bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Assessment of Breast Volume: Can 3D Imaging Be the Gold Standard?
Authors: Killaars Renee C. , Preuβ Myriam L. G. , de Vos Nathalie J. P. , van Berlo Camille C. J. L. Y. , Lobbes Marc B. I. , van der Hulst René R. W. J. , Piatkowski Andrzej A. 
Published: January 2021

Background:
Three-dimensional (3D) camera systems are increasingly used for computerized volume calculations. In this study we investigate whether the Vectra XT 3D imaging system is a reliable tool for determination of breast volume in clinical practice. It is compared with the current gold standard in literature, magnetic resonance imaging (MRI), and current clinical practice (plastic surgeon’s clinical estimation).

Methods:
Breast volumes of 29 patients (53 breasts) were evaluated. 3D images were acquired by Vectra XT 3D imaging system. Pre-existing breast MRI images were collected. Both imaging techniques were used for volume analyses, calculated by two independent investigators. Breast volume estimations were done by plastic surgeons during outpatient consultations. All volume measurements were compared using paired samples t-test, intra-class correlation coefficient, Pearson’s correlation, and Bland–Altman analysis.

Results:
Two 3D breast volume measurements showed an excellent reliability (intra-class correlation coefficient: 0.991), which was comparable to the reliability of MRI measurements (intra-class correlation coefficient: 0.990). Mean (SD) breast volume measured with 3D breast volume was 454 cm3 (157) and with MRI was 687 cm3 (312). These volumes were significantly different, but a linear association could be found: y(MRI) = 1.58 × (3D) – 40. Three-dimensional breast volume was not significantly different from volume estimation made by plastic surgeons (472 cm3 (69), P = 0.323).

Conclusions:
The 3D imaging system measures lower volumes for breasts than MRI. However, 3D measurements show a linear association with MRI and have excellent reliability, making them an objective and reproducible measuring method suitable for clinical practice.
A Novel Immediate Nipple Reconstruction Technique in Oncoplastic Breast Surgery: Inverted Lotus Bud Flap
Authors: Burusapat Chairat 
Published: January 2021

Summary:
Oncoplastic surgery is widely popular due to its ability to achieve curative tumor resection and symmetry of both breasts, and as a result of reduced psychological distress after mastectomy. Immediate nipple reconstruction was discussed and the gold standard procedure is inconclusive. Immediate nipple reconstruction with simultaneous breast reconstruction provides satisfactory esthetic results, compared with the delayed procedure. The “inverted lotus bud flap” was demonstrated as a new technique for immediate nipple reconstruction. The advantage of this technique is adequate nipple projection with minimization of scarring. In conclusion, oncoplastic breast surgery with immediate nipple reconstruction was demonstrated to be a safe and esthetically reliable procedure, leading to reduced psychological distress. This single-stage procedure promotes psychosocial well-being after breast cancer surgery. Immediate nipple reconstruction using the “inverted lotus bud flap” technique is versatile, reliable, and offers good esthetic results.
Early Expander-to-Implant Exchange after Postmastectomy Reconstruction Reduces Rates of Subsequent Major Infectious Complications
Authors: Schwartz Jean-Claude D. 
Published: January 2021

Background:
Major infectious complications after implant-based postmastectomy reconstruction commonly occur late (>30 days postoperative). We set out to determine if early expander-to-implant exchange (3–6 weeks after tissue expander placement) reduced rates of subsequent major infectious complications.

Methods:
We retrospectively examined patients after mastectomy and tissue expander reconstruction followed by early expander-to-implant exchange versus exchange at least 6 months after initial tissue expander placement (the control group). Multivariate logistic regression analysis was performed to determine whether the timing of implant exchange independently predicted major infectious complications occurring more than 30 days after initial tissue expander placement after adjusting for differences in patient variables between groups.

Results:
In total, 252 consecutive patients (430 breasts) between August 2014 and October 2019 were included. While the rates of major early infectious complications after mastectomy and tissue expander placement were similar between the groups, the control group had more subsequent major infectious complications during the reconstructive process [9.8% (n = 22) versus 1.9% (n = 4), P < 0.001].

Conclusions:
Early implant exchange results in a reduced subsequent rate of major infectious complications. This protocol reduces the window of time for late infectious complications to develop by proceeding with exchange within 6 weeks of tissue expander placement instead of the standard 6 months, which is common practice. We hypothesize that early exchange allows for washout of the mastectomy cavity, eliminating indolent bacterial contamination that could have subsequently manifested as a late infection. This protocol also obviates the need to operate on patients that undergo post-mastectomy radiotherapy, which also reduces reconstructive failure rates.
Effect of Time to Hand Therapy following Zone II Flexor Tendon Repair
Authors: Johnson Shepard P. , Kelley Brian P. , Waljee Jennifer F. , Chung Kevin C. 
Published: January 2021

Background:
This population-based study aimed to define how time to hand therapy following isolated zone II flexor tendon repairs impacts complications and secondary procedures.

Methods:
Insurance claims from the Truven MarketScan Databases were used to evaluate outcomes after isolated zone II flexor tendon repairs between January 2009 and October 2015. Cohorts differing in time to hand therapy were compared to evaluate the impact on complications, reoperation, and number of therapy sessions. Secondary outcomes analyzed how the number of therapy sessions affected rates of reoperation.

Results:
Hand therapy was identified in 82% of patients (N = 2867) following tendon reconstruction. Therapy initiation occurred within 1 week, 1–4 weeks, and after 4 weeks in 56%, 35%, and 9% of patients, respectively. Univariate analysis showed no difference in non-tendinous complications (27%, 30%, 29%; P = 0.29) or tendon rupture rates (13%, 13%, 10%; P = 0.42) within 90 days between cohorts. Multivariable analysis showed no difference in rates of tenolysis (6.3%, 6%, 4.4%; P > 0.01). In the early initiation cohort, >23 hand therapy sessions were associated with the highest rates of tenolysis (19%).

Conclusions:
Despite being a common fear of hand surgeons, early initiation of hand therapy was not associated with increased tendon rupture rates. Although delayed therapy is a concern for tendon scarring, it did not confer a higher risk of tenolysis. Complication rates do not appear to correlate with timing of hand therapy. Therefore, hand surgeons should promote early mobility following isolated flexor tendon injuries given the known functional outcome benefits.
Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers
Authors: Ebisudani Shogo , Inagawa Kiichi , Suzuki Yoshinori , Osugi Ikuko 
Published: January 2021

Background:
In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.

Methods:
The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.

Results:
The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.

Conclusion:
When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.
The Changing Landscape of Catholic Hospitals and Health Systems, 2008–2017
Authors: Homan Mary E. , White Kenneth R. 
Published: January 2021

EXECUTIVE SUMMARY
More than 600 Catholic hospitals operating in the United States face pressures for efficiency and effectiveness as well as compliance with demands of the Roman Catholic Church. They have responded to the pressures in various ways that have led to mixed models of organizational ownership and management. The purpose of this study was to describe and analyze the status of Catholic hospital ownership and management, especially the strategic and structural features of the parent health systems. Longitudinal data (2008–2017) were acquired and analyzed using repeated-measures analysis. Descriptive statistics were prepared using cross-sectional matched pairing for 2008 and 2017 data. Of 4,253 hospitals studied, 534 changed ownership or management. More Catholic Church-operated hospitals, regardless of type of ownership (for-profit, not-for-profit, church), became decentralized to a greater degree over the 8-year period and took on more attributes of non-Catholic hospitals.
The 21st century Catholic hospital is more likely to be partnered with a non-Catholic hospital or to be owned by a for-profit system than to be solely partnered with or operated by another Catholic system. Today’s Catholic hospitals appear to be more similar to their non-Catholic counterparts. With the trend toward larger systems that comprise more diverse partners, an increase in lay oversight could lead to further movement away from Catholic identity and the original mission of a hospital. As systems grow in size but shrink in number, administrators must make difficult decisions about the type and scope of services offered as well as the partners they need to deliver their services.
Differences in Work and Non-Work Support Associations With Job Stress, Burnout, and Well-Being Between Types of Healthcare Workers
Authors: Wolff Marilyn B. , O’Connor Patrick J. , Wilson Mark G. , Gay Jennifer L. 
Published: January 2021

Objective:
To determine associations between work and non-work supports with employee well-being, job stress, and burnout among direct and non-direct care healthcare workers.

Methods:
Cross-sectional data were collected from 550 full-time (≥ 35 h/wk), US Amazon Mechanical Turk workers (≥ 18 years of age) in the healthcare industry, had at least one supervisor, and at least one coworker. Canonical correlational analysis assessed the shared variance of organizational, supervisor, coworker, and family/friend support on employee outcomes.

Results:
Non-direct care support workers indicated a significantly stronger association between work supports and employee outcomes than family/friend supports. Direct care support workers had significant support from both work and non-work sources of support.

Conclusion:
Workplace supports are important resources for healthcare workers responsible for ensuring patient care and safety. Workplace interventions may tailor interventions to encourage types of support for subgroups within the healthcare industry.
New carotid plaque, but not the progression of intima-media thickness, predicts the progression of high-risk coronary plaque
Authors: Chao Chieh-Ju , Lakshmanan Suvasini , Ceponiene Indre , Luo Yanting , Nakanishi Rine , Nezarat Negin , Kanisawa Mitsuru , Budoff Matthew J 
Published: January 2021

Background
Carotid intima-media thickness (CIMT) is regarded as a controversial risk marker for cardiovascular disease (CVD). We aimed to evaluate the role of CIMT and carotid plaque progression as predictors for the progression of coronary plaque and compositions.

Methods
In the Garlic 4 study, asymptomatic patients with intermediate CVD risk (Framingham risk score 6–20%) were recruited for a serial carotid ultrasound, and coronary artery calcium score (CAC)/coronary computed tomography angiography (CCTA) studies for subclinical atherosclerosis at a baseline and 1 year. The association between progression of quantitatively measured coronary plaque compositions and the progression of CIMT/carotid plaque was analyzed. A P value <0.05 is considered as statistically significant.

Results
Forty-seven consecutive patients were included. The mean age was 58.5 ± 6.6 years, and 69.1 % were male. New carotid plaque appeared in 34.0 % (n = 16) of participants, and 55.3 % (n = 26) of subjects had coronary plaque progression. In multilinear regression analysis, adjusted by age, gender, and statin use, the development of new carotid plaque was significantly associated with an increase in noncalcified coronary plaque [β (SE) 2.0 (0.9); P = 0.025] and necrotic core plaque (1.7 (0.6); P = 0.009). In contrast, CIMT progression was not associated with the progression of coronary plaque, or coronary artery calcium (CAC) (P = NS).

Conclusion
Compared to CIMT, carotid plaque is a better indicator of coronary plaque progression. The appearance of a new carotid plaque is associated with significant progression of necrotic core and noncalcified plaque, which are high-risk coronary plaque components.
Refractory cardiac arrest: where extracorporeal cardiopulmonary resuscitation fits
Authors: Bartos Jason A. , Yannopoulos Demetris 
Published: January 2021

Purpose of review
Extracorporeal cardiopulmonary resuscitation (ECPR) is a powerful technique increasingly used to care for patients with refractory cardiac arrest. This review will detail where ECPR fits in the current care of cardiac arrest patients, including the key aspects of ECPR deployment and patient selection shown to maximize its benefit.

Recent findings
ECPR has been shown to improve neurologically favourable survival in patients with refractory cardiac arrest in numerous nonrandomized cohort studies. The haemodynamic, oxygenation and ventilation support provided by ECPR eliminates the need for return of spontaneous circulation (ROSC) and prevents ongoing injury from shock or rearrest. However, ECPR is one component of an entire system of resuscitation care necessary for positive outcomes. The intense resources needed require that patient eligibility criteria are well delineated to direct ECPR to patients likely to benefit. The other components of the system, including emergency medical services, cannulation teams and postarrest care teams, also require substantial training and dedication.

Summary
ECPR is a system of resuscitation care that must be optimized at every level to successfully treat patients with refractory cardiac arrest.
New drugs for acute kidney injury
Authors: Côté Jean-Maxime , Murray Patrick T. , Rosner Mitchell H. 
Published: January 2021

Purpose of review
To describe recent advances in the development of therapeutic agents for acute kidney injury (AKI).

Recent findings
Traditional care for AKI is mostly supportive. At present, no specific therapy has been developed to prevent or treat AKI. However, based on a better understanding of the pathophysiology of AKI, various potential compounds have been recently identified and tested. A variety of pathways has been targeted, including oxidative and mitochondrial stress, cellular metabolism and repair, inflammation, apoptosis and hemodynamics. Many of these potential agents are currently ongoing early-phase clinical trials, and the purpose of this review is to provide a summary of those with the most potential.

Summary
Despite the lack of therapies specifically approved for AKI, many interesting potential agents are entering clinical trials, with the potential to transform the care of patients with AKI.
Complications of Endoscopic Retrograde Cholangiopancreatography in Patients With Previous Bariatric Surgery
Authors: Choi Catherine , Barajas-Ochoa Aldo , Xue Pei , Hashemipour Reza , Rotundo Laura , Nasir Umair , Jiang Yi , Ahlawat Sushil 
Published: January 2021

Background:
Bariatric surgery (BS) has been proven to be effective in the treatment of obesity and weight-related diseases, but the anatomic changes after BS make endoscopic retrograde cholangiopancreatography (ERCP) technically challenging. This study aims to assess the safety and clinical outcomes of ERCP in patients with previous BS.

Materials and Methods:
The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with procedure diagnoses of ERCP. Those with prior BS were selected as cases and those without BS as controls. Case-control matching at a ratio of 1 case to 2 controls was performed based on sex, age, race, comorbidities, and obesity. The primary outcomes were inpatient mortality and ERCP-related complications. Multivariate regression analysis was used to identify independent risk factors associated to the primary outcomes.

Results:
A total of 1,068,862 weighted hospitalizations with ERCP procedure codes were identified. Of these, 6689 with BS were selected as cases, and 13,246 were matched as controls. The reason for hospital admission was most often biliary stone disease (60.7% vs. 55.5%), followed by malignancy (3.5% vs. 12.1%) and cholangitis (7.7% vs. 4.5%) with and without BS, P<0.05. The BS group had lower rates of post-ERCP pancreatitis (0.1% vs. 1.3%), cholecystitis (0.1% vs. 0.3%), bleeding (1.0% vs. 1.4%), and inpatient mortality (0.2% vs. 0.5%), but had higher rates of cholangitis (5.0% vs. 3.7%) and systemic infections (6.2% vs. 4.8%), all P<0.05.

Conclusions:
BS group had lower post-ERCP pancreatitis, cholecystitis and bleeding while had more cholangitis, and systemic infection compared with those without BS. Also, BS was independently associated with reduced inpatient mortality after adjusted for age, race, and comorbidity.
Clinical Risk Prediction Model for Neoadjuvant Therapy in Resectable Esophageal Adenocarcinoma
Authors: Thota Prashanthi N. , Alkhayyat Motasem , Gomez Cifuentes Juan D. , Haider Mahnur , Bena James , McMichael John , Sohal Davender P. , Raja Siva , Sanaka Madhusudhan R. 
Published: January 2021

Goals and Background:
Clinical staging with endoscopic ultrasound (EUS) and positron emission tomography (PET) is used to identify esophageal adenocarcinoma (EAC) patients with locally advanced disease and therefore, benefit from neoadjuvant therapy. However, EUS is operator dependent and subject to interobserver variability. Therefore, we aimed to identify clinical predictors of locally advanced EAC and build a predictive model that can be used as an adjunct to current staging methods.

Study:
This was a cross-sectional study of patients with EAC who underwent preoperative staging with EUS and PET scan followed by definitive therapy at our institution from January 2011 to December 2017. Demographic data, symptoms, endoscopic findings, EUS, and PET scan findings were obtained.

Results:
Four hundred and twenty-six patients met the study criteria, of which 86 (20.2%) patients had limited stage EAC and 340 (79.8%) had locally advanced disease. The mean age was 65.4±10.3 years of which 356 (83.6%) were men and 393 (92.3%) were White. On multivariable analysis, age (above 75 or below 65 y), dysphagia [odds ratio (OR): 2.84], weight loss (OR: 2.06), protruding tumor (OR: 2.99), and tumor size >2 cm (OR: 3.3) were predictive of locally advanced disease, while gastrointestinal bleeding (OR: 0.36) and presence of visible Barrett’s esophagus (OR: 0.4) were more likely to be associated with limited stage. A nomogram for predicting the risk of locally advanced EAC was constructed and internally validated.

Conclusions:
We constructed a nomogram to facilitate an individualized prediction of the risk of locally advanced EAC. This model can aid in decision making for neoadjuvant therapy in EAC.
Rectal Biopsy Technique for the Diagnosis of Hirschsprung Disease in Children
Authors: Comes Giovana Tuccille , Ortolan Erika Veruska Paiva , de Medeiros Moreira Maressa Maria , de Oliveira Junior Wilson Elias , Angelini Marcos Curcio , El Dib Regina , de Arruda Lourenção Pedro Luiz Toledo 
Published: January 2021

ABSTRACTThe diagnosis of Hirschsprung disease (HD) depends on the histopathological analysis of rectal biopsies. This review aims to define the best rectal biopsy technique. A systematic literature review and proportional meta‐analysis of the available case series studies of rectal biopsies were performed in this study. All case series with more than five rectal biopsies in children younger than 18 years of age suspected of HD that described at least one type of rectal biopsy were included. The studies that did not specify the rate of conclusive results and the rate of complications of the biopsy procedures were excluded. According to the literature review, there were four different techniques of rectal biopsy: open, suction, punch, and endoscopic. In the title and abstract screening process, we assessed 496 articles, 159 fulfilled the eligibility criteria, and 71 studies reported our outcomes of interest and were included in the meta‐analysis. The pooled proportion of conclusive results was 94% in open biopsies (95% CI 0.89–0.98), 95% in punch (95% CI 0.90–0.98), and 88% in suction group (95% CI 0.85–0.92). The pooled proportion of complication rates was 2% in open biopsies (95% CI 0.00031–0.04), 0.039% in suction (95% CI 0.00023–0.0006), and 2% in punch biopsies (95% CI 0.00075–0.04). Suction, punch, and open techniques presented comparable rates of conclusive results. In the suction group, the association between different methods of histopathological analysis increased conclusive results rates; however, the punch biopsy was associated with significantly higher complication rates than the suction technique.
Malignant Perivascular Epithelioid Cell Tumor Mimicking Renal Cell Carcinoma: A Diagnostic Pitfall
Authors: Chornenkyy Yevgen , Hakim Natalya , Qasem Shadi A. 
Published: January 2021

Abstract
We describe a case of metastatic malignant renal perivascular epithelioid cell tumor in a 56-year-old male. Computed tomography initially revealed bilateral heterogeneous enhancing kidney masses, the right one significantly larger than the left. The patient underwent a right radical nephrectomy. Upon gross examination, the mass was infiltrating into the surrounding fat and had a heterogeneous cut surface with multiple hemorrhagic foci. Histologically, majority of cells were highly atypical with abundant clear cytoplasm, pleomorphic nuclei, and enlarged prominent nucleoli. Extensive lymphovascular invasion was noted. Based on morphology, the diagnosis of renal cell carcinoma, Fuhrman grade 4, with extensive rhabdoid and focal sarcomatoid features was rendered. Follow-up computed tomography demonstrated a hypodense area within the right hepatic lobe, which upon resection showed identical morphology to the renal mass, except for focal areas of prominent epithelioid cells with abundant eosinophilic cytoplasm. Immunohistochemistry of both resection specimens (kidney and liver) demonstrated positive staining for Melan-A, HMB-45, and epithelial membrane antigen, focal positive staining for TFE3, and negative staining for PAX8 and cytokeratin. The initial diagnosis of renal cell carcinoma was amended to malignant epithelioid angiomyolipoma with hepatic metastasis. The diagnosis of angiomyolipoma/perivascular epithelioid cell tumor is particularly problematic owing to the large number of potential mimics. Immunohistochemistry for myomelanocytic differentiation should be considered in the context of kidney lesions with epithelioid and spindled cell morphology.