bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing and evaluating the impact of operative vision compromise (OViC) on surgeons’ practice: a qualitative study
Authors: Nabeel Ahmad , Al-Sabah Salman , Al-Ghanim Khalifa , Al-Roumi Dalal , Al-Basri Dana , Ziyab Ali , Ashrafian Hutan 
Published: July 2024

Background:
Assessing the effects of compromised vision in laparoscopic and robotic procedures is crucial to understanding its impact on surgical practice and patient safety. Our aim was to examine the impact of operative vision compromise (OViC) on surgeons’ practice.

Methods:
Intraoperative workload was qualitatively assessed using the NASA-TLX score. Participants included internationally trained surgeons performing laparoscopic sleeve gastrectomy (LSG) procedures. Video recordings of LSG procedures were quantitatively analyzed to assess OViC event frequency and duration to determine their influence on procedural time and surgical flow in a secondary care center. Surgeons’ views on OViC were assessed using a custom survey. Cost analysis of basic expenditures was performed.

Results:
Among 109 participants, the overall NASA-TLX score for OViC was 71.7, indicating a high workload. Out of 81 LSG procedures, 77 experienced at least one lens fouling episode, resulting in 471 OViC events, including 371 lens cleaning occurrences. Significant positive correlations were found between total procedure time and several OViC variables. Compromised vision accounted for 19.3% of total operative time. Lens cleaning constituted 2.5% of the total operative time. In nine (11%) cases, lens cleaning added an average of 7 min per procedure, with the most severe case adding 15 min of operative time. The majority of surgeons (94%) found OViC to impair their performance and compromise patient safety, with 61% reporting witnessing surgical errors or complications directly attributable to OViC.

Conclusions:
OViC was linked to increased procedure time, surgical flow disruptions, elevated surgeon workload, cognitive burden, and frustration, and potential patient safety concerns. These findings emphasize the need for innovative solutions to mitigate OViC, thereby potentially minimizing errors and enhancing operative outcomes.
Associations of biological age accelerations and genetic risk with incident endometrial cancer: a prospective analysis in UK Biobank
Authors: Yang Ziye , Shen Yufei , Zhang Tongtong , Tang Xiaolin , Mao Rui 
Published: July 2024

Background:
Endometrial cancer (EC) is one of the gynecologic malignancy cancer with increasing incidence and mortality rates, partly due to aging populations and genetic risks. This study explores the associations between biological age accelerations (BAA) and risk of incident EC and assesses the joint effect of genetic factors and BAA.

Materials and methods:
Based on the UK Biobank cohort, 132 315 women participants were included for primary analysis and 124 119 white participants for genetic risk analysis. Biological age (BA) was calculated using the Klemera-Doubal (KDM) and PhenoAge method based on clinical biomarkers. The authors calculated two metrics for BAA (including KDM residual and PhenoAge residual) using residual analysis, comparing them against chronological age. The risk of incident EC was evaluated using multivariable Cox proportional-hazards models, adjusting for relevant covariates. Polygenic risk scores (PRS) were computed from known EC-associated SNPs.

Results:
Both KDM and PhenoAge residual, were significantly associated with increased EC risk. In fully adjusted models, the highest tertile of KDM and PhenoAge residual was significantly associated with incident EC compared with the lowest group, with HRs of 1.278 (P=0.0044) and 1.424 (P<0.0001), repectively. The population-attributable fractions were 7.84% for KDM residual (P=0.0044), 9.78% for PhenoAge residual (P=0.0005), and 8.47% for genetic risk (P=0.0005). Additionally, joint associations of BAA and genetic risk with incident EC was evaluated. Compared with low genetic risk and low BAA, high genetic risk and high BAA was significantly associated with the incidence of EC with HRs of up to 2.172 (95% CI: 1.592–2.963) for KDM and 2.226 (95% CI: 1.640–3.022) for PhenoAge. Overall, higher levels of PhenoAge residual were consistently associated with an increased risk of incident EC, regardless of genetic risk.

Conclusion:
BAA and genetics both enhance the risk of incident EC. The effect of the PhenoAge residual is greater than that of the investigated genes, which in turn is greater than that of the KDM residual. These findings highlight the importance of considering both BAA and genetic factors in EC prevention.
Dilation Outcomes for Transgender and Nonbinary Patients Following Gender-Affirming Vaginoplasty in a US County Safety-Net System
Authors: Kvach Elizabeth , O’Connell Ryan , Sairafi Shereen , Holland Krystyna , Wittmer Nancy 
Published: July 2024

Purpose:
The study purpose was to report neovaginal dilation outcomes and identify factors associated with pain, dilation discontinuation, and sexual function for transgender individuals who underwent gender-affirming vaginoplasty.

Methods:
A retrospective cohort study design was employed of transgender patients 18 years or older undergoing full-depth vaginoplasty and pelvic floor physical therapy (PFPT) between May 2018 and April 2021 at a safety-net hospital through medical record review and an online survey developed with a patient advisory board. Exclusion criterion was minimal-depth vaginoplasty or loss to follow-up.

Results:
In total, 137 patients included underwent full-depth vaginoplasty (46.7% survey response rate) 796.2 days (mean) postoperatively. Patients received 4.3 PFPT visits, with the last visit 12.4 weeks postoperatively (mean). Ninety patients (64.3%) achieved the 2 widest dilators, and 68 patients dilated to a depth of 5.5 inches or more (49.6%). The mean progression time between dilators was 5 weeks. Twenty-nine patients (21.2%) had pain preventing dilation, associated with minor or any surgical complication (OR = 5.7; 95% CI, 1.3-25.0) and posttraumatic stress disorder (P = .01), and had more PFPT visits for longer postoperatively than those without pain (P = .03). Nineteen respondents (32.2%) reported not dilating and were younger (P = .02), more likely to be lesbian, pansexual, or asexual (P = .01), and experienced depression (P = .01). Forty-four respondents (77.2%) were sexually active in the past 6 months, which was not associated with pain during dilation. However, respondents self-reporting dilation pain had greater dissatisfaction with their sex life (P = .02).

Discussion:
Patient dilation practices following vaginoplasty differ from protocols recommended by surgeons. Dilation goals should be adapted to individual patient characteristics and needs.
The Development and Content Validity of the Fremantle Perineal Awareness Questionnaire (FrePAQ) for Use in People With Persistent Perineal Pain
Authors: Hardy Amanda , Campbell Leigh , Jones Carol , Vandyken Carolyn , Bond Jilly , Moss Penny , Smith Anne , Wand Benedict , Thompson Judith 
Published: July 2024

Background:
Altered body awareness and perception comprise a common feature of persistent pain. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body awareness and perception in people with back pain. There is no tool to measure these changes in people with persistent perineal pain.

Objective:
To develop the Fremantle Perineal Awareness Questionnaire (FrePAQ) to assess body awareness and perception in people with persistent perineal pain. To evaluate content validity using a qualitative survey.

Study Design:
Modified electronic Delphi and cross-sectional qualitative online survey.

Methods:
A focus group developed a draft questionnaire from the preexisting FreBAQ. A preliminary FrePAQ was developed through 3 Delphi rounds of anonymous voting by a panel of 14 experts. A qualitative survey was completed by individuals with persistent perineal pain to evaluate the comprehensiveness, comprehensibility, and relevance of the preliminary questionnaire. Responses were thematically analyzed, and demographic data were summarized descriptively.

Results:
Fourteen panel participants completed the Delphi study, with consensus achieved on a 9-item questionnaire after 3 rounds. One hundred thirty-five participants with persistent perineal pain completed the round 1 validation survey. Changes were made to the introduction and 7 items. A new group of 53 participants completed round 2, resulting in final changes to the introduction and 2 of the 9 items.

Conclusions:
An expert consensus was achieved in the wording of a new questionnaire aimed at assessing body awareness and perception in people with persistent perineal pain, which demonstrated acceptable content validity.
Hemorrhoids, Anorectal Symptoms, and Related Risk Factors in Pregnancy and the Postpartum Period: A Follow-up Study
Authors: Gülören Gülbala , Çınar Gamze Nalan , Baran Emine , Gürşen Ceren , Uzelpasacı Esra , Özgül Serap , Beksaç Kemal , Fadıloglu Erdem , Aydın Emine , Tanacan Atakan , Akbayrak Turkan , Beksaç Mehmet Sinan 
Published: July 2024

Purpose:
To investigate the presence of hemorrhoids and anorectal signs/symptoms and to identify various risk factors including anthropometric/musculoskeletal contributors associated with hemorrhoids in pregnancy and the postpartum period.

Background:
Pregnancy and the postpartum period may predispose women to develop hemorrhoids and anorectal symptoms because of hormonal and musculoskeletal changes.

Methods:
Fifty-one pregnant women with no history of anorectal disease were included in the study. The occurrence of hemorrhoids and other anorectal signs/symptoms was examined at 4 different times: first, second, and third trimesters, and postpartum 6th week. The Rome III criteria and the Bristol Stool Scale were used to confirm the presence of constipation and to determine stool type, respectively. Waist and hip circumference (as anthropometric contributors), bi-iliac and bitrochanteric width (as diameter measurements), diastasis recti abdominis, joint hypermobility, and lumbar lordosis (as musculoskeletal contributors) were evaluated. Personal, demographic, and clinical characteristics of the patients as well as postpartum period information were also recorded.

Results:
Hemorrhoids, perianal discomfort, perianal pain, and protrusion were significantly more frequent at postpartum than at the first trimester (P < .008). According to the multivariate analysis, body mass index, the presence of constipation, joint hypermobility, and birth weight were significant determinants of hemorrhoids at the third trimester and postpartum (odds ratio = 1.25-2.67).

Conclusions:
Body mass index, constipation, joint hypermobility, and increased birth weight of the newborn were potential risk factors for the development of hemorrhoids during pregnancy and postpartum. Hemorrhoids and anorectal complaints should be kept in mind and managed to increase the quality of life during pregnancy and the postpartum period.
A 3-Year Retrospective Review of Complex Suicides With a Review of the Literature
Authors: Paredes Rivera Alexandra , Dramé Awa Sarr , Knight Laura D. 
Published: July 2024

Abstract
Complex suicide is defined as death by the intentional use of more than 1 method to end one's life. Complex suicides can fit into the planned or premeditated category, where 2 or more methods are used simultaneously or in close succession, or unplanned, the use of 2 or more methods, in which the first method attempted fails (often because it is too unpleasant or painful), and another method is employed subsequently that is successful.
A retrospective review of 3 years of suicide fatalities examined by the Washoe County Regional Medical Examiner's Office in Reno, Nevada, was conducted. A total of 725 suicide cases dated from April 1, 2020, to April 1, 2023, were reviewed, including autopsy, toxicology, and scene investigation reports. Among the 725 suicide cases reviewed, 19 cases (2.62%) of complex suicide were identified. Of those cases, 17 employed 2 methods, and 2 cases employed 3 methods. No cases were identified with >3 methods.
In the 19 complex suicides that were identified, gender, age, marital status, military service, sexual orientation, religion, race, occupation, incident location, suicide note, suicidal ideation history, past suicide attempt, psychiatric disorders, and motive for suicide were examined in addition to methods used.
Three Deaths Associated With Facial and Upper Airway Burns Related to Oxygen Use
Authors: Hinton Cassidy A. , Prahlow Joseph A. , Shattuck Brandy , Tart Anna 
Published: July 2024

Abstract
Despite the implementation of numerous strategies to prevent unintentional burns, fire-related thermal injuries remain a significant source of morbidity and mortality. Unfortunately, fires that occur in the setting of medical oxygen do so despite many safeguards and warnings that accompany oxygen therapy. Oxygen-related accidental fires can occur both within the home and medical settings, and burns associated with these events tend to produce injuries of the face and upper airways. Thermal burns of the face and upper airway are of particular concern because of the vital respiratory function of these anatomic structures, and may initially appear minor, but due to the inhalational injury mechanism, can contribute to death. In this report, three deaths associated with accidental oxygen therapy-related facial/upper airway burns are reported, one occurring during surgery, and two occurring during home-oxygen use.
Caseous Calcification of the Mitral Annulus
Authors: Jorgenson Kyla M. , McMullen Phillip D. , Goldman Bruce I. , Jacob-Leonce Marisa 
Published: July 2024

Abstract
Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC) usually described as an antemortem finding. We report a case of sudden cardiac arrest in a 39-year-old male with end-stage renal disease undergoing hemodialysis with a history of Fabry disease by kidney biopsy. Autopsy revealed significant circumferential annular calcification in both mitral and aortic valves with a caseous gross appearance. Histologically, these areas consisted of amorphous basophilic material accompanied by a surrounding granulomatous-appearing infiltrate. Von Kossa staining on non-decalcified tissue revealed strong positive staining, confirming CCMA diagnosis. While identifiable, the atrioventricular node was displaced and distorted by caseous deposits. Toluidine blue staining of myocardium showed osmophilic accumulations, and electron microscopy (EM) showed myeloid/zebra bodies, consistent with Fabry disease. We posit that Fabry disease leads to end-stage kidney disease, altering calcium phosphate metabolism, a proposed mechanism for CCMA. This case highlights the multifactorial nature of sudden cardiac death in decedents with various structural cardiac changes and potential renal-disease–induced electrolyte imbalances. We aim to bring awareness to this rare entity, its potential role in a sudden cardiac death, and to highlight the need to use non-decalcified tissue when staining for calcium to establish the diagnosis.
Association Between Cardiovascular Disease and Death by Anaphylaxis
Authors: Garland Jack , Smith Peter , Tse Rexson , Ong Beng , Milne Nathan 
Published: July 2024

Abstract
Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis.
Sudden Death Due to Necrotizing Fasciitis After Routine Cervical Radiofrequency Ablation Treatment
Authors: Trivedi Ravi , deJong Joyce L. , Hansma Patrick A. 
Published: July 2024

Abstract
Cervical facet joint neurotomy, also known as cervical radiofrequency ablation (RFA) or cervical facet rhizotomy, is a medical procedure aimed at alleviating chronic neck pain caused by issues related to the cervical facet joints through ablation of neurons (J Pain Res 2021;14:2807–2831). Although generally safe, adverse events can occur. Infection is a rare consequence of this procedure. Most injection-site infections related to cervical RFA occur spontaneously and resolve with oral antibiotics without sequelae (World Neurosurg 2018;111:e644–e648). We report a case in which a cervical RFA injection resulted in the development of necrotizing fasciitis and ultimately death. To our knowledge, this has not been previously reported and is the first documented fatality due to infectious sequelae of a cervical RFA procedure.
Malaria in pregnancy: baby steps
Authors: Rogerson Stephen J. , Aitken Elizabeth H. 
Published: July 2024

Purpose of review
Malaria threatens pregnant women and their babies, particularly in Africa.

Recent findings
This century, the number of women at risk of malaria in pregnancy has decreased globally, apart from in Africa, where it has increased. Low and sub microscopic infections are increasingly documented but remain hard to diagnose with current point-of-care tests, and their contribution to morbidity and transmission are unclear. Artemether-lumefantrine has been endorsed for treatment in first trimester, but many women attend antenatal clinics later in pregnancy, and reaching high-risk young, first-time mothers is particularly difficult. Small-for-gestational-age babies frequently result from malaria, which affects the placenta's development and its functions such as nutrient transport. Resistance to continues to increase to sulphadoxine-pyrimethamine, the mainstay of intermittent preventive treatment in pregnancy. The alternative, dihydroartemisinin-piperaquine controls malaria better, but does not improve pregnancy outcomes, suggesting that sulphadoxine-pyrimethamine may have nonmalarial effects including improving gut function or reducing dangerous inflammation. Understanding of how the malaria parasite uses the VAR2CSA protein to bind to its placental receptor is increasing, informing the search for a vaccine to prevent pregnancy malaria.

Summary
Progress in several areas increases optimism that improved prevention and control of malaria in pregnancy is possible, but obstacles remain.
Trends in Top Surgery Patient Characteristics, Wound Complications, and CPT Code Use by Plastic Surgeons
Authors: Park John B. , Adebagbo Oluwaseun D. , Escobar-Domingo Maria J. , Rahmani Benjamin , Tobin Micaela , Yamin Mohammed , Lee Daniela , Fanning James E. , Prospero Matthew , Cauley Ryan P. 
Published: July 2024

Background
Gender-affirming top surgery is becoming increasingly common, with greater diversity in the patients receiving top surgery. The purpose of this study was to examine national trends in patient demographics, characteristics, wound complication rates, and concurrent procedures in patients receiving gender-affirming top surgeries.

Methods
Patients with gender dysphoria who underwent breast procedures, including mastectomy, mastopexy, breast augmentation, or breast reduction by a plastic surgeon between 2013 and 2022, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. These procedures were considered to be gender-affirming “top surgery.” Univariate analyses were performed to examine trend changes in the patient population and types of additional procedures performed over the last decade.

Results
There was a 38-fold increase in the number of patients who received top surgery during the most recent years compared to the first 2 years of the decade. Significantly more individuals receiving top surgery in recent years were nonbinary (P < 0.01). There was a significant decrease in percentage of active smokers (P < 0.01) while there was an increase in percentage of patients with diabetes (P = 0.03). While there was a significant increase in the number of obese patients receiving top surgery (P < 0.01), there were no differences in postoperative wound complications between the years. Significantly more patients received additional procedures (P < 0.01) and had about a 9-fold increase in distinct number of additional CPT codes from 2013–2014 to 2021–2022.

Conclusions
Our study found that there has been (1) a significant increase in the number of top surgery patients from 2013 to 2022 overall and (2) a particular increase in patients with preoperative comorbidities, such as a higher body mass index and diabetes. Understanding current and evolving trends in patients undergoing surgical treatment for gender dysphoria can inform individualized care plans that best serve the needs of patients and optimize overall outcomes.
MICK (Mobile Integrated Cognitive Kit) App for Concussion Assessment in a Youth Ice Hockey League
Authors: Hyman Sara , Blacker Mason , Bell Carter A. , Balcer Marc J. , Joseph Binu , Galetta Steven L. , Balcer Laura J. , Grossman Scott N. 
Published: July 2024

Background:
Visual symptoms are common after concussion. Rapid automatized naming (RAN) tasks are simple performance measures that demonstrate worse time scores in the setting of acute or more remote injury.

Methods:
We evaluated the capacity for the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number (SUN) testing to be feasibly administered during preseason testing in a cohort of youth ice hockey athletes using a novel computerized app, the Mobile Integrated Cognitive Kit (MICK). Participants from a youth hockey league underwent preseason testing.

Results:
Among 60 participants, the median age was 13 years (range 6–17). The median best time for the MULES was 49.8 seconds (range = 34.2–141.0) and the median best time for the SUN was 70.1 (range = 36.6–200.0). As is characteristic of timed performance measures, there were learning effects between the first and second trials for both the MULES (median improvement = 10.6 seconds, range = −32.3 to 92.0, P < 0.001, Wilcoxon signed-rank test) and SUN (median improvement = 2.4 seconds, range= −8.0 to 15.1, P = 0.001, Wilcoxon signed-rank test). Age was a predictor of best baseline times, with longer (worse) times for younger participants for MULES (P < 0.001, r

s
= −0.67) and SUN (P < 0.001, r

s
= −0.54 Spearman rank correlation). Degrees of learning effect did not vary with age (P > 0.05, r

s
= −0.2).

Conclusions:
Vision-based RAN tasks, such as the MULES and SUN, can be feasibly administered using the MICK app during preseason baseline testing in youth sports teams. The results suggest that more frequent baseline tests are necessary for preadolescent athletes because of the relation of RAN task performance to age.