bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-institutional Study
Authors: Inose Hiroyuki , Yoshii Toshitaka , Kimura Atsushi , Takeshita Katsushi , Inoue Hirokazu , Maekawa Asato , Endo Kenji , Miyamoto Takuya , Furuya Takeo , Nakamura Akira , Mori Kanji , Kanbara Shunsuke , Imagama Shiro , Seki Shoji , Matsunaga Shunji , Takahashi Kunihiko , Okawa Atsushi 
Published: January 2021

Study Design.
Prospective multicenter study.

Objectives.
The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls.

Summary of Background Data.
Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. However, there are no prospective studies that have investigated the risk factors for falls in these patients.

Methods.
We prospectively enrolled patients scheduled for surgery for DCM and evaluated the significance of various preoperative measures for predicting falls. We then examined the correlation between the number of falls and the preoperative factors. Lastly, we performed stepwise logistic regression analysis to assess the concurrent effects of various factors on the occurrence of falls.

Results.
Among the 135 patients analyzed, 64 experienced one or more falls from the time of enrollment to 1 year postoperatively. Univariate analysis showed that the preoperative potassium and albumin levels, handgrip strength, and the Japanese Orthopaedic Association score for the assessment of cervical myelopathy (C-JOA score) were lower and Nurick grade was higher in the fallers group. Serum potassium level, handgrip strength, C-JOA score, Nurick grade, European Quality of Life-5 Dimensions (EQ-5D) score, t1 pelvic angle, and sagittal vertical axis had weak correlations with the number of falls. The fallers group had a lower C-JOA and EQ-5D scores and a lower recovery rate at one year postoperatively. Stepwise multiple logistic regression analysis identified preoperative potassium level and handgrip strength as the independent preoperative predictors for falling.

Conclusion.
We identified preoperative lower serum potassium level and weaker handgrip strength as significant predictors of falls in patients with DCM. Therefore, DCM patients with these risk factors should be cautious about falls and might be candidates for immediate surgical intervention.

Level of Evidence: 3.
Conceptual Framework for a Plastic Surgery Residency Leadership Curriculum
Authors: Wang Jessica S. , Singh Tanvee , Bruno Evan A. , White John S. , Fan Kenneth L. 
Published: January 2021

Background:
Leadership development remains an overlooked component in the plastic surgery residency curriculum. Through a mixed-methods assessment of physician perceptions, this study aims to establish the value and structure of a formal leadership course for trainees.

Methods:
Qualitative interviews were conducted with plastic surgery residents to identify common themes concerning the current state of leadership training and goals for improvement. These themes then guided the design of a quantitative assessment, which surveyed faculty and residents regarding their perceived need for a curriculum, the domains that should be included, and the format of delivery.

Results:
Six residents underwent interviews, which yielded the following themes: (1) surgical residents require a distinct set of leadership skills that warrants more intensive training and (2) leadership training should assume a more structured format. The survey achieved a 76% (29/38) response rate, with residents comprising 55% of respondents. Participants were neutral to slightly satisfied with current resident leadership and “learning on the job” (4.62 and 4.03 on a 7-point Likert scale, respectively). Respondents reported a moderate need for formal leadership training (2.97 on a 5-point scale). Availability was ranked as the greatest barrier to curriculum implementation. Topics considered most important included effective communication, self-awareness/emotional intelligence, and strategic thinking. Formats considered most effective included in-person lectures, small group exercises, and case studies.

Conclusion:
This study presents a conceptual framework for the implementation of a leadership curriculum for plastic surgery residents that may empower the development of stronger physician leaders.
Certification and Accreditation in Plastic Surgery Subspecialty Training
Authors: Xue Erica Y. , Winocour Sebastian , Cen Nicholas , Davis Matthew J. , Buchanan Edward P. , Chu Carrie K. , Reece Edward M. 
Published: January 2021

Summary:
There are multiple subspecialties that residents can pursue after core plastic surgery training, including 5 major fellowship categories: aesthetic, burn, craniofacial, hand, and microsurgery. Hand surgery remains the only plastic surgery subspecialty to date, with a formal accreditation process following fellowship. The purpose of this study was to review the literature regarding the accreditation and match process of plastic surgery fellowship programs, the process of hand surgery certification, and future directions pertaining to certification in other plastic surgery subspecialties.
Ear Molding Therapy: Laypersons’ Perceptions, Preferences, and Satisfaction with Treatment Outcome
Authors: Vu Giap H. , Azzolini Anthony , Humphries Laura S. , Mazzaferro Daniel M. , Kalmar Christopher L. , Zimmerman Carrie E. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P. 
Published: January 2021

Background:
This study investigates laypersons’ perceptions of congenital ear deformities and preferences for treatment, particularly with ear molding therapy—an effective, noninvasive, yet time-sensitive treatment.

Methods:
Laypersons were recruited via crowdsourcing to view photographs of normal ears or one of the following ear deformities, pre- and post-molding: constricted, cryptotia, cupped/lopped, helical rim deformity, prominent, and Stahl. Participants answered questions regarding perceptions and treatment preferences for the ear. Statistical analyses included multiple linear and logistic regressions and Wilcoxon signed-rank tests.

Results:
A total of 983 individuals participated in the study. All deformities were perceived as significantly abnormal, likely to impair hearing, and associated with lower psychosocial quality of life (all P < 0.001). For all deformities, participants were likely to choose ear molding over surgery despite the logistical and financial implications of ear molding (all P < 0.02). Participants were significantly more satisfied with the outcome of ear molding in all deformities compared with control, except constricted ears (all P < 0.002, except Pconstricted = 0.073). Concern for hearing impairment due to ear deformity was associated with increased likelihoods of seeing a physician (P < 0.001) and choosing ear molding despite treatment logistics and costs (all P < 0.001).

Conclusions:
Laypersons perceived all ear deformities as abnormal and associated with low psychosocial quality of life. Despite logistical and financial implications, laypersons generally desired molding therapy for ear deformities; treatment outcomes were satisfactory for all deformities except constricted ears. Timely diagnosis of this condition is crucial to reaping the benefits of ear molding therapy.
Effect of Systemic Adipose-derived Stem Cell Therapy on Functional Nerve Regeneration in a Rodent Model
Authors: Schweizer Riccardo , Schnider Jonas T. , Fanzio Paolo M. , Tsuji Wakako , Kostereva Nataliya , Solari Mario G. , Plock Jan A. , Gorantla Vijay S. 
Published: January 2021

Background:
Regardless of etiology, peripheral nerve injuries (PNI) result in disruption/loss of neuromuscular junctions, target muscle denervation, and poor sensorimotor outcomes with associated pain and disability. Adipose-derived stem cells (ASCs) have shown promise in neuroregeneration. However, there is a paucity of objective assessments reflective of functional neuroregeneration in experimental PNI. Here, we use a multimodal, static, and dynamic approach to evaluate functional outcomes after ASC therapy in a rodent PNI model.

Methods:
Lewis rats were divided into 3 groups: 10 mm sciatic nerve resection (“CUT” group; n = 10), transection and repair (“REP” group; n = 10), transection and repair plus single-dose ASCs (“ASC” group; n = 12). Allogeneic (Brown Norway rat) ASCs (1 × 106) were administered intravenously on postoperative day 1. Functional outcome was assessed by static sciatic index, toe spread factor, and a dynamic swim test on a weekly basis for 6 weeks. Sciatic nerves and gastrocnemius muscles were harvested at endpoint (6 weeks) for histological analysis.

Results:
The ASC group showed accelerated functional recovery on the swim test at 2 weeks postoperatively, with continued improvement over 4 weeks, culminating in superior overall outcomes at 6 weeks compared with the REP group. The CUT group showed no significant improvement from baseline. Nerve histomorphometry correlated well with the swim test results in the ASC group. Gastrocnemius muscle weights showed no difference between the REP and the ASC groups.

Conclusion:
Our study confirms that early, single dose, systemic administration of ASC after PNI accelerates and enhances overall motor recovery on static and dynamic functional tests as evidenced by improvements in voluntary as well as involuntary motions.
Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly
Authors: Lee Jasmine , Alfonso Allyson R. , Kantar Rami S. , Diep Gustave K. , Berman Zoe P. , Ramly Elie P. , Daar David A. , Levine Jamie P. , Ceradini Daniel J. 
Published: January 2021

Background:
Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy.

Methods:
A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications.

Results:
A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; P = 0.03), overall complications (33.8% versus 19.5%; P < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; P < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08–2.20; P = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09–2.15; P = 0.02).

Conclusions:
Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery.
Flap Venous Congestion and Salvage Techniques: A Systematic Literature Review
Authors: Boissiere Florian , Gandolfi Silvia , Riot Samuel , Kerfant Nathalie , Jenzeri Abdesselem , Hendriks Sarah , Grolleau Jean-Louis , Khechimi Myriam , Herlin Christian , Chaput Benoit 
Published: January 2021

Background:
Venous congestion is a frequent problem in flap surgery. Other than surgical revision, there are a multitude of procedures in the literature to tackle this problem, but their effectiveness is not clear. Through a systematic review, we aimed to identify and evaluate the different interventions available for managing flap venous congestion.

Methods:
The MEDLINE, PubMed central, Embase, and Cochrane databases were searched. The study selection process was adapted from the PRISMA statement. All English and French original articles describing or comparing a method for managing flap venous congestion were included. For each article, a level of evidence was assigned, as defined by the Oxford Centre for Evidence-based Medicine. Lastly, we specifically analyzed the effectiveness of postoperative non-surgical methods. No formal analysis was performed.

Results:
Through literature searches carried out in various databases, we identified 224 articles. Finally, 72 articles were included. The majority of these studies had a low-level evidence. A total of 17 different methods (7 pre- and intraoperative, and 10 postoperative) were found. Concerning non-surgical methods, the most represented were leeches, local subcutaneous injection of heparin with scarification, venocutaneous catheterization, negative pressure therapy, and hyperbaric oxygen therapy.

Conclusions:
Risks of venous congestion of flaps must always be present in a surgeon’s mind, at every stage of flap surgery. Apart from studies on the use of leeches, which have a significant follow-up and large enough patient numbers to support their efficacy, the low-level evidence associated with studies of other methods of venous congestion management does not allow us to draw a scientifically valid conclusion about their effectiveness.
Observations Concerning the Match between Breast Implant Dimensions, Breast Morphometry, and a Patient-reported Outcome
Authors: Brown Tim 
Published: January 2021

Background:
Outcome studies in breast augmentation do not assess how an implant has been matched to the soft tissue envelope. The study hypothesis is that there is a relationship between breast and implant dimensions and the subjective outcome of patient satisfaction.

Methods:
In a study of patients undergoing subfascial breast augmentation (n = 341), morphometric measurements and a postsurgical survey of satisfaction with breast size were performed 3 months postoperatively. A ratio empirically derived from breast width, implant width, and projection (Rib) was calculated in patients who wished to have smaller, bigger, or no change in their implant size.

Results:
76% were content with breast size, 16.7% wished to be larger, and 7.3% wished to be smaller. Rib differed between groups who did not want to change size (n = 259, mean = 5.8, SD = 0.9), those who wished to be bigger (n = 57, mean = 5.6, SD = 1.1), and those who wished to be smaller (n = 25, mean = 5.3, SD = 1.3, H(341) = 14.0, P < 0.01). Rib differed between groups whose result was as expected (mean = 5.6, SD = 0.9), compared with those who expected to be bigger (mean = 5.4, SD = 1.2) or who expected a smaller outcome (mean = 5.6 SD = 1.0, H(341) = 18.3, P < 0.01).

Conclusions:
These data provide an objective measurement by which studies concerning breast augmentation can be reported and compared. The method may guide standardization of clinical research regarding breast implant surgery.
Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap
Authors: Ellabban Mohamed A. , Wyckman Alexander , Abdelrahman Islam , Steinvall Ingrid , Elmasry Moustafa 
Published: January 2021

Background:
The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer.

Methods:
A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP).

Results:
The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient.

Conclusions:
A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results.
A Phase 3, Randomized, Investigator-blinded Trial Comparing Ceftobiprole With a Standard-of-care Cephalosporin, With or Without Vancomycin, for the Treatment of Pneumonia in Pediatric Patients
Authors: Bosheva Miroslava , Gujabidze Rusudan , Károly Éva , Nemeth Agnes , Saulay Mikael , Smart Jennifer I. , Hamed Kamal A. 
Published: January 2021

Background:
The advanced-generation, broad-spectrum, intravenous (IV) cephalosporin, ceftobiprole, is an effective and well-tolerated treatment for adults with hospital-acquired pneumonia (HAP) or community-acquired pneumonia (CAP), but its effects in pediatric patients have not been established.

Methods:
In this multicenter, investigator-blinded, active-controlled, phase 3 study, patients 3 months to <18 years old with HAP or CAP requiring hospitalization were randomized (2:1) to ceftobiprole versus standard-of-care (SoC) IV cephalosporin treatments (ceftazidime or ceftriaxone), with or without vancomycin. After at least 3 days’ IV treatment, patients demonstrating clinical improvement could be switched to an oral antibiotic, to complete a minimum of 7 days’ treatment.

Results:
Overall, 138 patients were randomized to ceftobiprole (n = 94) or a SoC cephalosporin (n = 44). Median time to oral switch was 6.0 days in the ceftobiprole group and 8.0 days in the SoC cephalosporin group. While on IV therapy, adverse events and treatment-related adverse events were reported by 20.2% and 8.5% of ceftobiprole-treated patients and 18.2% and 0% of SoC cephalosporin-treated patients. Early clinical response rates at day 4 in the intention-to-treat population were 95.7% and 93.2% (between-group difference, 2.6%; 95% confidence interval, –5.5% to 14.7%) in the ceftobiprole and comparator groups, and clinical cure rates at the test-of-cure visit were 90.4% and 97.7% (between-group difference, –7.3%; 95% confidence interval, –15.7% to 3.6%), respectively.

Conclusions:
Ceftobiprole was well tolerated and, in this small phase 3 study, demonstrated similar efficacy to SoC cephalosporins in pediatric patients with HAP or CAP requiring hospitalization.
Deaths of Despair Among Healthcare Workers, Massachusetts, 2011 to 2015
Authors: Kaki Sahith , Hawkins Devan 
Published: January 2021

Objective:
To explore mortality rates and trends according to the occupation of healthcare workers who died from the deaths of despair (DoD).

Methods:
Death certificates for deaths from 2011 to 2015 due to poisonings, suicides, alcholic liver disease and cirrhosis were collected and coded based on the decedent's occupation. Mortality rates and rate ratios were calculated according to occupations for healthcare workers.

Results:
There were 540 DoDs among Massachusetts healthcare workers, accounting for an average annual rate of 32.4 deaths per 100,000 workers. The highest mortality rate for DoDs were among medical assistants; nursing, psychiatric, and home health aides; miscellaneous; health technologists and technicians; emergency medical technicians, and paramedics.

Conclusions:
Further research should examine factors contributing to elevated rates for DoDs among healthcare workers. Interventions targeted for these workers should be developed.
Conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma: where do we stand in 2018?
Authors: Satoi Sohei , Yamamoto Tomohisa , Matsui Yoichi 
Published: January 2021

Abstract
Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis, with a 5-year survival rate of <5%. Most (70%–80%) patients are classified as unresectable (UR) disease. Recent progress in chemotherapeutic approaches has provided a high response rate and improved short-term survival. Recently, conversion surgery (CS), which is defined as an additional surgery during multimodal therapy in patients with initially UR-PDAC who respond favorably to anti-cancer treatments, has been successfully introduced as a novel treatment option for locally advanced (UR-LA) and metastatic (UR-M) PDAC. Several studies have demonstrated high resectability rates (UR-LA, 20%–57%; UR-M, 2%–24%), high margin-negative resection rates (27%–91%), and high negative lymph node rates (29%–83%) in patients who underwent CS. Most studies also demonstrated acceptable mortality and morbidity. Median survival time (MST) varied between 24.9 and 35.3 months for patients with UR-LA, 19.5 and 64 months for UR-LA/M, and 26 and 56 months for UR-M, which is better than the MST of patients who did not undergo CS. The presence of M disease did not affect survival in patients who underwent CS. However, the actual clinical benefits of resection have not yet been fully investigated. There are still several issues to be resolved in this area. Therefore, sustained efforts to conduct appropriately designed clinical trials for confirming the efficacy of CS in the subset of patients with initially UR-PDAC are warranted.