bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidental Pathologic Findings in Young Adult Reduction Mammaplasty
Authors: Maroney Jenna , Collins K. C. , Dannheim Katelyn , Staffa Steven J. , Saldanha Francesca Y. L. , Labow Brian I. , Rogers-Vizena Carolyn R. 
Published: February 2021

Background:
This study aims to characterize incidental microscopic findings in this population to determine whether there is a benefit to routine histopathologic examination of breast tissue in young women.

Methods:
A retrospective review of young women who underwent reduction mammaplasty between June of 2010 and May of 2018 was performed at a single institution to identify demographics, age at the time of surgery, breast cancer risk factors, and pathologic data. Histologic reevaluation was performed when diagnostic clarification was needed. Descriptive, univariate, and multivariable statistical analyses were performed.

Results:
A total of 798 young women were included. At the time of surgery, the mean patient age was 17.5 ± 2.0 years, the mean body mass index was 28.7 ± 5.7 kg/m2, and the mean resection weight was 685 ± 339 g/breast. The majority of patients were reported to have pathologically normal tissue [n = 704 (88.2 percent)]. Of the 94 patients (11.8 percent) with abnormal findings, 21 (2.6 percent) had benign nonproliferative changes, 64 (8.0 percent) had proliferative lesions without atypia, nine (1.1 percent) had proliferative lesions with atypia, and a single patient (0.1 percent) had a borderline phyllodes tumor. Univariate and multivariate analyses revealed that age at menarche younger than 12 years was significantly associated with increased incidence of proliferative lesions.

Conclusions:
Over 10 percent of young women with reduction mammaplasty have histopathologic findings. Although this study demonstrated an overall low incidence of atypical lesions, because early identification offers potential for improved surveillance, the authors continue to advocate for routine pathologic evaluation, particularly for women with early menarche.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Does the Textured-Type Tissue Expander Affect the Outcomes of Two-Stage Prosthetic Breast Reconstruction? A Propensity Score Matching Analysis between Macrotextured and Microtextured Expanders
Authors: Lee Kyeong-Tae , Park Hae Yeon , Jeon Byung-Joon , Mun Goo-Hyun , Bang Sa Ik , Pyon Jai Kyong 
Published: February 2021

Background:
In two-stage prosthetic breast reconstruction, two types of tissue expanders are used for the first stage: microtextured Siltex and macrotextured Biocell. Despite emerging concerns regarding the safety of macrotextured prostheses, the association between the use of macrotextured expanders and adverse outcomes remains unknown clinically. This study aimed to evaluate potential impacts of the type of tissue expander on the long-term outcomes of implant-based breast reconstruction.

Methods:
Patients who underwent immediate two-stage tissue expander/implant breast reconstruction between 2014 and 2018 were evaluated and categorized into two groups according to the expander type. Those two were propensity score matched for baseline characteristics and compared for complication rates after the first- and second-stage operations. The impacts of several variables, including type of tissue expander used, on outcomes were assessed using multivariable logistic regression analyses.

Results:
Of the 1391 cases in 1294 patients, 276 pairs (552 cases) were successfully propensity score matched. In the first-stage operation, the macrotextured group showed a significantly shorter drain indwelling period and lower rate of seroma than the microtextured group. These differences retained influences after adjusting for other variables. Incidence rates of other complications were similar between the groups. Regarding the second-stage operation, the use of macrotextured expanders showed a significant association, with an increased rate of severe capsular contracture on the multivariable analyses in cases using textured implants. Development of other complications was not affected by the expander type.

Conclusion:
The type of tissue expander might influence the outcomes of two-stage implant-based breast reconstruction, and generally acceptable safety of both microtextured and macrotextured expanders was shown.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Nerve Pain after Burn Injury: A Proposed Etiology-Based Classification
Authors: Klifto Kevin M. , Hultman C. Scott , Dellon A. Lee 
Published: February 2021

Background:
Understanding the mechanism of nerve injury may facilitate managing burn-related nerve pain. This proposed classification, based on cause of nerve injury, was developed to enhance the understanding and management of burn-related nerve pain.

Methods:
This retrospective investigation included patients aged 15 years or older admitted to the burn center from 2014 to 2019. Burn-related nerve pain was patient-reported and clinically assessed as pain 6 months or more after burn injury, unrelated to preexisting illnesses/medications. The pain classification consisted of direct nerve injury, nerve compression, electrical injury, and nerve dysfunction secondary to systemic injury. The four categories were statistically analyzed between groups, using 52 variables.

Results:
Of the 1880 consecutive burn patients, 113 developed burn-related nerve pain and were eligible for validation of the classification: direct nerve injury, n = 47; nerve compression, n = 12; electrical injury, n = 7; and nerve dysfunction secondary to systemic injury, n = 47. Factors, significantly increased, that distinguished one category from another were as follows: for direct nerve injury, continuous symptoms (p < 0.001), refractory nerve release response (p < 0.001), nerve repair (p < 0.001), and pruritus (p < 0.001); for nerve compression, Tinel signs (p < 0.001), shooting pain (p < 0.001), numbness (p = 0.003), intermittent symptoms (p < 0.001), increased percentage total body surface area burned (p = 0.019), surgical procedures (p < 0.001), and nerve release (p < 0.001); and for electrical injury, Tinel sign (p < 0.001), intermittent symptoms (p = 0.002), amputations (p = 0.002), fasciotomies (p < 0.001), and nerve release (p < 0.001). Nerve dysfunction secondary to systemic injury was distinguished by significantly less Tinel signs (p < 0.001), shooting pain (p < 0.001), numbness and tingling (p < 0.001), pruritus (p < 0.001), fascial excision (p = 0.004), skin grafts (p < 0.001), amputation (p = 0.004), nerve releases (p < 0.001), and third-degree burns (p = 0.002).

Conclusion:
A classification consisting of direct nerve injury, nerve compression, electrical injury, and nerve dysfunction secondary to systemic injury is presented that may guide patient management and research methods, with the goal of improving pain outcomes in burn-related nerve pain.
Opioid Use among Adolescents Undergoing Surgical Repair of Facial Trauma
Authors: Som Avira , Santosa Katherine B. , Skolnick Gary B. , Lapidus Jodi B. , Waljee Jennifer F. , Patel Kamlesh B. 
Published: February 2021

Background:
New persistent opioid use has been quantified among adults undergoing surgery; less is known about the risk among adolescents. The authors examine new persistent opioid use in opioid-naive adolescent patients who underwent operative repair of facial fractures.

Methods:
Using the IBM MarketScan Commercial Database, the authors performed a retrospective analysis of patients aged 11 to 17 years who underwent facial fracture repair between 2006 and 2015. The incidences of prolonged opioid use and potentially inappropriate opioid prescriptions were determined.

Results:
Of 4892 patients, 78.5 percent filled a prescription. Among these patients, 7.9 percent had prolonged opioid use. Significant risk factors included older age (i.e., age 15 to 17 years) (OR, 1.579; 95 percent CI, 1.173 to 2.126 compared to younger patients), multiple comorbidities (OR, 3.005; 95 percent CI, 1.193 to 7.568), mandible fracture (OR, 1.614; 95 percent CI, 1.213 to 2.146), and multiple fractures (OR, 1.542; 95 percent CI, 1.002 to 2.372). Overall, 24.1 percent received a potentially inappropriate opioid prescription. Mandible fracture repair was associated with increased risk (OR, 2.753; 95 percent CI, 2.275 to 3.331) of potentially inappropriate opioid prescription.

Conclusions:
Nearly one in 12 adolescents met criteria for prolonged opioid use; nearly one in four received a potentially inappropriate opioid prescription. Significant risk factors included mandible fracture, older age, multiple comorbidities, and multiple fractures. Like adults, many adolescents are at high risk for potentially inappropriate opioid prescriptions and prolonged opioid use following surgical repair.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Amputation versus Free Flap: Long-Term Outcomes of Microsurgical Limb Salvage and Risk Factors for Amputation in the Diabetic Population
Authors: Kotha Vikas S. , Fan Kenneth L. , Schwitzer Jonathan A. , Youn Richard , Black Cara K. , Attinger Christopher E. , Evans Karen K. 
Published: February 2021

Background:
Reconstructive microsurgery is an effective limb-saving option for nonhealing lower extremity wounds in diabetic patients. However, the ability to predict the future need for amputation is unclear. This article seeks to identify risk factors for amputation following microsurgical free tissue transfer in the diabetic lower extremity.

Methods:
Diabetic patients undergoing lower extremity free flap surgery between August of 2011 and January of 2018 performed by a single surgeon were identified retrospectively. Patient comorbidities, reconstructive conditions and flap traits, microsurgical outcomes, and long-term outcomes were examined. Variables conferring risk for future amputation were examined by means of regression analysis.

Results:
Sixty-four patients met the criteria. The overall immediate flap success rate was 94 percent (60 of 64). Long term, 50 patients (78.1 percent) underwent successful salvage, and 14 patients (21.9 percent) required major amputation. Acute flap loss resulted in four amputations, and delayed complications (hematoma, infection, recurrent nonhealing) resulted in 10 amputations. The average time to amputation was 5.6 months. Risk factors for amputation were end-stage renal disease (OR, 30.7; p = 0.0087), hindfoot wounds (OR, 4.6; p = 0.020), elevated hemoglobin A1C level greater than 8.4 percent (OR, 1.4; p = 0.05), and positive wound cultures (OR, 6.1; p = 0.003).

Conclusions:
Multiple comorbidities and poor glucose control were identified as risk factors for amputation after free flap limb salvage. However, successful limb preservation is possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Salvia miltiorrhiza Injection Promotes the Adipogenic Differentiation of Human Adipose-Derived Stem Cells
Authors: Lin Huaian , Zhang Yifan , Yu Li , Zheng Danning , An Juan 
Published: February 2021

Background:
Autologous fat grafting is a commonly used strategy to repair soft-tissue defects that has shown an approximately 40 percent increase in use in the past 5 years. However, the high reabsorption rates (average, 50 percent) often result in an unsatisfactory outcome. Current approaches aimed at increasing the blood supply of grafted fat have little clinical support. Here, we found that Salvia miltiorrhiza could improve fat graft survival by promoting adipogenic differentiation of adipose-derived stem cells by means of peroxisome proliferator-activated receptor gamma (PPARγ) and CCAAT-enhancer binding protein alpha (C/EBPα) signaling.

Methods:
Adipose tissue was harvested from the thighs of two women. Adipose-derived stem cells were characterized by flow cytometry (CD29, CD90, and CD105). The samples (2 × 104 cells/liter) were incubated with or without S. miltiorrhiza injection (0.001, 0.005, 0.01, 0.05, 0.1, 0.5, 1, and 5 g/liter) during adipogenic differentiation. Oil Red O staining, triglyceride content, and adipogenic gene expression (PPARγ and C/EBPα) were performed to detect adipogenic differentiation.

Results:
The triglyceride content in the 0.5-g/liter group was increased significantly compared with that in control groups (0.231 ± 0.010, 76.90 percent versus control, p < 0.001, day 9; 0.303 ± 0.010, 91.28 percent versus control, p < 0.001, day 10; 0.361 ± 0.008, 86.65 percent versus control, p < 0.001, day 11). The expression levels of PPARγ and C/EBPα in the 0.5-g/liter group were both increased significantly compared with those in control groups (0.0097 ± 0.0015, 48.1 percent versus control, p < 0.05 for PPARγ; 0.0423 ± 0.003, 112 percent versus control, p < 0.001 for C/EBPα).

Conclusions:

S. miltiorrhiza injection has a positive effect on adipogenesis of adipose-derived stem cells in vitro. The effect of this treatment on improving fat graft survival needs more in vivo research.
A Systematic Review of Health Disparities Research in Plastic Surgery
Authors: Baxter Natalie B. , Howard Julia C. , Chung Kevin C. 
Published: February 2021

Background:
In this systematic review, the authors report on the current state of health disparities research in plastic surgery and consider how equity-oriented interventions are taking shape at the patient, provider, and health care system levels.

Methods:
The authors performed a systematic literature search of the PubMed/MEDLINE and Embase databases using search terms related to the social determinants of both health and plastic surgery. Two independent reviewers screened the article titles and abstracts for relevance and identified the plastic surgery focus and study characteristics of the included literature. The articles were then categorized as detecting, understanding, or reducing health disparities according to a conceptual framework. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results:
One hundred forty-seven articles published between 1997 and 2019 met the inclusion criteria. Health disparities research in gender-affirming, craniofacial, cosmetic, and hand surgery was lacking relative to breast reconstruction. Racial/ethnic and socioeconomic disparities were reported across subspecialties. Place of residence was also a large determinant of access to care and quality of surgical outcomes. Half of the included studies were in the detecting phase of research. Meanwhile, 40 and 10 percent were in the understanding and reducing phases, respectively.

Conclusions:
Investigators suggested several avenues for reducing health disparities in plastic surgery, yet there is limited evidence on the actual effectiveness of equity-oriented initiatives. More comprehensive research is needed to disentangle the patient, provider, and system-level factors that underlie inequity across subspecialties.
Cardiovascular Magnetic Resonance Mapping and Strain Assessment for the Diagnosis of Cardiac Involvement in Idiopathic Inflammatory Myopathy Patients With Preserved Left Ventricular Ejection Fraction
Authors: Wang Yue , Wang Qian , Cao Jian , Li Xiao , Lin Lu , Chen Wei , Wang Yi-Ning , Jin Zheng-Yu 
Published: February 2021

Purpose:
The aim of the study was to evaluate the role of cardiac magnetic resonance (CMR) mapping and strain analysis in the identification of cardiac involvement in idiopathic inflammatory myopathy (IIM) patients with preserved left ventricular ejection fraction.

Materials and Methods:
In all, 38 IIM patients who underwent CMR examination at our institution were retrospectively included. Twenty-three age-matched healthy individuals served as controls. Mapping parameters including native T1, extracellular volume (ECV), and T2 mapping and strain parameters including global radial strain, global circumferential strain, and global longitudinal strain were measured semiautomatically using a dedicated processing software. All the mapping and strain values were compared between patients and controls.

Results:
Late gadolinium enhancement was only present in IIM patients (n=17, 44.7%). IIM patients showed higher native T1 (1346 vs. 1269 ms, P<0.001), ECV (31.1% vs. 27.4%, P<0.01), and higher T2 (44.4 vs. 39.2 ms, P<0.001) values compared with controls. The global radial strain (36.7% vs. 46.9%, P<0.001), global circumferential strain (−21.2% vs. −24.1%, P<0.01), and global longitudinal strain (−13.6% vs. −15.6%, P<0.05) values were significantly reduced compared with controls.

Conclusions:
Native T1, ECV, T2 values, and global strain values may hold promise for the detection of subclinical myocardial involvement in IIM patients with preserved left ventricular ejection fraction.
Characteristics of T- and NK-cell Lymphomas After Renal Transplantation: A French National Multicentric Cohort Study
Authors: Barba Thomas , Bachy Emmanuel , Maarek Alizée , Fossard Gaëlle , Genestier Laurent , Anglicheau Dany , Moal Valérie , Dantal Jacques , Rieu Philippe , Chemouny Jonathan , Charrier Manon , Durrbach Antoine , Provot François , Ducloux Didier , Westeel Pierre-François , Heng Anne-Elisabeth , Rerolle Jean-Philippe , Barrou Benoit , Grimbert Philippe , Chatelet Valérie , Mousson Christiane , Janbon Bénédicte , Pernin Vincent , Frimat Luc , Ouali Nacera , Glotz Denis , Thierry Antoine , Mariat Christophe , Büchler Mathias , Gaulard Philippe , Leblond Véronique , Morelon Emmanuel , Dubois Valérie , Salles Gilles , Caillard Sophie , Thaunat Olivier 
Published: February 2021

Background.
Posttransplant lymphoproliferative disorders (PTLDs) encompass a spectrum of heterogeneous entities. Because the vast majority of cases PTLD arise from B cells, available data on PTLD of T or NK phenotype (T/NK-cell PTLD) are scarce, which limits the quality of the management of these patients.

Methods.
All adult cases of PTLD diagnosed in France were prospectively recorded in the national registry between 1998 and 2007. Crosschecking the registry data with 2 other independent national databases identified 58 cases of T/NK-cell PTLD. This cohort was then compared with (i) the 395 cases of B-cell PTLD from the registry, and of (ii) a cohort of 148 T/NK-cell lymphomas diagnosed in nontransplanted patients.

Results.
T/NK-cell PTLD occurred significantly later after transplantation and had a worse overall survival than B-cell PTLD. Two subtypes of T/NK-cell PTLD were distinguished: (i) cutaneous (28%) and (ii) systemic (72%), the latter being associated with a worse prognosis. Compared with T/NK-cell lymphomas of nontransplanted patients, overall survival of systemic T/NK-cell PTLD was worse (hazard ratio: 2.64 [1.76-3.94]; P < 0.00001).

Conclusions.
This difference, which persisted after adjustment on tumoral mass, histological subtype, and extension of the disease at diagnosis could be explained by the fact that transplanted patients were less intensively treated and responded less to chemotherapy.
Perioperative Stroke Detected Using Novel SSEP Analysis
Authors: Kelly Michael E. , Peeling Lissa , Norton Jonathan 
Published: February 2021

Summary:
Using a previously described technique that measures the “velocity” of the upswing of the median nerve SSEP, we identified an ischemic event during a carotid surgery that did not meet traditional alarm criteria. Mechanical thrombectomy successfully removed a thrombus, and the patient experienced a good recovery. Analysis of the SSEP waveform may allow for the detection of events missed with traditional alarm criteria.
Preservation of neutralizing antibody function in COVID-19 convalescent plasma treated using a riboflavin and ultraviolet light-based pathogen reduction technology
Authors: Yonemura Susan , Hartson Lindsay , Dutt Taru , Henao-Tamayo Marcela , Goodrich Raymond , Marschner Susanne 
Published: February 2021

AbstractBackground and ObjectiveConvalescent plasma (CP) has been embraced as a safe therapeutic option for coronavirus disease 2019 (COVID-19) while other treatments are developed. However, transfusion-transmitted disease is a risk, particularly in regions with high endemic prevalence of transfusion-transmissible diseases. Pathogen reduction can mitigate this risk; thus, the objective of this study was to evaluate the effect of riboflavin and ultraviolet light (R+UV) pathogen reduction technology on the functional properties of CCP.Materials and MethodsCCP units (n = 6) from recovered COVID-19 research donors were treated with R+UV. Pre- and post-treatment samples were tested for coagulation factor and immunoglobulin retention. Antibody binding to spike protein receptor binding domain (RBD), S1, and S2 epitopes of SARS-CoV-2 was assessed by ELISA.Neutralizing antibody (nAb) function was assessed by pseudovirus reporter viral particle neutralization (RVPN) assay and plaque reduction neutralization test (PRNT).ResultsMean retention of coagulation factors was ≥ 70% while retention of immunoglobulins was 100%. Starting nAb titers were low, but PRNT50titers did not differ between pre- and post-treatment samples. No statistically significant differences were detected in levels of IgG (P≥ 0.3665) and IgM (P≥ 0.1208) antibodies to RBD, S1, and S2 proteins before and after treatment.ConclusionR+UV PRT effects on coagulation factors were similar to previous reports, but no significant effects were observed on immunoglobulin concentration and antibody function. SARS-CoV-2 nAb function in COVID-19 convalescent plasma is conserved following R+UV PRT treatment.
Reported COVID-19 Incidence in Wisconsin High School Athletes During Fall 2020
Authors: Sasser Phillip , McGuine Timothy , Haraldsdottir Kristin , Biese Kevin , Goodavish Leslie , Stevens Bethany , Watson Andrew M. 
Published: February 2021

ABSTRACTIntroductionThe purpose of this study was to describe the reported incidence of COVID-19 in Wisconsin high school athletes in September 2020, and to investigate the relationship of COVID-19 incidence with sport and face mask use.MethodsSurveys were sent to athletic directors of all Wisconsin high schools regarding sports during September 2020. The association between reported case rates in athletes in each county and the county general population were evaluated with a weighted linear model. Multivariable negative binomial regression models evaluated the associations between COVID-19 incidence and sport type and face mask use by players, adjusting for the county COVID-19 incidence for each school.Results207 schools that had reinitiated sport reported 270 COVID-19 cases among 30,074 players, for case and incidence rates of 809 cases per 100,000 players and 32.6 cases per 100,000 player-days, respectively. The case rates for athletes in each county were positively correlated with the case rates for the county’s general population (β =1.14±0.20, r=0.60, p<0.001). One hundred fifteen (55%) of cases were attributed to household contact, 85 (41%) to contact outside sport or school, 5 (2.4%) to school contact, and 1 (0.5%) to sport contact. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14), although the difference between outdoor and indoor sports approached statistical significance (IRR=0.52 [0.26-1.1], p=0.07). 84% of schools required face masks while playing. For those sports with >50 participating schools, there were no significant associations between COVID-19 incidence and face mask use in cross country (IRR=0.71 [0.2-2.2], p=0.52), football (IRR=1.6 [0.6-5.1], p=0.404), boys soccer (IRR=2.3 [0.5-17], p=0.31), or girls volleyball (IRR=1.4 [0.3-6.6], p=0.64).ConclusionsIncidence of reported COVID-19 among athletes was related to background county incidence and most cases were attributed to household and community contact. Although not statistically significant, reported COVID-19 incidence may be lower in outdoor sports. Face mask use did not have a significant benefit, which may be due to relatively low rates of COVID-19 and the small number of schools that did not report using face masks.