bluuebunny/crossref_metadata_2025_split huggingface dataset:
Updates in palliative care of gynecologic oncology patients
Authors: Khoo Teresa , Karlin Daniel , Pietras Christopher 
Published: October 2024

Purpose of review
This review assesses the impact of early integration of palliative care and the disparities that exist among patients with gynecologic malignancies. It also highlights the recent advances in symptom management, goals of care communication, and end of life care.

Recent findings
Although palliative care has been utilized earlier, there are still barriers to its integration both nationally and worldwide, manifesting as predominantly late hospice referrals and aggressive care at the end of life. However, there are increasing efforts to promote earlier integration and discussion around goals of care through multidisciplinary approaches. Apart from symptom burdens, patients with gynecologic malignancies experience financial toxicity that impact various aspects of their lives, leading to potentially harmful choices to mitigate costs. A growing area of interest in palliative care is the realm of psychedelic-assisted therapy, which has shown benefits in treating advanced cancer patients with depression.

Summary
While significant strides have been made in incorporating palliative care earlier, continued research in palliative care is needed to address symptomatic and psychosocial suffering worldwide.
A Meta-analysis Comparing Deep Inferior Epigastric Perforator Flaps and Latissimus Dorsi Flaps in Breast Reconstruction
Authors: Tanas Yousef , Tanas Julie , Swed Sarya , Spiegel Aldona J. 
Published: October 2024

Background:
Deep inferior epigastric perforator (DIEP) flaps and latissimus dorsi (LD) flaps are two widely used breast reconstruction techniques, each with distinct advantages and limitations. This meta-analysis aims to compare patient satisfaction and incidence of complications between these two techniques to inform clinical decision-making.

Methods:
PubMed, Scopus, and Web of Science were searched for relevant studies. We included studies with data comparing DIEP and LD flaps, BREAST-Q patient satisfaction, and complications. Statistical analyses were performed using RevMan 5.4.

Results:
The search yielded 788 studies, of which 13 were included in the meta-analysis. A total of 2128 patients were analyzed, with 1378 undergoing DIEP flap reconstruction and 750 receiving LD flap reconstruction. The analysis showed greater improvement with DIEP flaps in breast satisfaction [mean difference (MD) = 9.48, 95% confidence interval (CI) = 6.90–12.05, P < 0.00001], physical well-being (MD = 5.95, 95% CI = 2.98–8.92, P < 0.0001), and satisfaction with outcome (MD = 9.36, 95% CI = 3.01–15.71, P = 0.004). Nonetheless, DIEP flaps had higher rates of skin flap necrosis [risk ratio (RR) = 4.27, 95% CI = 2.44 to 7.46, P < 0.00001], wound dehiscence (RR = 5.12, 95% CI = 2.53–10.35, P < 0.00001), and reoperation (RR = 2.24, 95% CI = 1.58 -3.16, P < 0.00001) but lower seroma rates (RR = 0.27, 95% CI = 0.10–0.74, P = 0.01).

Conclusions:
DIEP flap reconstruction offers superior patient satisfaction compared with LD flap reconstruction, despite a higher incidence of certain complications.
Midface Skeletal Sexual Dimorphism: Lessons Learned from Advanced Three-dimensional Imaging in the White Population
Authors: Abushehab Abdallah , Rames Jess D. , Hussein Sara M. , Meira Pazelli Alexandre , Sears Tori A. , Wentworth Adam J. , Morris Jonathan M. , Sharaf Basel A. 
Published: October 2024

Background:
Facial shape is significantly influenced by the underlying facial bony skeleton. Sexual dimorphisms in these structures are crucial for craniofacial, aesthetic, and gender-affirming surgery. Previous studies have examined the orbits and upper face, but less is known about the midface. This study aimed to elucidate the sexual dimorphism in the midface region, focusing on the maxilla and zygomatic bones.

Methods:
A retrospective review was conducted using facial computed tomography scans from 101 White patients aged 20–79 years, using Materialise Mimics and 3-Matics for segmentation and 3D reconstruction. Measurements and statistical shape modeling of the midfacial skeleton were performed.

Results:
Our results show a distinct sexual dimorphism in the midfacial skeletal structure across all age groups. Women typically had a narrower bizygomatic width by 1.5 mm (P = 0.04), a shallower maxillary depth by 1.6 mm (P < 0.01), and a midfacial vertical height that was 4 mm shorter than that of men (P = 0.018). In contrast, men exhibited a greater distance between the frontozygomatic sutures by 5.4 mm (P < 0.01), a 3-mm greater interorbitale distance (P < 0.01), and a 2.1-mm wider infraorbital foramina distance (P = 0.007). There were no significant differences in the pyriform and maxillary angles (P = 0.15 and P = 0.52, respectively).

Conclusions:
Our analysis of midfacial skeletal anatomy revealed sexual dimorphism differences. Men exhibited more pronounced facial features than women, with a broader horizontal midfacial skeleton, a longer midfacial vertical height, and greater maxillary depths compared with women.
Racial Disparities in Plastic Surgery Outcomes: A Systematic Literature Review and Meta-Analysis
Authors: Skorochod Ron , Wolf Yoram 
Published: October 2024

Background:
Racial disparities in surgical outcomes have been shown to lead to subpar results in various patients. Variability and contradictions in the current literature highlight the need for a crucial evaluation of the matter in studies focusing on plastic and reconstructive surgery. Investigating the matter is a pivotal step toward effective guidelines that mitigate factors contributing to racial disparities in outcomes and improve our perception of a patient-centered health-care system. The study aimed to identify whether racial disparities exist in plastic and reconstructive surgery procedures.

Methods:
Systematic review of the literature as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find relevant articles assessing the impact of race on surgical outcomes. PubMed, Embase, MEDLINE, and Cochrane library were screened by both authors, and relevant articles were identified. Prevalence of complications were extracted from included studies, and odds ratio (OR) with 95% confidence interval (CI) was calculated and grouped for a statistical analysis.

Results:
Meta-analysis of 13 studies, with a mean of 8059 patients per study, demonstrated a pooled OR of 1.21 (95% CI: 1.00–1.46), indicating an insignificant association between non-White race and postoperative complications. Subanalysis comparing African American patients to White patients (10 studies) showed an OR of 1.36 (95% CI: 1.06–1.74), signifying a statistically significant risk for African Americans. No publication bias was observed, but substantial heterogeneity (73% and 79%) suggested varied study factors influencing outcomes.

Conclusions:
Racial disparities exist in plastic and reconstructive outcomes. Physicians and medical staff should focus on patients’ sociodemographic background, accessibility to care, support cycles, and language proficiency, while determining the surgical plan and postoperative care.
Technical Strategies and Learning Curve in Robotic-assisted Peripheral Nerve Surgery
Authors: Aman Martin , Struebing Felix , Weigel Jonathan , Bigdeli Amir K. , Gazyakan Emre , Kneser Ulrich , Harhaus Leila , Boecker Arne H. 
Published: October 2024

Background:
Robotic-assisted peripheral nerve surgery (RASPN) has emerged as a promising advancement in microsurgery, offering enhanced precision and tremor reduction for nerve coaptations. This study investigated the largest published patient collective in RASPN and provided specific technical aspects, operative setups, and a learning curve.

Methods:
Data collection involved creating a prospective database that recorded surgical details such as surgery type, duration, nerve coaptation time, and number of stitches. The experienced surgeon first underwent a 12-hour training program utilizing the Symani robot system in combination with optical magnification tools before using the system clinically.

Results:
The study included 19 patients who underwent robot-assisted peripheral nerve reconstruction. The cohort included six men (31.6%) and 13 women (68.4%), with an average age of 53.8 ± 18.4 years. The procedures included nerve transfers, targeted muscle reinnervation, neurotized free flaps, and autologous nerve grafts. Learning curve analysis revealed no significant reduction in time per stitch over the initial nine coaptations (4.9 ± 0.5 min) compared with the last 10 coaptations (5.5 ± 1.5 min).

Conclusions:
The learning curve for RASPN was compared with early experiences with other surgical robots, emphasizing the importance of surgical proficiency and assistant training. Obstacles such as instrument grip strength and blood clot formation were highlighted, and suggestions for future advancements were proposed. RASPN presents an exciting opportunity to enhance precision; however, ongoing research and optimization are necessary to fully harness its benefits.
A Unique Advantage of a 24-hour Surgical Delay in Autologous Breast Reconstruction
Authors: Melancon Devin M. , Yoo Daniel , Stern-Buchbinder Zachary , Morin Samantha , St. Hilaire Hugo , Allen Robert J. 
Published: October 2024

Summary:
The surgical delay technique can be used effectively in autologous breast reconstruction when there is unfavorable flap vascular anatomy or when the reconstruction necessitates a larger volume of donor tissue to obtain optimal results. The length of time between surgically delaying the flap to pedicle division and inset of the flap often varies based on surgeon preference but is typically approximately a week or longer. The authors present a case in which a 24-hour surgical delay was successfully used to augment deep inferior epigastric perforator flaps for autologous reconstruction. This technique is beneficial as it does not allow time for scarring and adhesions to develop between stages and allows for both stages to be performed in the same hospital admission.
Vulvar Reconstruction with Freestyle Perforator Flap from the Medial Thigh Using Color Doppler Ultrasound
Authors: Landau Madeleine B. , Imbrescia Kory , Smith Christopher 
Published: October 2024

Summary:
Vulvoperineal defects mount significant functional and aesthetic challenges for reconstructive surgeons, often followed by postoperative complications. Ideal flap creation and perforator selection is vital for proper healing, especially in those with comorbid health concerns. This report details an innovative approach to vulvar reconstruction using a freestyle perforator flap from the medial thigh, identified by color flow Doppler ultrasound (CDU). This noninvasive imaging technique made possible the exact identification and confirmation of a well-vascularized pedicle, giving rise to a tailored flap for enhanced postoperative recovery and healing. The flap was designed based on real-time vascular mapping by CDU and validated through indocyanine green angiography, ensuring robust perfusion. The case of this patient demonstrated the successful application of portable CDU to navigate the intricate vessel network of the medial thigh, which would not have been possible with traditional imaging modalities such as computed tomography alone. The lack of postoperative complications following reconstruction demonstrates how this strategy for addressing vulvoperineal defects is advantageous due to meticulous perforator selection based on the patient’s unique anatomy. CDU is therefore an important tool for achieving optimal outcomes related to form and function, all while reducing the risks of donor site morbidity.
RELATIONSHIP BETWEEN THE HEIGHT OF WIDE AND NARROW PRIMARY MACULAR STAPHYLOMA AND MYOPIC MACULAR RETINOSCHISIS
Authors: García-Ben Antonio , Fernández Martín Marta , Olivier Pascual Nuria , Arroyo Castillo Rosa , Rubio Cid Sara , Ortigueira Espinosa Rafael , Álvarez Díaz María Dolores 
Published: October 2024

Purpose:
To investigate the relationship between the depth of wide and narrow primary macular staphyloma and myopic macular retinoschisis.

Methods:
Sixty-nine highly myopic eyes with wide and narrow primary macular staphyloma were included in this cross-sectional study and classified into two groups according to the presence or absence of myopic macular retinoschisis on swept-source optical coherence tomography. All patients received a complete ophthalmologic examination with determination of macular staphyloma depth by ocular ultrasonography (B-scan).

Results:
Nine eyes (9/69, 13.04%) present myopic macular retinoschisis on swept-source optical coherence tomography. Eyes with vitreomacular tractions, arteriolar traction, and greater macular staphyloma depth were more likely to develop myopic macular retinoschisis (odds ratio, 11.32; P = 0.001; odds ratio, 6.23; P = 0.039; and odds ratio, 3.37; P = 0.01, respectively). We did not observe statistically significant differences regarding best-corrected visual acuity between eyes with and without myopic macular retinoschisis (P = 0.39).

Conclusion:
The depth of the wide and narrow primary macular staphyloma appears to be a new and an important factor in the development of myopic macular retinoschisis.
Visual and anatomical outcomes following vitrectomy with subretinal tPA injection in patients with submacular haemorrhages secondary to wet AMD
Authors: Gallagher David , Hurley Daire , O’Brien Luke , Petronzi Vincenzo , Connell Paul , Dooley Ian 
Published: October 2024

Purpose:
Submacular haemorrhages (SMHs) are most commonly associated with wet age-related macular degeneration (AMD) and their size and duration are strong prognostic factors for visual outcome. The aim of this audit was to evaluate outcomes of direct injection of submacular tissue plasminogen activator (t-PA) into these lesions during pars plana vitrectomy (PPV).

Methods:
All patients presenting to the Mater Misericordiae Hospital from January 2017 to December 2019 with large SMHs secondary to wet AMD who underwent this treatment were included for review. All ten patients underwent complete PPV, injection of 0.2ml (50µg) subretinal t-PA and air tamponade. Pre-operative and post-operative evaluations included visual acuity testing (VA), optical coherence tomography (OCT) and slit lamp examination.

Results:
Eight patients (80%) showed improvement of their VA, with 4 patients achieving a VA of ≤0.4 LogMAR (20/50). Six patients had a total clearing of the macular haemorrhage, with a further 2 having sub-total clearance. One patient subsequently developed a retinal detachment requiring oil tamponade.

Conclusions:
SMH secondary to wet AMD is a sight threatening event with a varied prognosis but in most cases, vitrectomy with subretinal t-PA injection results in improved anatomical and visual outcomes.
Comparative Analysis of the Intrinsic Disorder Within the Layers of the Human Cornea
Authors: Djulbegovic Mak B. , Antonietti Michael , Taylor Gonzalez David J. , Mattes Robby , Kim Colin , Uversky Vladimir N. , Martinez Jaime D. , Karp Carol L. 
Published: October 2024

Purpose:
The human cornea is essential for vision, providing structural integrity and refractive power to the eye. Recent advancements have deepened our understanding of the corneal molecular composition, yet the role of intrinsically disordered proteins within the cornea is unexplored.

Methods:
We analyzed 3,250 corneal proteins identified by Dyrlund et al, focusing on the epithelium, stroma, and endothelium layers. We performed a bioinformatics analysis to characterize the amino acid composition, the propensity for intrinsic protein disorder, and the distribution of protein types in 3 corneal layer proteome.

Results:
Our study demonstrates that each corneal layer exhibited unique patterns in amino acid composition related to protein disorder. Order-promoting amino acids were generally depleted except for leucine, whereas disorder-promoting amino acids like arginine and glutamic acid were enriched across all layers. Significant variations were observed in the levels of intrinsic disorder among the different corneal layers, with substantial proportions of highly disordered proteins present in each. Analysis of protein class type in each layers revealed that no significant differences were detected in the distribution of protein classifications across the layers, suggesting a consistent population of the protein types across all corneal layers.

Conclusions:
Our findings reveal a sophisticated landscape of protein structures where intrinsic disorder varies across layers, suggesting an adaptation of the corneal proteome to the unique physiological demands of each layer. These structural variations may reflect the intricate requirements for corneal transparency, biomechanical stability, and environmental responsiveness.
Acquired Ankyloblepharon Correction Using Ocular Surface and Tarsal Mucous Membrane Grafting in Cicatrizing Ocular Surface Diseases
Authors: Patil Gaurav , Shanbhag Swapna S. , Basu Sayan , Singh Swati 
Published: October 2024

Purpose:
To report the long-term surgical outcomes of acquired ankyloblepharon correction using mucous membrane graft.

Methods:
Five eyes of 4 patients (median age, 19 years) with acquired ankyloblepharon were managed using eyelid splitting and mucous membrane graft anchored to the recti muscles on the bulbar surface in the respective quadrant and onto the bare tarsal surface. Outcome measures include a change in the palpebral fissure width, ability to fit scleral contact lenses, visual acuity, and cosmesis.

Results:
The underlying etiologies of ankyloblepharon were chronic Stevens-Johnson syndrome (n = 3), and chemical injury (n = 2). All 5 eyes had conjunctival shortening, and 3 had severe dry eyes (median Schirmer 4.5 mm). Four eyes had limbal stem cell deficiency. The median horizontal palpebral fissure width improved to 22 mm from 8 mm. This single-staged surgical technique allowed for fornix formation and prosthetic replacement of the ocular surface ecosystem lens fitting in all 5 eyes. Median logMAR visual acuity improved from 2.1 to 0.7 following ankyloblepharon release, prosthetic replacement of the ocular surface ecosystem lens fitting in 4 eyes, and keratoprosthesis in 1 eye. Repeat mucous membrane graft for recurrent symblepharon in 1 quadrant was required in 2 eyes where complete 360 degrees bulbar and tarsal conjunctiva loss were present preoperatively. At the median follow-up period of 27 months, all patients reported better cosmesis and had no symblepharon recurrence following repeat surgery in 2 eyes and single surgery in 3 eyes. The donor site healed well without any complications. No mitomycin C or symblepharon ring was used.

Conclusion:
Ocular surface and adnexal reconstruction using bulbar and tarsal mucous membrane grafts help visually rehabilitate patients with acquired ankyloblepharon secondary to cicatrizing ocular surface disorders.
Microscopic Anatomy of Orbital Septum
Authors: Gouigoux Stefano , Vaidya Aric , Naito Munekazu , Takahashi Yasuhiro , Kakizaki Hirohiko 
Published: October 2024

Purpose:
To study the microscopic anatomy of the orbital septum and evaluate its relationships with the adjoined structures.

Methods:
Histological evaluation of 11 upper eyelids (5 right, 6 left) from 10 Japanese cadavers (age range: 36–94-year-old, average: 71.1) was performed. The specimens were fixed in 10% formalin and stained with Elastica Van Gieson. Specimens were microscopically analyzed using different magnifications (20×, 40×, and 100×).

Results:
The orbital septum was the single fibrous layer in all the specimens, anteriorly separated from the retro-orbicularis fat pad capsule and posteriorly from the preaponeurotic fat pad capsule. At the junction of the orbital septum with the levator aponeurosis, the orbital septum proceeded towards the tarsal plate, and the preaponeurotic fat pad capsule reflected posteriorly.

Conclusions:
The orbital septum is constituted of a single layer of fibrous tissue anteriorly separated from the retro-orbicularis fat pad capsule and posteriorly from the preaponeurotic fat pad capsule by the corresponding virtual spaces.
Endophthalmitis rates after secondary intraocular lens surgeries: 11-year Medicare fee-for-service analysis
Authors: Kerrison Caroline H. , Chang David F. , Dun Chen , Sabharwal Jasdeep , Woreta Fasika A. 
Published: October 2024

Purpose:
To assess postoperative endophthalmitis (POE) rates and risk factors after secondary intraocular lens (IOL) implantation for preoperative aphakia and IOL exchange combined with or without vitrectomy.

Setting:
Medicare fee-for-service (FFS) beneficiaries, United States.

Design:
Retrospective study.

Methods:
Medicare FFS beneficiaries who underwent IOL exchange or secondary IOL implantation for preoperative aphakia between January 1, 2011, and November 19, 2022, were identified. POE rates were calculated overall and separately for each surgical category—secondary IOL for aphakia vs IOL exchange, with subsets for concurrent anterior or posterior vitrectomy. Multivariate analysis of potential risk factors was implemented.

Results:
97 152 patients were included. The 42-day POE rates for secondary IOL implantation for aphakia and for IOL exchange were 0.35% and 0.28% overall, 0.31% and 0.30% when combined with posterior vitrectomy, and 0.84% and 0.42% with anterior vitrectomy, respectively. The risk of POE increased when secondary IOL surgery was combined with anterior vitrectomy compared with no vitrectomy (adjusted odds ratio [aOR], 1.849; P < .001) and with higher Charlson Comorbidity Indexes compared with 0: 1 to 2 (aOR, 1.495; P = .01), 3 to 4 (aOR, 1.591; P = .01), 5 to 6 (aOR, 1.617; P = .046), and ≥7 (aOR, 3.290; P < .001). Risk was decreased for IOL exchange compared with secondary IOL implantation for preoperative aphakia (aOR, 0.783; P = .04).

Conclusions:
The overall POE rate for all secondary IOL surgeries was 0.31% during the 11-year period. We hypothesize that the absence of the posterior capsular barrier would explain the higher POE rates compared with cataract surgery, especially if a concurrent vitrectomy was performed with the secondary IOL procedure.
Comparing visual outcomes of keratorefractive lenticule extraction, PRK, and LASIK procedures in the military population
Authors: Evangelista Charisma B. , Harris Justin P. , Trinh Toan M. , Kohler Paul D. , Mackie Ryan , Turovets Sergei , Aden James K. , Capo-Aponte Jose E. 
Published: October 2024

Purpose:
To assess the 6-month visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) as compared with laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in a military population at a Joint Warfighter Refractive Surgery Center.

Setting:
Joint Warfighter Refractive Surgery Center (JWRSC), Lackland Air Force Base, San Antonio, Texas.

Design:
Retrospective study.

Methods:
Patients who underwent KLEx, PRK, or LASIK between 2019 and 2022 were included. Anonymized data collected included demographics, preoperative and postoperative uncorrected and corrected visual acuity, and manifest refraction.

Results:
Of the 4466 treated eyes, 737 (16.5%) underwent the KLEx, 2801 (62.7%) underwent PRK, and 928 (20.8%) underwent LASIK treatment. Regarding efficacy, there was no statistically significant difference at postoperative month (POM) 6 between the percentage of eyes reaching an uncorrected distance visual acuity of 20/20 or better between the 3 procedures. At POM1 (P < .001) and POM3 (P < .001), there were a greater number of eyes in the KLEx group that achieved the same or 1 line better of distance visual acuity than the PRK group. The efficacy indices of KLEx, PRK, and LASIK at POM6 were 1.09, 1.10, and 0.97, respectively. The safety indices for KLEx, PRK, and LASIK at POM6 were 0.96, 1.01, and 0.81, respectively.

Conclusions:
After the initial recovery period, KLEx demonstrates comparable outcomes in efficacy, safety, and accuracy as compared with LASIK and PRK.