bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population
Authors: Weiss Jakob B.W. , Kollár Branislav , Eisenhardt Steffen U. 
Published: November 2024

Abstract
Background Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear.
Methods We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study.
Results Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (p > 0.05). There were no major bleeding complications or deep vein thrombosis.
Conclusion The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.
Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and Vein
Authors: Cho Jeongmok , Kim Donggeon , Kim Taehyun , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio 
Published: November 2024

Abstract
Background This research aims to validate the proficiency and accuracy of the robotic microsurgery platform using rat femoral vessel model.
Methods A total of 256 rat femoral vessels were performed, half using robotic and the other by manual microanastomosis by eight microsurgeons with less than 5 years of experience given eight trials (rats) each. Vessel demographics, proficiency (duration of suture and Structured Assessment of Robotic Microsurgical Skills [SARMS]), and accuracy (patency and scanning electron microscopic [SEM]) were analyzed between the two groups.
Results Using the robot, an average of four trials was needed to reach a plateau in total anastomosis time and patency. Significant more time was required for each vessel anastomosis (34.33 vs. 21.63 minutes on the eighth trial, p < 0.001) one factor being a higher number of sutures compared with the handsewn group (artery: 7.86 ± 0.51 vs. 5.86 ± 0.67, p = 0.035, vein: 12.63 ± 0.49 vs. 9.57 ± 0.99, p = 0.055). The SARMS scores became nonsignificant between the two groups on the fourth trial. The SEM showed a higher tendency of unevenly spaced sutures, infolding, and tears in the vessel wall for the handsewn group.
Conclusion Using the robot, similar patency, accuracy, and proficiency can be reached through a fast but steep learning process within four trials (anastomosis of eight vessels) as the handsewn group. The robotic anastomosis may take longer time, but this is due to the increased number of sutures reflecting higher precision and accuracy. Further insight of precision and accuracy was found through the SEM demonstrating the possibility of the robot to prevent unexpected and unwanted complications.
Fetal Growth Ultrasound in Obese Patients for the Detection of Growth Abnormalities
Authors: Martins Juliana G. , Miller Elizabeth , Horgan Rebecca , Kawakita Tetsuya 
Published: November 2024

Objective This study aimed to examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses.
Study Design Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. First-trimester ultrasound was performed to establish accurate dating criteria. Ultrasound assessments were performed at 16 to 21 and 22 to 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference <10th percentile) or LGA (EFW >90th percentile) among obese compared with nonobese women. A secondary analysis was performed after limiting ultrasound performed from 28 to 29 weeks. To estimate adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates.
Results Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16 to 21 weeks (16.0% vs. 13.2%; aRR 1.23; 95% CI 1.06–1.42) and 22 to 29 weeks (16.0% vs. 12.1%; aRR 1.33; 95% CI 1.14–1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16 to 21 weeks (12.5% vs. 10.3%; aRR 1.24; 95% CI 1.05–1.47) and 22 to 29 weeks (10.6% vs. 6.9%; aRR 1.66; 95% CI 1.38–2.01). In a secondary analysis limited to the ultrasound at 28 to 29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared with normal weight.
Conclusion Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.
Key Points
Transition-Metal-Catalyzed Deuteration via Hydrogen Isotope Exchange
Authors: Jiang Zhi-Jiang , Gao Zhanghua , Bai Jian-Fei 
Published: November 2024

AbstractDirect hydrogen isotope exchange represents a distinctive strategy for deuterium labelling, where the protium is directly replaced by deuterium. In this graphical review, we summarize the progress in deuteration via transition-metal-catalyzed hydrogen isotope exchange. The review is organized according to the mechanism of C–H bond activation relating to the homogeneous catalysis, and heterogeneous catalysis is also discussed according to the catalyst type. Representative mechanistic processes are depicted, and proven cases for tritiation are also highlighted.
Brisk Walking Pace Offsets Venous Thromboembolism Risk Equivalent to Established Monogenic Mutations
Authors: Xian Wenyan , Tao Yifan , You Chong , Sun Ruinan , Ranson Janice M. , Napolioni Valerio , Lau Patrick W.C. , Huang Jie 
Published: November 2024

Background Mendelian mutations in the Prothrombin gene (F2) and the factor V Leiden gene (F5) genes are established risk factors for venous thromboembolism (VTE). Walking pace is associated with the risk of coronary artery diseases, but no study has investigated its association with VTE. This study aimed to investigate the association and causality between walking pace and VTE, compare its population risk with established Mendelian mutations, and determine if blood biomarkers mediate its effect.
Methods We followed up 445,261 UK Biobank participants free of VTE at baseline. Self-reported walking pace was collected via touchscreen questionnaire at baseline. The carrier status of two Mendelian mutations in F2 and F5 genes was determined by the genotypes of rs1799963 (G20210A, c.*97 G > A) and rs6025 (p.R534Q), respectively. Cox proportional hazard model was used to estimate the effect of walking pace on incident VTE. We conducted a bidirectional Mendelian randomization (MR) analysis, by using 70 single-nucleotide polymorphisms (SNPs) from a walking pace genome-wide association studies (GWAS) and 93 SNPs from a VTE GWAS as instrumental variables. We used both individual-level data and GWAS summary statistics for mediation analysis.
Results Over a median follow-up period of 12.8 years, 11,155 incident VTE cases were identified. The 10-year incidence rates for brisk and slow walking pace were 1.32% (confidence interval [CI]: 1.27–1.37%) and 3.90% (CI: 3.71–4.09%), respectively. For noncarriers, F2 and F5 carriers, the 10-year incidence rates were 1.70% (CI: 1.66–1.73%), 2.94% (CI: 2.66–3.22%), and 3.62% (CI: 3.39–3.84%), respectively. The overall risk of VTE for F5 mutation carriers with a brisk walking pace (2.65%) was smaller than that for noncarriers with a slow walking pace (3.66%). For F5 mutation carriers, brisk pace (but not steady pace) reduces the risk of VTE (p interaction < 0.05). MR analyses displayed a causal relationship (inverse variance weighted: p = 3.21 × 10−5) from walking pace to VTE incidence. Mediation analysis showed that serum albumin (ALB) and cystatin C (CYS) levels partially mediated the effect of brisk walking pace on the risk of VTE incidence, with mediation proportions of 8.7 to 11.7%, respectively.
Conclusion On the population scale, the protective effect of brisk walking pace offsets the risk of VTE caused by Mendelian mutations. We provided preliminary evidence that a brisk walking pace causally reduces the risk of VTE. Serum ALB and CYS partially mediate this effect.
Diagnosis and Management of Mitral Valve Disease in the Elderly
Authors: Kumar Preetham , Aedma Surya , Varadarajan Padmini , Pai Ramdas G. 
Published: November 2024

AbstractCalcific mitral stenosis, commonly seen in the elderly in developed countries, occurs primarily due to mitral annular calcification, and its prevalence is increasing secondary to an aging population. Mitral regurgitation, commonly seen across all age groups, occurs primarily due to anatomical or functional impairment of one or more components of the mitral apparatus or the left ventricle that are necessary for normal valve function, and its prevalence is increasing secondary to an increasing number of patients with heart failure. The current review discusses the diagnosis of and treatment options (medical, surgical, and transcatheter) for mitral valve disease, including the associated challenges, specifically in the elderly.
Hand Rejuvenation by Autologous Fat Grafting in Post-Hansen's Hand Atrophy: Aesthetic and Psychological Implications
Authors: Yamani Venkata Ramana , Gurindagunta Swamy Vivek , Raju Rama Linga , Kumar Shree , Valluri Mukesh Krishna , Sharma Mrigya 
Published: November 2024

Abstract
Introduction Contemporary medical science has been using fat grafting in aesthetic and reconstructive procedures, consistently achieving successful outcomes. Hansen's disease, caused by Mycobacterium leprae, leads to hand deformities due to peripheral neuropathy, resulting in soft-tissue atrophy, volume loss, and compromised hand function. Tendon transfer surgery is a common remedy for functionality, but it often does not address aesthetic concerns and the patient's psychological impact of living with an atrophic hand. Autologous fat grafting can effectively address these concerns.
Materials and Methods This prospective study evaluates the efficacy of fat grafting for hand rejuvenation in patients with Hansen's disease posttendon transfer surgery, focusing on aesthetic and psychological outcomes. We recorded data from 12 patients who underwent the procedure between 2015 and 2024. Using the Coleman technique, fat was harvested from the paraumbilical region of the abdomen and injected into various hand regions.
Results Autologous fat grafting showed high patient satisfaction with significant improvements in hand contour, skin texture, and psychological health. The benefits of the procedure included improved self-esteem, enhanced quality of life, reduced social stigma, and psychological well-being.
Conclusion Autologous fat grafting is a safe and effective technique for hand rejuvenation in patients with Hansen's disease, after functional treatment addressing both physical deformities and their psychological impacts. It could be considered one of the components in the comprehensive management of Hansen's disease–related hand deformities, significantly enhancing patients' overall quality of life.
An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk
Authors: R. Sivakumar , Chowdhury Sumit Roy , Bhutia Karma Ongmu , Sokhal Suman 
Published: November 2024

AbstractA 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.
Distinct Care Needs and Episodes of Care: Comparing Medical versus Orthopaedic Readmissions after Elective Primary Total Knee Arthroplasty
Authors: Turan Oguz , Ramos Michael S. , Pasqualini Ignacio , Piuzzi Nicolas S. ,   Cleveland Clinic Adult Reconstruction Research Group
Published: November 2024

AbstractHospital readmissions after primary total knee arthroplasty (TKA) significantly drive health care expenditure and resource utilization. Recent studies have suggested differences between medical and orthopaedic readmissions after TKA and their episodes of care (EOCs) but lack patient-level data reporting. This study aimed to compare EOCs for medical and orthopaedic-related readmissions regarding initial readmission wards, services consulted, intensive care unit (ICU) admissions, blood transfusions, surgical interventions, length of stay, and discharge disposition.All patients enrolled in a prospective data collection system at a tertiary medical center undergoing elective, unilateral, primary TKA from 2016 to 2020 and readmitted within 90 days of discharge were included. Readmissions were categorized as related to medical or orthopaedic causes. Patients' electronic medical records were reviewed to collect demographic and clinical information about EOC associated with the readmission hospital course.In total, 82.4% (580/704) of 90-day readmissions after elective, primary TKA were related to medical causes, with the remaining 17.6% (124/704) of readmissions due to orthopaedic causes. Medical readmissions most often pertained to gastrointestinal complaints, while wound complications accounted for most orthopaedic readmissions. Most readmissions (63.1%, 444/704) occurred within the first 30 days after TKA. Patients with medical and orthopaedic readmissions had differences in EOC, such that more medical readmissions required ICU care (10.6 vs. 1.6%, p < 0.001), and more patients with orthopaedic readmissions needed a surgical intervention (65.4 vs. 6.7%, p < 0.001).By understanding differences in EOC for medical and orthopaedic readmissions after TKA, targeted initiatives can be developed to deliver more efficient, cost-effective orthopaedic surgical care, as the orthopaedic surgical community continues to provide value-based care.
British Skull Base Society Consensus on Vestibular Schwannoma Surveillance
Authors: Sethi Mantegh , Borsetto Daniele , Tysome James , Buttimore Juliette , Gamazo Nicola , Mannion Richard , Guilfoyle Matthew , Bance Manohar , Obholzer Rupert , Das Tilak , Scoffings Dan , Minett Thais , Jones Jonathan , Joshi Yogish , Scott Francis , Matys Tomasz , Freeman Simon , Lloyd Simon , Rutherford Scott , Potter Gillian , Siripurapu Rekha , Abdulla Sarah , Laitt Roger , Saloojee Ziyad , Summers David , Saeed Shakeel R. , Bandino Fabrizio , MacKeith Samuel , Jeyaretna Sanjeeva , Philpott Carl , Shah Jagrit , Robertson Iain , Thomas Sebastian , Hattangadi Nameet , Paluzzi Alessandro , Kay Andrew , Awan Bushra , Rhys Rhian , Muthu Senthil , Clamp Philip J , Nannapaneni Ravi , Hayhurst Caroline , Gurusinghe Nihal , Alalade Andrew , Gilkes Catherine , Munir Nazia , Yousseff Ahmed , Patel Parag , Hampton Susanne , Hammerbeck-Ward Charlotte , Saunders Nick , Irving Richard , Monksfield Peter , Thomas Nicholas , Kitchen Neil , Barazi Sinan , Maratos Eleni , Connor Steve , Leonard Colin , Dawe Nicholas , Mohamed Hassan , Axon Patrick , Donnelly Neil 
Published: November 2024

Abstract
Objective Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). Consensus is lacking on the optimal duration, frequency, and modality of imaging. Standardizing this approach would ensure safe and effective care, reduce patient distress, and promote consistency in management decisions among clinicians.
Methods In July 2022, a multi-disciplinary Delphi consensus was conducted at the British Skull Base Society Meeting. Expert United Kingdom-based skull-base surgeons and neuroradiologists were presented semi-systematic literature reviews summarizing current evidence on VS management. Anonymized opinions were collated and discussed to reach a majority vote, which was deemed the final consensus opinion.
Results Recommendations for VS managed by surveillance are: (1) surveillance frequency should decrease over time; (2) surveillance may be discontinued when the remaining lifetime risk of VS growth is <0.5% (∼8.5 years); (3) factors such as age, VS size, VS location, and cystic components should be considered. Surveillance after surgery or radiotherapy has limited evidence but recommendations are: (4) surveillance should be adjusted based on residual tumor size or nodular enhancement. Imaging modality and sequences are recommended to be (5) high-resolution magnetic resonance imaging with T1, T2, FIESTA/CISS multiplanar sequences, contrast is not required in untreated cases, and linear reporting of measurements is pragmatically sufficient.
Conclusion This consensus and literature review provides an evidence and expert opinion–based guide to help clinicians with the surveillance of patients with VS. Further research should focus on better understanding the dynamic nature of growth risks and the growth characteristics of postintervention VS to enable personalized growth risk stratification.
Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery
Authors: Daum Rachel , Grimm David , Yong Michael , Hosseinzadeh Farideh , Lee Christine K. , Fernandez-Miranda Juan C. , Nayak Jayakar V. , Patel Zara M. , Hwang Peter H. , Chang Michael T. 
Published: November 2024

Abstract
Background Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion.
Methods A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI).
Results A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Transpterygoid approaches showed greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability.
Conclusion ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.
Combined Percutaneous Lithotripsy and Transjejunal Stone Extraction for Intrahepatic Bile Duct Stones
Authors: Garg Parul , Sharma Malay 
Published: November 2024

AbstractThis case report describes the treatment of intrahepatic duct stones in a 21-year-old woman, who developed these stones as a long-term complication after undergoing choledochal cyst excision and hepaticojejunostomy at the age of 3 years. The calculi were fragmented by combining percutaneous SpyGlass laser lithotripsy and percutaneous transjejunal crushing and retrieval of stones using a lithotripter and endoscopic retrograde cholangiopancreatography balloon extraction catheter. This case reminds us of long-term complications of stone formation after choledochal cyst surgery with biliary-enteric anastomosis and emphasizes the use of combined methods we can utilize for treating these stones.