bluuebunny/crossref_metadata_2025_split huggingface dataset:
Induction to Methadone 80 mg in the First Week of Treatment of Patients Who Use Fentanyl: A Case Series From an Outpatient Opioid Treatment Program
Authors: Steiger Scott , McCuistian Caravella , Suen Leslie W. , Shapiro Brad , Tompkins D. Andrew , Bazazi Alexander R. 
Published: August 2024

Objectives
Current guidelines for methadone titration may unnecessarily delay reaching effective doses for patients using fentanyl, resulting in an increased risk of ongoing fentanyl use, dissatisfaction with treatment, and early dropout. Development and evaluation of rapid methadone induction protocols may improve treatment for patients using fentanyl.

Methods
Retrospective chart review was conducted for patients admitted in 2022 to a single licensed opioid treatment program (OTP) where a rapid induction protocol provides methadone 40 mg on day 1, 60 mg on day 2, and 80 mg on day 3 to patients using fentanyl <65 years old without significant medical comorbidities. The primary feasibility outcome was completion of the protocol, defined by receipt of methadone dose 80 mg or more on treatment day 7. The primary safety outcomes were oversedation, nonfatal overdose, and death. A secondary outcome was retention in treatment at 30 days.

Results
Rapid induction was ordered for 93 patients and completed by 65 (70%). Average dose on day 7 for patients who completed was 89 mg (SD 9.5 mg) versus 49 mg (SD 14.0 mg) for those who did not. No episodes of oversedation, nonfatal overdose, or death were observed. At 30 days, 85% of the patients who had the rapid protocol ordered (79/93) were retained, with 88% (57/65) who completed the protocol retained versus 79% (22/28) who did not complete (OR 1.9, 95% CI 0.6–6.2).

Conclusions
Rapid induction to methadone 80 mg by day 7 was feasible for outpatients using fentanyl in this study at a single OTP. No significant safety events were identified.
Complex Fractures of the Radial and Ulnar Shaft
Authors: Lynch Thomas B. , Sabbag Casey M. , Wilson David J. , Plucknette Benjamin F. 
Published: August 2024

Summary:
Successful management of radial and ulnar shaft fractures is an essential skill for all orthopaedic surgeons. The frequent presentation of these injuries coupled with the nuanced anatomic considerations that must be observed for successful outcomes dictate that these injuries require a thorough understanding by the treating surgeon. Intraoperative care to restore the anatomic radial bow and rotation is essential for the resumption of functional forearm rotation postinjury. Often, problems arising during the operative treatment of radial and ulnar shaft fractures come in predictable patterns that can be mitigated with preoperative planning and sound technique. Cases of increased complexity with segmental bone defects and soft tissue defects require a variety of advanced reconstructive techniques.
Reverse Essex-Lopresti and Other Forms of Longitudinal Forearm Instability
Authors: Heifner John J. , Mercer Deana M. 
Published: August 2024

Summary:
Longitudinal forearm instability is a consequence of interosseous ligament complex disruption. Radiographic identifiers should alert the surgeon to the disrupted structures. Understanding the injury pattern can simplify the treatment process. The clinical presentation will vary based on the involved interosseous ligament components. The surgeon should aim to restore the anatomic radioulnar relationship and then address the remaining pathology as needed. The central band is the foundational structure that maintains this relationship and should be addressed in each injury pattern when disrupted. In this study, we describe rare forms of longitudinal forearm instability.
Tumor necrosis factor ALPHA Inhibitor Associated Köhlmeier–Degos Disease as a Novel Iatrogenic Paradigm That Underscores Excessive Type I Interferon in Its Pathogenesis
Authors: Magro Cynthia M. , Sanders Scott 
Published: August 2024

Abstract:
Malignant atrophic papulosis/Köhlmeier–Degos disease was first described in 1941 by Köhlmeier in an anecdotal case report that described a young man who presented with extensive multiple intestinal perforations and a papular skin rash. Köhlmeier–Degos disease represents a unique vasculopathy targeting both the microvasculature and the arterial system. One of its most characteristic features is reflected by the discrete multifocal depressed porcelain lesions involving the skin and gastrointestinal tract. The pathological findings are striking and can be broadly categorized into those that are vascular in nature versus extravascular matrix production in the context of extensive extravascular hyaluronic acid and collagen deposition. A dynamic evolutionary morphology is observed not only clinically but also histologically. The microvascular alterations are particularly evident in the skin and are characterized by endothelial cell necrosis with subsequent endothelial cell detachment accompanied by intraluminal fibrin deposition, defining a thrombogenic microangiopathy that in later stage lesions is typically pauci-inflammatory. The arterial lesions are very distinctive and include significant neointimal proliferation with vascular luminal occlusion by amorphous plugs of collagen intimately admixed with platelets. Pathogenetically enhanced type I interferon signaling and endothelial cell injury mediated by the membranolytic attack complex (ie, C5b-9) are key in the evolution of the thrombotic microvascular and obliterative fibrosing arteriopathic changes. We describe a case of Köhlmeier–Degos disease that developed in the setting of tumor necrosis factor (TNF)-alpha inhibitor therapy with the drug golimumab. The clinical features, light microscopic findings, and a pathophysiologic paradigm based on the critical role of TNF-alpha in controlling the type I interferon response are discussed.
Pseudo-random Number Generator Influences on Average Treatment Effect Estimates Obtained with Machine Learning
Authors: Naimi Ashley I. , Yu Ya-Hui , Bodnar Lisa M. 
Published: August 2024

Background:
The use of machine learning to estimate exposure effects introduces a dependence between the results of an empirical study and the value of the seed used to fix the pseudo-random number generator.

Methods:
We used data from 10,038 pregnant women and a 10% subsample (N = 1004) to examine the extent to which the risk difference for the relation between fruit and vegetable consumption and preeclampsia risk changes under different seed values. We fit an augmented inverse probability weighted estimator with two Super Learner algorithms: a simple algorithm including random forests and single-layer neural networks and a more complex algorithm with a mix of tree-based, regression-based, penalized, and simple algorithms. We evaluated the distributions of risk differences, standard errors, and P values that result from 5000 different seed value selections.

Results:
Our findings suggest important variability in the risk difference estimates, as well as an important effect of the stacking algorithm used. The interquartile range width of the risk differences in the full sample with the simple algorithm was 13 per 1000. However, all other interquartile ranges were roughly an order of magnitude lower. The medians of the distributions of risk differences differed according to the sample size and the algorithm used.

Conclusions:
Our findings add another dimension of concern regarding the potential for “p-hacking,” and further warrant the need to move away from simplistic evidentiary thresholds in empirical research. When empirical results depend on pseudo-random number generator seed values, caution is warranted in interpreting these results.
Nrf2 Ameliorates Atrial Fibrosis During Antithrombotic Therapy for Atrial Fibrillation by Modulating CYP2C9 Activity
Authors: Wu Liting , Li Zhumeng , Xu Lijuan , Fan Yingchao , Mao Delong , Sun Hanxiao , Zhuang Wenfang 
Published: August 2024

Abstract:
Anticoagulant therapy can significantly reduce the incidence of stroke and peripheral embolism events in patients with atrial fibrillation (AF). Although warfarin is widely used as an anticoagulant drug, a wrong dose can lead to increased risks of bleeding or blood clots. The aim of this study was to assess whether nuclear factor–erythroid-2–related factor 2 (Nrf2) can improve the efficacy of warfarin through the regulation of cytochrome P450 family 2 subfamily C member 9 (CYP2C9) using a rat model of AF. Results showed that AF significantly reduced Nrf2 in myocardial tissue of sham-operated rats. Furthermore, Nrf2 overexpression effectively reduced AF-induced atrial fibrosis by reducing collagen in the left atrium, inhibiting the expression of the fibrosis-related genes collagen I and transforming growth factor-β1 in rats with AF. Nrf2 overexpression can activate CYP2C9, decrease the serum concentration of warfarin, and decrease prothrombin time and international normalized ratio in AF rats. In this article, Nrf2 overexpression protects against fibrosis, increased survival in AF rats, and activated CYP2C9 expression, thus broadening the therapeutic range of warfarin in AF rats.
A Comparison of Capsular Contracture Rates after Immediate Implant-based Breast Reconstruction Using Biologic versus Synthetic Mesh
Authors: Ferenz Sarah , Bai Jennifer , Fracol Megan , Kim John Y.S. 
Published: August 2024

Background:
Capsular contracture is one of the most common reasons for reoperation after implant-based breast reconstruction. Prior investigations have suggested that biologic mesh may mitigate capsular contracture development. This study sought to compare capsular contracture rates between patients undergoing immediate implant-based breast reconstruction with biologic versus synthetic mesh.

Methods:
A retrospective review was conducted of the senior author’s primary implant-based breast reconstructions between 2008 and 2023. Demographics and the incidence of clinically significant Baker grade III or IV capsular contractures were compared between biologic and synthetic mesh cohorts. Univariate and multivariate logistic regressions were then performed to assess potential risk factors for the development of capsular contracture.

Results:
A total of 772 breasts underwent immediate reconstruction, of which 689 (89.2%) used biologic and 83 (10.8%) used synthetic mesh. Capsular contracture occurred in 15 (2.2%) biologic mesh breasts and three (3.6%) synthetic mesh breasts with no significant difference between the two groups (P = 0.430). Logistic regression showed that radiation was a borderline significant risk factor for developing capsular contracture, but the use of either biologic or synthetic mesh was not significant (P = 0.351).

Conclusions:
Biologic and synthetic meshes function as effective tools in prosthetic breast reconstruction. Our long-term data suggest that the risk of capsular contracture with these devices is low, and there does not seem to be a difference between the two materials. However, there does need to be a shift in how capsular contracture is assessed and discussed in the reconstruction population.
Evolving Role of Exosomes in Plastic and Reconstructive Surgery and Dermatology
Authors: McGraw Ian T. , Wilson Erin Elise , Behfar Atta , Paradise Christopher R. , Rohrich Rod J. , Wyles Saranya P. 
Published: August 2024

Summary:
Exosomes, or extracellular vesicles, represent the latest cell-free addition to the regenerative medicine toolkit. In vitro preclinical studies have demonstrated the safety and efficacy of exosomes, which vary based on source and biomanufacturing, for a myriad of potential therapeutic applications relevant to skin and soft tissue reconstruction. Primary search was performed in September 2021 on the MEDLINE database via PubMed and Ovid, with focus on articles about therapeutic application of exosomes or extracellular vesicles. In total, 130 articles met criteria for applicability, including early-stage clinical trials, preclinical research studies with in vivo application, and articles applicable to plastic and reconstructive surgery and dermatology. Most studies used animal models of human disease processes, using either animal donor cells to isolate exosomes, or human donor cells in animal models. Exosome technology has catapulted as an acellular therapeutic vehicle with off-the-shelf accessibility. These features eliminate prior threshold for broad adoption of regenerative cell-based therapies into surgical and medical practice. To date, there are no exosome products approved by the US Food and Drug Administration. This review highlights exosomes as the new frontier in regenerative medicine and outlines its preclinical therapeutic applications for cutaneous repair and restoration.
Thigh Perforator Exchange: Intraflap Perforator Augmentation of Anterolateral Thigh Free Flaps
Authors: Palines Patrick A. , Nungesser Matthew E. , Baudoin Morgan E. , Melancon Devin M. , Stalder Mark W. 
Published: August 2024

Summary:
Peripheral perfusion in large anterolateral thigh flaps may be inadequate if perforator zones are not properly planned during flap design and harvest, and variations in vascular anatomy can contribute to operative difficulty and morbidity. Intraflap anastomosis of extrinsic perforators may allow for augmentation of perfusion while avoiding significant intramuscular dissection. Adaptation of the perforator exchange technique, previously described in autologous breast reconstruction, optimizes vascular flow in anterolateral thigh flaps. Here, we present a technique for intraflap perforator anastomosis (the thigh perforator exchange) and illustrate its use in a subset of patients. This technique is relatively simple and rapid to perform with no vascular complications observed in our series.
NOVEL AGENTS IN THE MANAGEMENT OF DIABETES AND RISK OF WORSENING DIABETIC RETINOPATHY
Authors: Rajagopal Rithwick , McGill Janet B. 
Published: August 2024

Purpose:
Novel therapies for diabetes have potent effects on glycemic control, obesity, and cardiovascular risk reduction, but some, including the popular drug semaglutide, have also been implicated in worsening of diabetic retinopathy (DR). Given the ubiquity of these new agents, understanding the risks to vision is important. Here, we review the data for several newly available agents in terms of systemic efficacy and retinal safety.

Methods:
Literature review.

Results:
Novel antihyperglycemic treatments include incretin mimetics and enhancers, sodium-glucose cotransporter inhibitors, long-acting insulins, and insulin delivery systems. All improve glycemic control, and some have been shown to reduce major cardiovascular outcomes. In a pivotal trial, semaglutide was associated with approximately 75% increased risk of DR worsening. The novel long-acting insulin icodec, formulated for once weekly dosing, showed increased risk of DR worsening over a once daily insulin. No other recent antihyperglycemic agent was associated with DR worsening, although following the semaglutide trials, nearly all studies excluded patients with preexisting DR. Cases of DR worsening were rare in all instances. Dedicated safety studies for semaglutide in DR are currently underway.

Conclusion:
For most patients being considered for treatment with a novel antihyperglycemic agent, benefits on systemic metabolic and cardiovascular health are very likely to outweigh potential retinal harms. Although the true risks of the new agents on DR are unclear because their safety data come from secondary end points, the most vulnerable patients are those with preexisting high-risk DR, poor baseline glycemic control, and using insulin.
Neurotrophic corneal melt after deep anterior lamellar keratoplasty
Authors: McAlinden Colm , Matsou Artemis 
Published: August 2024

Introduction:
This case report features the management of a challenging case of neurotrophic keratopathy (NK). Important considerations in the management of epithelial defects in neurotrophic eyes after corneal transplantation are discussed.

Patient and Clinical Findings:
A 73-year-old man was referred for management of secondary microbial keratitis on a background of neurotrophic herpes simplex keratitis in the left eye. Acinetobacter parvus was identified and treated. After the resolution of the infection, a residual central corneal scar was significantly affecting vision; therefore, an 8-mm deep anterior lamellar keratoplasty (DALK) was performed 3 years later.

Diagnosis, Intervention, and Outcomes:
After DALK, a large central epithelial defect occurred, and this progressed to graft melt with a descemetocele. An emergency tectonic DALK was performed along with an amniotic membrane, bandage contact lens, and lateral temporary tarsorrhaphy. No epithelial defect or further melt was observed in the postoperative period, including after removal of the tarsorrhaphy, and at 9 months postoperatively, the graft remains clear with no epithelial defect.

Conclusions:
In NK, frank epithelial defects, especially after corneal transplantation, require careful consideration. Immediate management options including amniotic membrane transplantation and tarsorrhaphy should be considered to reduce the risk of progression to corneal melting.
Erector Spinae Plane Block Reduces Postoperative Pain and Narcotic Utilization Compared With Transversus Abdominis Plane Block After Cystectomy With Urinary Diversion
Authors: Igel Daniel A. , Martin Austin , Sullivan Peter , Wyre Hadley W. , Mirza Moben , Taylor John A. , Holzbeierlein Jeffrey M. , Thompson Jeffrey , Pozek John-Paul , Lee Eugene K. 
Published: August 2024

Background:
Regional analgesia is a critical component of enhanced recovery after surgery pathways for cystectomy, but there is little research comparing different modalities. Transversus abdominis plane block is a well-established procedure used for postoperative regional analgesia, whereas erector spinae plane block is a recently described technique that some contend improves pain control.

Objective:
We sought to compare these modalities in patients undergoing cystectomy, with primary end points of pain scores and total narcotic utilization measured in morphine milliequivalents.

Methods:
We retrospectively reviewed 77 consecutive patients who underwent open radical cystectomy. Patients who did not undergo erector spinae plane block or transversus abdominis plane block or who used chronic narcotics were excluded. Pain intensity scores were measured immediately postoperatively and in 24-hour intervals until 72 hours postoperatively. Cumulative narcotic utilization at 72 hours, return to bowel function, and length of stay were measured.

Results:
Fifty-one patients met inclusion criteria. Seventeen patients underwent erector spinae plane block and 34 transversus abdominis plane block. Erector spinae plane block patients reported lower pain scores immediately postoperatively (P = .046), at 48 hours (P = .019), and 72 hours (P = .019). Erector spinae plane block patients used less narcotics after 72 hours than transversus abdominis plane block patients (median: 62.50 morphine milliequivalents vs 146.25 morphine milliequivalents, P = .008).

Conclusions:
Compared with transversus abdominis plane block, erector spinae plane block reduced total narcotic utilization by 234% while also reducing subjective patient pain scores. Increased adoption of erector spinae plane block could have major impacts on both clinical outcomes and patient satisfaction in patients undergoing radical cystectomy.
An Analysis of the Procedure Volume and Geographic Distribution of US Urologists Performing Outpatient-Based Inflatable Penile Prosthesis Implantation
Authors: Du Comb William S. , Durand Kathryn , Rojanasarot Sirikan 
Published: August 2024

Introduction:
This study described the procedure volume and geographic distribution of US urologists performing outpatient-based inflatable penile prosthesis (IPP) implantation.

Methods:
This retrospective administrative claims analysis from Definitive Healthcare identified urologists performing outpatient IPP implantation (Current Procedural Terminology 54405) on commercially insured or Medicare patients in 2021 in hospital outpatient settings. Procedural volumes for each implanter were calculated, and geographical analyses used their primary affiliated hospitals to identify the states in which the procedures were performed.

Results:
In 2021, 2049 urologists conducted 21,835 outpatient-based IPP procedures on a representative sample of commercially insured and Medicare patients, averaging 10.7 procedures per implanter annually. Procedural volumes were right-skewed: 8.6% of urologists performed 33.7% of procedures. Most urologists (91.4%) performed <20 cases. The highest volume implanters who performed more than 100 cases accounted for 6.3% of procedure volumes. Geographical analysis showed Florida (11.2%), California (7.8%), Texas (7.5%), New York (5.9%), Michigan (4.2%), Ohio (3.9%), and Georgia (3.9%) had the highest numbers of outpatient implanters, consistent with the top 7 states by IPP implantation volume (Florida [11.4%], Texas [9.4%], New York [6.5%], California [6.3%], Ohio [5.8%], Georgia [4.2%], and Michigan [3.4%]).

Conclusions:
Most urologists performing outpatient IPP (91.4%) performed <20 procedures per year in 2021. Less than 10% performed approximately one-third of the procedures. These findings highlight essential considerations for fostering development in the field of urology, particularly for emerging implanters aiming to expand patient outreach. The implications aim to establish a balanced and accessible landscape, benefiting both practitioners and the patients they serve.
Anatomical Retrofitting: Pi (脾) as Spleen and the Persistence of Ontological Ambivalence
Authors: Li Lan A. 
Published: August 2024

Abstract
Over the past decade, medical researchers in China have debated whether the Pi (脾) corresponds to the biomedical spleen or pancreas. This debate exemplifies a broader phenomenon of “anatomical retrofitting”, or the anachronistic imposition of contemporary categories onto living historical objects. “Anatomical retrofitting” as a means of rectifying cases of mistranslation further positions the biomedical spleen and pancreas as representing ahistorical, universal truths. This framework gives rise to a conceptual binary: while the biomedical spleen is universalized as what philosophers may describe as “logical” ontology, the Pi connects to a different nature of reality, or “metaphysical” ontology. Far from being an object of imprecision, the Pi was a dynamic vessel that also shared characteristics with the humoral spleen. Given that scholars in China have already subjected Pi to historical scrutiny, this paper urges scholars to do the same with biomedical anatomy. For instance, historically situating the humoral spleen demonstrates that it became less known and less articulated as it transformed into the biomedical spleen. Meanwhile, the pancreas remained an unstable epistemic object that took on the dynamic functions of the humoral spleen in nineteenth-century organotherapy. Through primary source analysis and literature review, this paper contends that the apparent ontological incommensurability between Pi and spleen is neither mutually exclusive nor irreconcilable. Instead, the dynamic nature of internal viscera, their many functions, and their participation in epistemic practices contribute to an ongoing ontological ambivalence that persists despite the forced certainty of anatomical retrofitting.