teams are ad hoc, multidisciplinary teams that perform complex patient care and medical decision making under dynamic conditions. The ability to measure and thus understand trauma team processes is still limited. Agent-based simulation modeling (ABSM) can be used to investigate complex relationships and performance within a trauma team. However, the foundational work to support such efforts is lacking. The goal of this work is to develop a comprehensive process model for the primary survey in trauma that can support ABSM.

Methods
A process model for the primary survey of patients with blunt traumatic injuries was developed using Advanced Trauma Life Support guidelines and peer-reviewed publications. This model was then validated using video recordings of 25 trauma resuscitations in a level 1 trauma center. The assessment and treatment pathway followed in each video were mapped against the defined pathway in the process model. Deviations were noted when resuscitations performance did not follow the defined pathway.

Results
Overall the process model contains 106 tasks and 78 decision points across all domains, with the largest number appearing in the circulation domain, followed by airway and breathing. A total of 34 deviations were observed across all 25 videos, and a maximum of 3 deviations were observed per video.

Conclusions
Overall, our data offered validity support for the blunt trauma primary survey process model. This process model was an important first step for the use of ABSM for the support of trauma care operations and team-based processes.
A national study defining 1.0 full-time employment in trauma and acute care surgery
Authors: Murphy Patrick B. , Coleman Jamie , Karam Basil , Morris Rachel S. , Figueroa Juan , de Moya Marc 
Published: December 2021

BACKGROUND
Trauma and acute care surgery (ACS) staffing models vary widely across the United States, resulting in large discrepancies in staffing, compensation, schedule, and clinical/nonclinical expectations. An urgent need exists to define clinical, academic, and schedule expectations for a full-time employment (FTE) of a trauma and ACS surgeon in the United States.

METHODS
A survey was distributed to departmental leaders at Levels I, II, III trauma centers across the United States regarding current workload. Variables concerning the responsibilities of surgeons, compensation models, and clinical expectations were collected. This was followed by virtual semistructured interviews of agreeable respondents. A thematic analysis was used to describe current staffing challenges and “ideal” staffing and compensation models of trauma centers.

RESULTS
Sixty-eight of 483 division chiefs/medical directors responded (14%), the majority (66%) representing Level I centers. There were differences in clinical responsibilities, elective surgery coverage as well as number of and reimbursement for call. The median description of an FTE was 26 weeks (interquartile range, 13 weeks) with a median of 8 (interquartile range, 8) 12-hour call shifts per month. Level III centers were more likely to perform elective surgery and covered more call shifts, typically from home. In our qualitative interviews, we identified numerous themes, including inconsistent models and staffing of services, surgeon—administration conflict and elective surgery driven by productivity and desire.

CONCLUSION
Defining the workload of a full-time trauma and ACS surgeon is nuanced and requires consideration of local volume, acuity and culture. Between the quantitative and qualitative analysis, a reasonable workload for a 1.0 FTE acute care surgeon at a Level I center is 24 to 28 service weeks per year and four to five in-house calls per month. Nighttime and daytime staffing needs can be divergent and may lead to conflict with administration. Future research should consider the individual surgeon's perspective on the definition of an FTE.

LEVEL OF EVIDENCE
Prognostic and epidemiological, Level III.
Single Cord Blood Transplantation Versus HLA-Haploidentical-related Donor Transplantation Using Posttransplant Cyclophosphamide in Patients With Hematological Malignancies
Authors: Wada Fumiya , Kanda Junya , Yoshioka Satoshi , Ishikawa Takayuki , Akasaka Takashi , Ueda Yasunori , Hirata Hirokazu , Arai Yasuyuki , Yago Kazuhiro , Anzai Naoyuki , Watanabe Mitsumasa , Ikeda Takashi , Yonezawa Akihito , Imada Kazunori , Itoh Mitsuru , Kitano Toshiyuki , Takeoka Tomoharu , Hishizawa Masakatsu , Nohgawa Masaharu , Arima Nobuyoshi , Asagoe Kousuke , Kondo Tadakazu , Takaori-Kondo Akifumi ,   Kyoto Stem Cell Transplantation Group (KSCTG)
Published: December 2021

Background.
Unrelated cord blood (UCB) and haploidentical related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) have become alternative options to treat patients with hematological malignancies without a HLA-matched donor.

Methods.
We conducted a retrospective study using registry data from the Kyoto Stem Cell Transplantation Group for patients with hematological malignancies who received their first allogeneic hematopoietic cell transplantation using a single UCB unit (n = 460) or PTCy-haplo (N = 57) between 2013 and 2019.

Results.
We found that overall survival in the UCB group was comparable to that in the PTCy-haplo group (hazard ratio, 1.00; 95% confidence interval, 0.66-1.52), although neutrophil and platelet engraftment were significantly delayed. Nonrelapse mortality risk and the incidence of graft-versus-host disease in the UCB group were also comparable to those in the PTCy-haplo group. Although the relapse risk was similar between the UCB group and the PTCy-haplo group regardless of the disease risk, acute myeloid leukemia patients benefit from UCB transplant with a significantly lower relapse rate (hazard ratio, 0.38; 95% confidence interval, 0.18-0.76).

Conclusions.
UCB transplant gives outcomes comparable to PTCy-haplo transplant, and both UCB and PTCy-haplo units are suitable as alternative donor sources for patients without an HLA-matched sibling or unrelated donor.
Anesthesia Inmutable Registry of Real-time Vital Signs and Waveforms using Blockchain
Authors: Gutiérrez Alejandro Figar , Garbino Jorge A. Martinez , Burgos Valeria , Rajah Taimoore , Risk Marcelo , Francisco Redelico 
Published: December 2021

AbstractHealthcare has become one of the most important emerging application areas of blockchain technology.[1] Although the use of a cryptographic ledger within Anesthesia Information Management Systems (AIMS) remains uncertain. The need for a truly immutable anesthesia record is yet to be established, given that the current AIMS database systems have reliable audit capabilities. Adoption of AIMS has followed Roger’s 1962 formulation of the theory of diffusion of innovation. Between 2018 and 2020, adoption was expected to be the 84% of U.S. academic anesthesiology departments.[2] Larger anesthesiology groups with large caseloads, urban settings, and government affiliated or academic institutions are more likely to adopt and implement AIMS solutions, due to the substantial amount of financial resources and dedicated staff to support both the implementation and maintenance that are required. As health care dollars become scarcer, this is the most frequently cited constraint in the adoption and implementation of AIMS.[3]We propose the use of a blockchain database for saving all incoming data from multiparametric monitors at the operating theatre. We present a proof of concept of the use of this technology for electronic anesthesia records even in the absence of an AIMS at site. In this paper we shall discuss its plausibility as well as its feasibility. The Electronic medical records (EMR) in AIMS might contain errors and artifacts that may (or may not) have to be dealt with. Making them immutable is a scary concept. The use of the blockchain for saving raw data directly from medical monitoring equipment and devices in the operating theatre has to be further investigated.