bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study
Authors: Ma Congcong , Zhou Ying , Kang Jia , Zhang Ye , Ma Yidi , Wang Yuan , Tian Weijie , Xu Tao , Liang Shuo , Fan Guorong , Cui Yiran , Zhu Lan 
Published: February 2021

Abstract

Objective:
To evaluate the 5-year pessary continuation rate and identify clinical risk factors associated with discontinuation in patients with symptomatic pelvic organ prolapse (POP).

Methods:
In this prospective observational study, 312 women with symptomatic POP received pessary treatment between November 2013 and July 2015 in Peking Union Medical College Hospital, China, a tertiary referral center. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted and continued to use the pessary 2 weeks later. Patients with successful pessary fitting were followed for 5 years. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression.

Results:
In total, 265 patients (84.9%) had successful pessary fitting. After 5 years, 180 of 239 patients continued pessary use (75.3% continuation rate), with 26 lost to follow-up. The discontinuation rates decreased over time, from 8.7% at 1 year to 2.7% at 5 years. Total vaginal length < 7.5 cm (TVL, OR = 2.7, 95% CI 1.3-5.7, P = 0.007), improvement in Urinary Impact Questionnaire-7 scores < 50% at 3 months (OR = 2.1, 95% CI 1.1-4.2, P = 0.025), and incapability of self-care (OR = 2.6, 95% CI 1.3-5.1, P = 0.008) were potential discontinuation risk factors.

Conclusion:
Three-quarters of patients with symptomatic POP had successful pessary treatment at 5-year follow-up. TVL < 7.5 cm, poor urinary symptom relief at 3 months, and incapability of self-care were potential discontinuation risk factors.
Lymphovenous Anastomoses and Microscopic Lymphatic Ligations for the Treatment of Persistent Lymphocele
Authors: Uyulmaz Semra , Planegger Andrea , Grünherz Lisanne , Giovanoli Pietro , Lindenblatt Nicole 
Published: February 2021

Background:
Numerous approaches have been employed to treat chronic lymphocele and cutaneous lymphatic fistulas (LFs) with little success. Given a high incidence and substantial consequences for patients, there is an ongoing demand for effective therapeutic and preventive strategies. The aim of this study was to evaluate the results after microscopic lymphatic ligation (MLL) and lymphovenous anastomosis (LVA) as a therapeutic and preventive approach in this context.

Methods:
Demographic data, surgical characteristics, complications, and the overall outcome of all patients undergoing surgery for postoperative LF from 2014 to 2019 were collected retrospectively. Patients were categorized in accordance with predefined inclusion/exclusion criteria and with their treatment. Statistical analysis was conducted using descriptive, summary statistics to identify a central tendency.

Results:
Thirty-four patients underwent indocyanine-green-lymphangiography guided revision surgery for LF. Two patients were lost to follow-up at 6 months. LF was successfully treated in all patients (n = 32) with a multimodal approach. Only MLL was performed in 22 patients and MLL/LVA in 10 patients. LF resolved in 78% of all patients with MLL only or MLL/LVA. In the remaining 22%, LF resolved after additional sclerotherapy within 3 months.

Conclusions:
Treatment of LF should follow a standardized staged surgical approach to optimize outcome. LF was treated successfully in all our patients. We therefore propose a multimodal interdisciplinary approach to this common clinical problem that includes adjunctive sclerotherapy.
Post-mastectomy Breast Reconstruction with Autologous Tissue: Current Methods and Techniques
Authors: Garza Ramon , Ochoa Oscar , Chrysopoulo Minas 
Published: February 2021

Summary
Breast reconstruction is an option that should be considered for any patient facing a mastectomy. Autologous breast reconstruction provides the benefits of excellent longterm results, natural appearance, natural feel, and the best opportunity for sensory restoration. These factors lead many patients to choose autologous tissue over implant-based reconstruction. With improved anatomic and technical knowledge, the donor site morbidity previously associated with abdominally based autologous reconstruction has been significantly reduced. Today, the DIEP flap is the preferred autologous method allowing restoration of a “natural,” aesthetic breast with potential for sensation while simultaneously minimizing abdominal donor site morbidity. Alternative flaps and adjunctive procedures provide options when dealing with patients who present with challenging clinical scenarios because of an inadequate abdominal donor site. This paper reviews current methods employed by a high volume breast reconstruction practice to achieve these goals.
The Negative Impact of COVID-19 on Medical Education amongst Medical Students Interested in Plastic Surgery: A Cross-sectional Survey Study
Authors: Haley Caleb , Lee Jasmine , Xun Helen , Yesantharao Pooja , Nolan Ian T. , Harirah Muhammad , Crowe Christopher S. , Lopez Joseph , Morrison Shane D. , Drolet Brian C. , Janis Jeffrey E. 
Published: February 2021

Background:
The COVID-19 pandemic has resulted in unpreceded changes to medical education. Medical students interested in urology and neurosurgery have reported concerns regarding COVID-19’s effects on clinical experience and the residency application process; however, the impact amongst students interested in plastic surgery is unknown. We hypothesized that students applying into plastic surgery may experience much distress as a result of the COVID-19 pandemic.

Methods:
An electronic survey was developed by 3 plastic surgery residents and 2 academic plastic surgeons and later refined by 4 fourth-year medical students. Questions focused on medical education curricular changes, perceived impact on medical education, and demographics. From April–May 2020 the survey was distributed to medical students who were interested in plastic surgery. Participants were identified through plastic surgery residency program personnel and social media platforms.

Results: In total,
130 of the 140 respondents reported interest in plastic surgery careers. An estimated 67% were in their clinical years or completing research year(s) before residency applications. Of the respondents, 80% believed that the COVID-19 pandemic had a negative impact on their medical education. Clinical-level students compared with preclinical-level students, and students applying to residency during the 2020–2021 match cycle compared with students not applying during the 2020–2021 match cycle were significantly more likely to perceive the COVID-19 pandemic as having a negative impact on their medical education (P = 0.04 and 0.03, respectively).

Conclusion:
Medical students interested in plastic surgery perceive the COVID-19 pandemic as having a negative impact on their education, likely due to a reduction in clinical exposure.
Implementing a New Service Line Model to Support Growth and Serve Patients
Authors: Fine Peter S. , Kuhlenbeck Kathy 
Published: February 2021

SUMMARY
Many healthcare organizations are reinvesting in clinical service lines to differentiate themselves, standardize evidence-based care, and add value. Typically, service line structures are built around hospital-based procedures and are accountable solely to local operations. That can be a blueprint for missed growth and lost value.
Banner Health, based in Phoenix, Arizona, with operations in six southwestern states, has pivoted to a systemwide service line strategy to foster growth and support value-based care. Service lines are now organized to maximize both revenue and quality across the continuum of care, to the benefit of both the system and its patients. The new, team-based structure allows Banner Health to respond nimbly to changes in the healthcare environment because it is based on the ways patients access the system. In 2021, just two years into this complex transition, the results have demonstrated that this service line model can achieve measurable benefits that include growth; improved financial performance, safety, and clinical outcomes; and increased collaboration in value-based payment models—all helping the system to realize its mission of making healthcare easier so that life can be better for our patients.
The genetics of left ventricular noncompaction
Authors: Cannie Douglas , Elliott Perry 
Published: February 2021

Purpose of review
This article summarises current understanding of the genetic architecture underpinning left ventricular noncompaction (LVNC) and highlights the difficulty in differentiating LVNC from hypertrabeculation seen in normal, healthy individuals, that caused by physiological adaptation or that seen in association with cardiomyopathy phenotypes.

Recent findings
Progress has been made in better defining the LVNC phenotype and those patients who may benefit from genetic testing. Yield of diagnostic genetic testing may be low in the absence of syndromic features, systolic dysfunction and a family history of cardiomyopathy. Sarcomeric gene variants are most commonly identified but a wide-range of genes are implicated, emphasising the high degree of heterogeneity of studied cohorts.

Summary
More accurate phenotyping and genotype–phenotype correlation are required to better characterise the genetic architecture of LVNC.
Identification of Ferroptosis Biomarker in AHH-1 Lymphocytes Associated with Low Dose Radiation
Authors: Yin Jie , Hu Nan , Yi Lan , Zhao Weichao , Cheng Xinjie , Li Guoqing , Yang Nanyang , Li Guangyue , Ding Dexin 
Published: February 2021

Abstract
The impact of long-term low-dose radiation on human health has always been a concern. Long-term low-dose gamma radiation causes cells continuous injury and causes chromosomal mutations to greatly increase the chance of cancer. Because it is significant to identify biomarkers for long-term low-dose gamma radiation, we investigate the influence of low dose rate on the gene expressions in the AHH-1 lymphocytes cell line (AHH-1 cells) for long-term irradiation. Different dose rates (7, 14, 26, 34, and 43 μGy h−1) of irradiation from gamma radiation in uranium tailings powder were used to irradiate AHH-1 lymphocytes. We used flow cytometry to test the apoptosis of AHH-1 lymphocytes at different dose rates and irradiation times (7-84 d). It was found that 14 μGy h−1 is the most sensitive dose rate of AHH-1 lymphocyte irradiation. The 7-, 14-, and 21-d (2.4, 4.8, and 7.2 mGy) irradiation groups were sensitive, and the 84-d (28.8 mGy) irradiation group was insensitive to low dose gamma radiation. Microarray analysis was conducted on the significantly differentially expressed genes (p<0.05) in the 2.4, 4.8, 7.2, and 28.8 mGy irradiation groups. We found that TFRC1, SLC3A2, SLC39A8, FTH1, ACSL4, and GPX4 are significant genes with low-dose radiation and were constituents of the ferroptosis signaling pathway. In the range of 0–4.8 mGy radiation dose, the expressions of these genes were downregulated with increasing radiation dose, while in the range of 4.8–28.8 mGy, its expression increased with increasing radiation dose. RT-PCR and Western blot were used to detect the mRNA and protein expression of these genes. The results were consistent with those from microarray analysis. Our findings indicate that expression of the TFRC, SLC3A2, SLC39A, FTH1, ACSL4, and GPX4 genes is sensitive to low-dose radiation, and they are main members of the ferroptosis signaling pathway. Therefore, there is a very important connection between ferroptosis and low-dose radiation, which has become a hot topic in international research. These results can provide reference to the effect of ferroptosis on human health with low-dose radiation.
Are X-ray Safety Glasses Alone Enough for Adequate Ocular Protection in Complex Radiological Interventions?
Authors: Grau Mathias , Eldergash Osama , Amin Sandeep Sunder , Kowald Tobias , Schnabel Johannes , Wißmann Anika , Simka Sebastian , Chavan Ajay , Mathys Christian , Poppe Björn , Schmuck Bernhard , Thomas Rohit Philip 
Published: February 2021

Abstract
The maximum annual radiation ocular dose limit for medical staff has been reduced to 20 mSv in the current European directive 2013/59/Euratom. This multi-centric study aims at reporting the protected and unprotected eye lens doses in different fluoroscopically guided interventions and to evaluate any other factors that could influence the ocular dose. From July 2018 to July 2019, ocular radiation doses of six interventionists of four departments during complex interventions were recorded with a thermoluminescent dosimeter in front of and behind radiation protection glasses to measure the protected and unprotected doses. The position of personnel, intervention type, fluoroscopy time, total body dose and use of pre-installed protection devices like lead acrylic shields were also systematically recorded. Linear regression analysis was used to estimate the doses at 2 y and 5 y. The annual unprotected/protected ocular doses of six interventionists were 67/21, 32.7/3.3, 27.4/5.1, 7/0, 21.8/2.2, and 0/0 mSv, respectively. The unprotected dose crossed the 20-mSv annual limits for four interventionists and protected dose for one less experienced interventionist. The estimated 5-y protected ocular dose of this interventionist was 101.318 mSv (95%CI 96.066-106.57), also crossing the 5-y limit. The use of a lead acrylic shield was observed to have a significant effect in reducing ocular doses. The annual unprotected and protected ocular doses for interventionists dealing with complex interventions could cross the present permitted yearly limit. The measurement of significant protected ocular dose behind the radiation protection glasses emphasizes the additional indispensable role of pre-installed radiation protection devices and training in reducing radiation doses for complex procedures.
Inhalation of Soluble Plutonium: 53-year Follow-up of Manhattan Project Worker
Authors: Šefl Martin , Avtandilashvili Maia , Tolmachev Sergei Y. 
Published: February 2021

Abstract
This whole-body tissue donor to the United States Transuranium and Uranium Registries was occupationally exposed to plutonium nitrate-dioxide mixture via chronic inhalation. This individual was involved in the Manhattan Project operations and later participated in medical follow-up studies. Soft tissues and bones collected at autopsy were analyzed for 238Pu, 239+240Pu, and 241Am. Fifty-three years post-intake, 700±2 Bq of 239+240Pu were still retained in the skeleton, 661±11 Bq in the liver, and 282±3 Bq in the respiratory tract. Bioassay measurements and organ activities at the time of death were used to estimate the intake and radiation doses using the TAURUS internal dosimetry software. For this individual, an ICRP Publication 130 Human Respiratory Tract Model with case-specific particle size of 0.3 μm, ICRP Publication 100 Human Alimentary Tract Model, and ICRP Publication 141 Plutonium Systemic Model adequately described long-term plutonium retention and excretion. The total cumulative 239+240Pu intake of 31,716 Bq was estimated, of which 24,853 Bq (78.4%) were contributed by inhalation of plutonium nitrate and 6,863 Bq (21.6%) of plutonium dioxide. The committed equivalent doses to the red bone marrow, bone surface, liver, lungs, and brain were 0.71 Sv, 6.5 Sv, 8.3 Sv, 3.8 Sv, and 0.068 Sv, respectively. The committed effective dose was 1.22 Sv.
CORRELATION OF OUTER RETINAL TUBULATIONS AND CHORIOCAPILLARIS FLOW SIGNAL DEFICITS SURROUNDING GEOGRAPHIC ATROPHY
Authors: Haensli Christof , Sugiura Yoshimi , Freund K Bailey , Zweifel Sandrine A. 
Published: February 2021

Purpose:
To evaluate and compare paralesional and perilesional choriocapillaris vascular impairment in eyes with geographic atrophy with and without outer retinal tubulations (ORT).

Methods:
Using swept-source optical coherence tomography angiography, 6 × 6 mm scans of eyes with geographic atrophy with and without ORT were acquired. Choriocapillaris en-face flow and structural images were binarized, before flow signal deficit (FD) analysis in the paraatrophy zone (a 500-µm-wide band adjacent to the geographic atrophy) and the periatrophy zone (a 500-µm-wide band adjacent to the latter).

Results:
Twenty-four eyes of 19 patients with ORT and 18 eyes of 15 patients without ORT were analyzed. With and without ORT, mean percental area of FD (%FD) was greater in para- than in periatrophy zone. The difference of %FD between para- and periatrophy zone (deltaFD) was lower in eyes with ORT (mean 1.8477%, 95% confidence interval 0.8607–2.8346) than without ORT (mean 4.0018%, 95% confidence interval 2.8622–5.1414).

Conclusion:
In eyes with geographic atrophy caused by non–neovascular age-related macular degeneration, smaller reductions in FDs were found between the para- and periatrophy zone in eyes with ORT. In both cohorts, the paraatrophy zone had more FD than the periatrophy zone.
BACILLARY LAYER DETACHMENT BECAUSE OF MACULAR NEOVASCULARIZATION
Authors: Jung Jesse J. , Soh Yu Qiang , Yu Daryle Jason G. , Rofagha Soraya , Lee Scott S. , Freund K. Bailey , Hoang Quan V. 
Published: February 2021

Purpose:
To describe the clinical and multimodal imaging features of bacillary layer detachment (BD), and its response to intravitreal anti-vascular endothelial growth factor therapy, in eyes with macular neovascularization.

Methods:
Retrospective, observational case series of 14 eyes (14 patients, 7 men) imaged with eyes (14 patients, 7 men) were imaged with spectral-domain optical coherence tomography, and either fluorescein angiography or optical coherence tomography angiography. Therapeutic response was monitored with serial imaging and best-corrected visual acuity assessments.

Results:
The mean age was 75 ± 13 (range: 45–96) years, with mean follow-up duration of 27 ± 21 (range: 1–56) months. Neovascular age-related macular degeneration was found in 71% (10/14) eyes. Type 2 macular neovascularization lesions were associated with BD in all 14 eyes. Subretinal hemorrhage was noted in 79% (11/14) eyes. BD promptly resolved after intravitreal antivascular endothelial growth factor therapy in all eyes. The baseline best-corrected visual acuity improved from logarithm of the minimum angle of resolution 0.84 ± 0.32 (Snellen equivalent 20/138) to logarithm of the minimum angle of resolution 0.48 ± 0.31 (Snellen equivalent 20/60) at the last follow-up, with treatment of the macular neovascularization.

Conclusion:
Type 2 macular neovascularization and subretinal hemorrhage are associated with BDs, which may be due to a rapid influx of exudative fluid into the potential space between the external limiting membrane and ellipsoid zone. Intravitreal antivascular endothelial growth factor therapy results in rapid resolution of BDs and visual improvement in most eyes.
“IRIS SHELF” TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES
Authors: Soliman Wael , Tawfik Mohamed A. , Abdelazeem Khaled , Kedwany Salma M. 
Published: February 2021

Purpose:
To describe “iris shelf” technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes.

Methods:
Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision.

Results:
Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1–8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes).

Conclusion:
The “iris shelf” technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.
CHOROIDAL IMAGING BIOMARKERS TO PREDICT HIGHLY RESPONSIVE AND RESISTANT CASES TREATED WITH STANDARDIZED ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR REGIMEN IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Jhingan Mahima , Cavichini Melina , Amador Manuel , Dans Kunny , Bartsch Dirk-Uwe , Cheng Lingyun , Chhablani Jay , Freeman William R. 
Published: February 2021

Purpose:
To determine structural predictors of treatment response in neovascular age-related macular degeneration analyzing optical coherence tomography (OCT)–related biomarkers.

Methods:
A retrospective review of patients undergoing treatment for neovascular age-related macular degeneration at a tertiary institute was performed at presentation. High-intensity regimen included eyes on long-term anti–vascular endothelial growth factor treatment with the inability to extend beyond a month without a relapse and needed double the dose of medication (n = 25). Low-intensity regimen had eyes that went into long-term remission after at least three injections and remained dry for more than a year until the last visit (n = 20). Multimodal imaging including fluorescein angiogram, OCT, and comprehensive ocular evaluation were done. Choroidal vascularity index, total choroidal area, luminal area, subfoveal choroidal thickness, choriocapillaris thickness and Haller and Sattler layer thickness were analyzed for statistical significance.

Results:
The groups had no significant difference at baseline in age, gender, incidence of reticular pseudodrusen, polypoidal choroidal vasculopathy feature on OCT, type of choroidal neovascular membrane, and geographic atrophy. Multinomial logistic regression revealed that thicker subfoveal choroidal thickness and larger total choroidal area were the significant predictors of poor response to anti–vascular endothelial growth factor treatment (E = 0.02; P = 0.02; E = 1.82; P = 0.0075).

Conclusion:
Thicker subfoveal choroidal thickness and higher total choroidal area are useful variables to predict a poor treatment response.