bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmune Disease and Breast Implants
Authors: Coriddi Michelle , Burke Elizabeth Anne , Myers Paige , Soudant Celine , McCarthy Colleen M. 
Published: June 2021

Abstract
Given that the use of breast implants for both cosmetic and reconstructive purposes is growing in the United States, an evaluation of factors that may affect the outcome of breast implant surgery is needed. A systematic review was conducted to evaluate the question: Does a personal or family history of autoimmune disease affect outcomes in breast implant surgery? The literature search yielded 2425 records, but after removal of duplicates, abstract screening, and full-text assessment, only 2 studies met the inclusion criteria for the final review. Both studies provided level III evidence and the average Methodological Index for Non-Randomized Studies score was 16.5 (range, 15–18 of 24), indicating a fair level of evidence overall. This systematic review found no evidence to support that a diagnosis of an autoimmune disease and/or a family history of autoimmune diseases will lead to poor surgical outcomes in breast implant surgery. Further study is warranted.
Patents for the Plastic Surgeon
Authors: Schultz Brent E. , Jalalabadi Faryan , Raghuram Anjali C. , Davis Matthew J. , Abu-Ghname Amjed , Winocour Sebastian , Khan Umraz , Vorstenbosch Joshua , Reece Edward M. 
Published: June 2021

Abstract
Although innovation and entrepreneurship are complementary in the process of creating new products, plastic surgeons are frequently discouraged by the challenges associated with the regulatory and administrative environments in patent filing. The following primer provides a step-by-step guide for understanding patents and outlines the steps and costs involved in patent filing. To improve opportunities for successful patent filing, we elaborate on some of the common pitfalls in the process, including the timing of public disclosure, conducting a private art search, selecting a patent attorney or agent, determining the level of inventor involvement, and navigating academic and employment contracts. The innovative drive in plastic surgery provides a strong impetus for strengthening knowledge about patents and patent filing in order to support efforts for providing high-value patient care.
Reasons for Long-term Opioid Prescriptions After Guideline-directed Opioid Prescribing and Excess Opioid Pill Disposal
Authors: Barth Richard J. , Porter Eleah D. , Kelly Julia L. , Bessen Sarah Y. , Molloy Lida B. , Phillips Joseph D. , Loehrer Andrew P. , Wilson Matthew Z. , Ivatury Srinivas J. , Billmeier Sarah E. , Seigne John D. , Wong Sandra L. , Wilkinson-Ryan Ivy 
Published: June 2021

Objectives:
The aim of this study was to determine the frequency and reasons for long-term opioid prescriptions (rxs) after surgery in the setting of guideline-directed prescribing and a high rate of excess opioid disposal.

Background:
Although previous studies have demonstrated that 5% to 10% of opioid-naïve patients prescribed opioids after surgery will receive long-term (3–12 months after surgery) opioid rxs, little is known about the reasons why long-term opioids are prescribed.

Methods:
We studied 221 opioid-naïve surgical patients enrolled in a previously reported prospective clinical trial which used a patient-centric guideline for discharge opioid prescribing and achieved a high rate of excess opioid disposal. Patients were treated on a wide variety of services; 88% of individuals underwent cancer-related surgery. Long-term opioid rxs were identified using a Prescription Drug Monitoring Program search and reasons for rxs and opioid adverse events were ascertained by medical record review. We used a consensus definition for persistent opioid use: opioid rx 3 to 12 months after surgery and >60day supply.

Results:
15.3% (34/221) filled an opioid rx 3 to 12 months after surgery, with 5.4% and 12.2% filling an rx 3 to 6 and 6 to 12 months after surgery, respectively. The median opioid rx days supply per patient was 7, interquartile range 5 to 27, range 1 to 447 days. The reasons for long-term opioid rxs were: 51% new painful medical condition, 40% new surgery, 6% related to the index operation; only 1 patient on 1 occasion was given an opioid rx for a nonspecific reason. Five patients (2.3%) developed persistent opioid use, 2 due to pain from recurrent cancer, 2 for new medical conditions, and 1 for a chronic abscess.

Conclusions:
In a group of prospectively studied opioid-naïve surgical patients discharged with guideline-directed opioid rxs and who achieved high rates of excess opioid disposal, no patients became persistent opioid users solely as a result of the opioid rx given after their index surgery. Long-term opioid use did occur for other, well-defined, medical or surgical reasons.
A Randomized Trial of Robotic Mastectomy Versus Open Surgery in Women With Breast Cancer or BrCA Mutation
Authors: Toesca Antonio , Sangalli Claudia , Maisonneuve Patrick , Massari Giulia , Girardi Antonia , Baker Jennifer L. , Lissidini Germana , Invento Alessandra , Farante Gabriel , Corso Giovanni , Rietjens Mario , Peradze Nickolas , Gottardi Alessandra , Magnoni Francesca , Bottiglieri Luca , Lazzeroni Matteo , Montagna Emilia , Labo Piergiorgio , Orecchia Roberto , Galimberti Viviana , Intra Mattia , Sacchini Virgilio , Veronesi Paolo 
Published: June 2021

Objective:
The aim of this study was to compare robotic mastectomy with open classical technique outcomes in breast cancer patients.

Summary Background Data:
As the use of robotic nipple sparing mastectomy continues to rise, improved understanding of the surgical, oncologic, and quality of life outcomes is imperative for appropriate patient selection as well as to better understand indications, limits, advantages, and dangers.

Methods:
In a phase III, open label, single-center, randomized controlled trial involving 80 women with breast cancer (69) or with BRCA mutation (11), we compared the outcome of robotic and open nipple sparing mastectomy. Primary outcomes were surgical complications and quality of life using specific validated questionnaires. Secondary objective included oncologic outcomes.

Results:
Robotic procedure was 1 hour and 18 minutes longer than open (P < 0.001). No differences in the number or type of complications (P = 0.11) were observed. Breast-Q scores in satisfaction with breasts, psychosocial, physical and sexual well-being were significantly higher after robotic mastectomy versus open procedure. Respect to baseline, physical and sexual well-being domains remained stable after robotic mastectomy, whereas they significantly decreased after open procedure (P < 0.02). The overall Body Image Scale questionnaire score was 20.7 ± 13.8 versus 9.9 ± 5.1 in the robotic versus open groups respectively, P < 0.0001. At median follow-up 28.6months (range 3.7–43.3), no local events were observed.

Conclusions:
Complications were similar among groups upholding the robotic technique to be safe. Quality of life was maintained after robotic mastectomy while significantly decrease after open surgery. Early follow-up confirm no premature local failure.
ClinicalTrials.gov NCT03440398
Disparities in Perioperative Use of Patient Engagement Technologies - Not All Use is Equal
Authors: Theiss Lauren M. , Wood Lauren , Shao Connie , Marques Isabel , Kim Dae Hyun , Hollis Robert , Gunnells Drew , Hardiman Karin , Cannon Jamie , Morris Melanie , Kennedy Gregory , Chu Daniel I. 
Published: June 2021

Objective:
To determine the association of patient-level characteristics on the use of a patient engagement technology during the perioperative period.

Summary of Background Data:
As implementation of patient engagement technologies continues to grow, it remains unclear who uses, and not uses, these technologies. Existing literature suggests significant disparities in usage of other technologies by patient age, race, sex, and geographic location, however, have yet to characterize patient usage of patient engagement technologies.

Methods:
This is a retrospective cohort study of patients undergoing elective surgery by a colorectal surgeon between January 2018 and March 2020 who enrolled in a patient engagement technology at a single institution. Patients enrolled received educational content, healthcare reminders, patient reported outcome (PRO) surveys, and health checks preoperatively, in-hospital, and for 30-days postdischarge. The primary outcome was patient activation of the patient engagement technology. Secondary outcomes were completion of at least 1 PRO survey, 1 in-hospital health check, and 1 postdischarge health check.

Results:
Of 549 patients who enrolled in the patient engagement technology, 473 (86.2%) activated. On multivariable stepwise regression, female patients [odds ratio (OR) 2.4, confidence interval (CI) 1.4–4.0, P = 0.001] and privately insured patients (OR 2.0, CI 1.1–3.8, P = 0.03) were more likely to activate. Black patients were less likely to activate (OR 0.5, CI 0.3–0.9, P = 0.02). Once activated, privately insured patients were more likely to complete PRO surveys (OR 2.3, CI 1.2–4.3, P = 0.01), in-hospital health checks (OR 2.4, CI 1.4–4.1, P = 0.002), and postdischarge health checks (OR 1.9, CI 1.1 −3.3, P < 0.001) than uninsured patients. Black patients were less likely to complete PRO surveys (OR 0.4, CI 0.3-0.7, P = 0.001) and in-hospital health checks (OR 0.6, CI 0.4–0.9, P = 0.03) than White patients.

Conclusions:
Use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. These technologies may not be used equally by all patients, which should be considered during implementation of interventions to improve surgical outcomes.
A Novel and Generic Workflow of Indocyanine Green Perfusion Assessment Integrating Standardization and Quantification Toward Clinical Implementation
Authors: Noltes Milou E. , Metman Madelon J. H. , Heeman Wido , Rotstein Lorne , van Ginhoven Tessa M. , Vriens Menno R. , Engelsman Anton F. , Boerma E. Christiaan , Brouwers Adrienne H. , van Dam Gooitzen M. , Pasternak Jesse D. , Kruijff Schelto 
Published: June 2021

Objective:
This study aims to generate a reproducible and generalizable Workflow model of ICG-angiography integrating Standardization and Quantification (WISQ) that can be applied uniformly within the surgical innovation realm independent of the user.

Summary Background Data:
Tissue perfusion based on indocyanine green (ICG)-angiography is a rapidly growing application in surgical innovation. Interpretation of results has been subjective and error-prone due to the lack of a standardized and quantitative ICG-workflow and analytical methodology. There is a clinical need for a more generic, reproducible, and quantitative ICG perfusion model for objective assessment of tissue perfusion.

Methods:
In this multicenter, proof-of-concept study, we present a generic and reproducible ICG-workflow integrating standardization and quantification for perfusion assessment. To evaluate our model's clinical feasibility and reproducibility, we assessed the viability of parathyroid glands after performing thyroidectomy. Biochemical hypoparathyroidism was used as the postoperative endpoint and its correlation with ICG quantification intraoperatively. Parathyroid gland is an ideal model as parathyroid function post-surgery is only affected by perfusion.

Results:
We show that visual subjective interpretation of ICG-angiography by experienced surgeons on parathyroid perfusion cannot reliably predict organ function impairment postoperatively, emphasizing the importance of an ICG quantification model. WISQ was able to standardize and quantify ICG-angiography and provided a robust and reproducible perfusion curve analysis. A low ingress slope of the perfusion curve combined with a compromised egress slope was indicative for parathyroid organ dysfunction in 100% of the cases.

Conclusion:
WISQ needs prospective validation in larger series and may eventually support clinical decision-making to predict and prevent postoperative organ function impairment in a large and varied surgical population.
Muscle deteriorations become prominent within 24 hours after admission in severely burned adults
Authors: Martini Wenjun Z. , Yu Yong-Ming , Chung Kevin K. , Dubick Michael A. 
Published: June 2021

BACKGROUND
Severe burn injury results in profound catabolic deterioration. Although burn-related catabolism has been well stated, it is unclear when the catabolic response begins. This study characterized acute changes of muscle protein breakdown at the admission and the day after in severely burned adults.

METHODS
Twelve patients (43 ± 19 years old) with 40% ± 21% total body surface area burns were prospectively enrolled into an observational study approved by institutional review board. Urinary samples were collected on admission day and the day after (day 1). Patient demographic and clinical data of vital signs, blood gas and chemistry, and coagulation status were collected. Catabolic changes of muscle breakdown were quantified by urinary excretion of 3-methylhisitidine, determined by gas chromatography and mass spectrometry analysis.

RESULTS
Compared with admission day, burned patients had elevated mean ± SD arterial pressure (from 90 ± 5 mm Hg to 108 ± 7 mm Hg) and heart rate (from 102 ± 7 beats per minute to 119 ± 4 beats per minute both p < 0.05) after 24 hours. Their 24-hour urinary output was 1,586 ± 813 mL at admission day to 1,911 ± 1,048 mL on day 1. The 24-hour urea excretion was elevated from 172 ± 101 mg/kg per day at admission day to 302 ± 183 mg/kg per day on day 1 (both p < 0.05), with no change in creatinine excretion. Urinary 3-methylhisitidine excretion increased from 0.75 ± 0.74 mg/kg per day at admission to 1.14 ± 0.86 mg/kg per day on day 1 (p < 0.05). The estimated skeletal muscle protein breakdown was increased from 1.1 ± 1.0 g/kg per day at admission day to 1.6 ± 1.2 g/kg per day on day 1 (p < 0.05). There were no changes in prothrombin time, activated partial thromboplastin time, or platelets.

CONCLUSION
In severely burned patients, catabolic muscle protein breakdown is elevated within 24 hours after admission and before changes in coagulation. These findings suggest that early interventions may be needed to effectively attenuate the catabolic responses in burn patients.

LEVEL OF EVIDENCE
Prospective and observational study, level II.
Allele-specific epigenetic activity in prostate cancer and normal prostate tissue implicates prostate cancer risk mechanisms
Authors: Shetty Anamay , Seo Ji-Heui , Bell Connor A. , O’Connor Edward P. , Pomerantz Mark , Freedman Matthew L. , Gusev Alexander 
Published: June 2021

AbstractBackgroundGenome-wide association studies of prostate cancer have identified >250 significant risk loci, but the causal variants and mechanisms for these loci remain largely unknown. Here, we sought to identify and characterize risk harboring regulatory elements by integrating epigenomes from primary prostate tumor and normal tissues of 27 patients across the H3K27ac, H3K4me3, and H3K4me2 histone marks and FOXA1 and HOXB13 transcription factors.ResultsWe identified 7,371 peaks with significant allele-specificity (asQTL peaks). Showcasing their relevance to prostate cancer risk, H3K27ac T-asQTL peaks were the single annotation most enriched for prostate cancer GWAS heritability (40x), significantly higher than corresponding non-asQTL H3K27ac peaks (14x) or coding regions (14x). Surprisingly, fine-mapped GWAS risk variants were most significantly enriched for asQTL peaks observed in tumors, including asQTL peaks that were differentially imbalanced with respect to tumor-normal states. These data pinpointed putative causal regulatory elements at 20 GWAS loci, of which 11 were detected only in the tumor samples. More broadly, tumor-specific asQTLs were enriched for expression QTLs in benign tissues as well as accessible regions found in stem cells, supporting a hypothesis where some germline variants become reactivated during/after transformation and can be captured by epigenomic profiling of the tumor.ConclusionOur study demonstrates the power of allele-specificity in chromatin signals to uncover GWAS mechanisms, highlights the relevance of tumor-specific regulation in the context of cancer risk, and prioritizes multiple loci for experimental follow-up.
Short-term variability of proton density fat fraction in pancreas and liver assessed by multi-echo chemical-shift encoding-based MRI at 3 T
Authors: Machann Jürgen , Hasenbalg Maytee , Dienes Julia , Wagner Robert , Köhn Arvid , Birkenfeld Andreas L. , Nikolaou Konstantin , Kullmann Stephanie , Schick Fritz , Heni Martin 
Published: June 2021

AbstractBACKGROUNDQuantification of pancreatic fat (PF) and intrahepatic lipids (IHL) is of increasing interest in cross-sectional epidemiological and interventional studies in subjects at risk for metabolic diseases. Up to now, short- and medium-term variations as well as their dependence on actual nutritional status are almost unknown.PURPOSE or HYPOTHESISTo assess short-term intraday variations of PF/IHL after a high-fat meal as well as medium-term changes after 5 days of high-caloric diet with a 1500 kcal surplus on individual daily energy requirement.STUDY TYPE(retrospective/prospective/longitudinal/case control/cohort etc.) Prospective cohort study.SUBJECTSTwelve healthy subjects (6m/6f) for intraday variations, 15 healthy male subjects for medium-term high-caloric diet and 11 age- and BMI-matched controls.FIELDSTRENGTH/SEQUENCE3 T whole-body imager (Magnetom Vida, Siemens Healthineers, Erlangen, Germany), assessment of proton density fat fraction by chemical-shift encoded MRI (multi-echo gradient echo sequence, qDixon).ASSESSMENTManually drawn regions of interest in head, body and tail of pancreas as well as in liver by an experienced medical physicist carefully avoiding inclusion of surrounding visceral fat (pancreas) or blood-vessels (liver).STATISTICAL TESTS (please list the significance level)Repeated measurements Anova for variabilities of PF and IHL, linear correlation analyses for relation of PF, IHL and BMI. Significance level p < 0.05 for all.RESULTS (must have numerical data and statistical testing for each phrase)Non-significant changes in PF in both studies (2.5±0.9 vs. 2.5±1.0% after high-fat meal, 1.4±0.8 vs. 1.6±0.6% after high-caloric diet and 1.6±0.7 vs. 1.8±1.0% in the isocaloric control group), unchanged IHL after high-fat meal (2.5±0.9 vs. 2.4±1.0 %) and in the control group (1.1±0.6 vs. 1.2±1.1%), but significantly increased IHL after 5-day high-caloric diet (1.6±2.2% vs. 2.6±3.6%, p < 0.05).DATA CONCLUSIONDaytime and nutritional status have no significant influence on ectopic fat depots in pancreas and liver and will therefore represent no major confounders in epidemiologic or clinical studies.
A novel strategy for the detection of SARS-CoV-2 variants based on multiplex PCR-MALDI-TOF MS
Authors: Zhao Fei , Zhang Jianzhong , Wang Xuemei , Hou Xuexin , Qin Tian , Meng Fanliang , Xu Xiaona , Li Tianyi , Zhou Haijian , Kan Biao , Lu Jinxing , Xiao Di 
Published: June 2021

AbstractBackgroundThe second wave of coronavirus disease 2019 (COVID-19) has been incessantly causing catastrophe worldwide, and the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants causes further uncertainty regarding epidemic risk. Here, a novel strategy for the detection of SARS-CoV-2 variants using multiplex PCR coupled with MALDI-TOF MS was developed.MethodsPlasmids carrying gene sequences containing 9 mutation types in 7 mutated sites (HV6970del, N501Y, K417N, P681H, D614G, E484K, L452R, E484Q and P681R) in the receptor-binding domain of the spike protein of SARS-CoV-2 variants were synthesized. Using the nucleic acid sequence of SARS-CoV-2 nonvariant and a synthetic SARS-CoV-2-variant-carrying plasmid, a MALDI-TOF MS method based on the single-base mass probe extension of multiplex PCR amplification products was established to detect the above nine mutation types. The detection limit of this method was determined via the concentration gradient method. Twenty-one respiratory tract pathogens (9 bacteria, 11 respiratory viruses) and pharyngeal swab nucleic acid samples from healthy people were selected for specific validation. Sixteen samples from COVID-19 patients were used to verify the accuracy of this method.ResultsThe 9 mutation types could be detected simultaneously by triple PCR amplification coupled with MALDI-TOF MS. SARS-CoV-2 and all six variants (B.1.1.7, B.1.351, B.1.429, B.1.526, P.1 and B.1.617) could be identified. The detection limit for all 9 sites was 1.5×103 copies. The specificity of this method was 100%, and the accuracy of real-time PCR CT values less than 30 among positive samples was 100%. This method is open and extensible, and can be used in a high-throughput manner, easily allowing the addition of new mutation sites as needed to identify and track new SARS-CoV-2 variants as they emerge.ConclusionsMultiplex PCR-MALDI-TOF MS provides a new detection option with practical application value for SARS-CoV-2 and its variant infection.Key pointAn all-in-one SARS-CoV-2 variant identification method based on a multiplex PCR-MALDI-TOF MS system was developed. All of the SARS-CoV-2 variants can be identified based on 9 types of 7 mutated sites of RBD of spike protein using this method.
A clinical observational analysis of aerosol emissions from dental procedures
Authors: Dudding T. , Sheikh S. , Gregson F. , Haworth J. , Haworth S. , Main B.G. , Shrimpton A.J. , Hamilton F.W. ,   AERATOR group, Ireland A.J. , Maskell N.A. , Reid J.P. , Bzdek B.R. , Gormley M. 
Published: June 2021

AbstractAerosol generating procedures (AGPs) are defined as any procedure releasing airborne particles <5 μm in size from the respiratory tract. There remains uncertainty about which dental procedures constitute AGPs. We quantified the aerosol number concentration generated during a range of periodontal, oral surgery and orthodontic procedures using an aerodynamic particle sizer, which measures aerosol number concentrations and size distribution across the 0.5–20 μm diameter size range. Measurements were conducted in an environment with a sufficiently low background to detect a patient’s cough, enabling confident identification of aerosol. Phantom head control experiments for each procedure were performed under the same conditions as a comparison. Where aerosol was detected during a patient procedure, we assessed whether the size distribution could be explained by the non-salivary contaminated instrument source in the respective phantom head control procedure using a two-sided unpaired t-test (comparing the mode widths (log(σ)) and peak positions (DP,C)). The aerosol size distribution provided a robust fingerprint of aerosol emission from a source. 41 patients underwent fifteen different dental procedures. For nine procedures, no aerosol was detected above background. Where aerosol was detected, the percentage of procedure time that aerosol was observed above background ranged from 12.7% for ultrasonic scaling, to 42.9% for 3-in-1 air + water syringe. For ultrasonic scaling, 3-in-1 syringe use and surgical drilling, the aerosol size distribution matched the non-salivary contaminated instrument source, with no unexplained aerosol. High and slow speed drilling produced aerosol from patient procedures with different size distributions to those measured from the phantom head controls (mode widths log(σ)) and peaks (DP,C), p< 0.002) and, therefore, may pose a greater risk of salivary contamination. This study provides evidence for sources of aerosol generation during common dental procedures, enabling more informed evaluation of risk and appropriate mitigation strategies.