bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histologic Examination of Mastectomy Scars during Breast Reconstruction: A Systematic Review
Authors: Berger Ori , Talisman Ran 
Published: May 2024

Background:
Breast reconstruction is a standard procedure in postmastectomy plastic surgery. The necessity of routine histological examinations for mastectomy scars during delayed reconstruction remains a topic of debate. We evaluated the need for histological examination of scars during delayed breast reconstruction.

Methods:
We conducted a systematic review using PubMed, TDnet, and Cochrane Central in August 2023. Inclusion criteria involved delayed breast reconstruction with histological scar analysis and malignancy reporting. Exclusion criteria encompassed noncancerous breast diseases, prophylactic mastectomies, articles lacking relevant information, case reports, technique descriptions, and reviews. We independently assessed articles. Differences in recurrence rates were determined using a Z-test for proportions. A linear regression model explored the relationship between reconstruction timing and pathological results. The number needed to treat was calculated based on the literature. The Wilcoxon test was used to compare mean reconstruction times and postreconstruction follow-up between groups.

Results:
Our analysis covered 11 retrospective observational studies published between 2003 and 2018, including 3754 mastectomy scars. The malignancy recurrence rate was 0.19%, consistent with previous reports, with a number needed to treat of 144.93–188.68 patients. The timing of breast reconstruction postmastectomy averaged 19.9 months, without statistically significant association between reconstruction timing and recurrence rates. Postreconstruction follow-up periods ranged from 60 to 87 months. The postreconstruction adverse outcomes ratio was 2.21%.

Conclusions:
Assessing the necessity of histological examination in breast reconstruction is complex. Based on the literature and this study, we do not recommend routine histological examination of mastectomy scars during delayed reconstruction. A selective approach based on risk factors may be beneficial, warranting further research.
The effectiveness of combined extrahepatic bile duct resection in radically resected cases with intrahepatic cholangiocarcinoma: a SEER-based retrospective cohort study and an external validation
Authors: Lv Tian-Run , Wang Jun-Ke , Li Fu-Yu , Hu Hai-Jie 
Published: May 2024

Objective:
To evaluate the effectiveness of the combined extrahepatic bile duct resection (EHBDR) in cases with intrahepatic cholangiocarcinoma (IHCC) in terms of clinicopathological features and long-term survival.

Methods:
Radically resected cases with IHCC from 2000 to 2020 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Comparative analyses were performed between resected IHCC patients who received EHBDR and those without EHBDR. Moreover, an external validation was further performed based on a single-center cohort.

Results:
A total of 1521 radically resected cases with IHCC (EHBDR: 189) were identified from the SEER database. Comparable age, sex, race, marital status, liver cirrhosis, differentiation status, and adjuvant chemotherapy were acquired between the two groups. EHBDR was associated with a higher incidence of adequate lymphadenectomy (P<0.001). The incidence of cases with T3–4 or N+ disease was significantly higher in EHBDR group (P<0.001). Adjuvant radiotherapy was more frequently performed in cases with EHBDR (P<0.001). EHBDR failed to bring any survival benefit and was associated with a worse prognosis even after matching. Similar findings have also been revealed in the external validation cohort (n=522, EHBDR: 117). EHBDR was associated with more extended resections, more aggressive tumor biological features, and worse prognosis. In the matched validation cohort, EHBDR was still associated with a higher incidence of early recurrence.

Conclusion:
EHBDR was an indicator of the advanced stage and failed to bring any survival benefit. It is the tumor stage that really determines the prognosis. More in-depth analyses focusing on different situations of EHBDR with more detailed clinical data are required.
Two cases of inflammatory myofibroblastic tumor treated with targeted drugs: A case report
Authors: Liu Mengyao , Zhu Dongyuan 
Published: May 2024

Introduction:
Inflammatory myofibroblastic tumor (IMT) is a rare invasive soft tissue tumor. Many IMTs are positive for anaplastic lymphoma kinase (ALK) with ALK gene fusion; other gene mutations have also been reported, which indicates a key role for genetic testing and the development of target therapy to optimize treatment strategies.

Patient concerns:
We report 2 patients who obtained clinical benefits following targeted treatment with ensartinib.

Diagnosis:
The first patient was diagnosed as IMT, with TFG-ROS1 fusion gene mutation. The second patient was IMT harboring the ALK-STRN fusion gene mutation.

Interventions:
We performed gene testing for these 2 patients. According to the test result, both patients received ensartinib 225 mg QD as targeted therapy for a 30-day cycle.

Outcomes:
The first patient achieved partial remission and maintained a stable state for 14.7 months. The second patient was treated for 10 months and reached complete remission after 5 months and is currently still benefiting from treatment. Treatment-related side effects were mild in both patients.

Conclusion:
Our cases provided some new insights and approaches for the clinical diagnosis and treatment of IMT.
The role of computed tomography in acute bowel obstruction due to a supravesical hernia: a case report from Nepal
Authors: Panthi Anup , Thapaliya Ishwor , Khadka Laxman , Bhusal Madhav , Dev Santosh , Jha Sanjeeb Kumar , Neupane Anand , Sah Jayant Kumar 
Published: May 2024

Introduction and importance:
Supravesical hernias are rare internal hernias but potential cause of small-bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male sex, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis

Case presentation:
The authors are reporting a case of small-bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small-bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small-bowel obstruction.

Clinical discussion:
The case focuses supravesical hernia as a rare yet life-threatening etiology of small-bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of CT scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of CT scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons.

Conclusion:
Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.
Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway
Authors: Radman Monique , McGuire John , Sharek Paul , Baden Harris , Koth Andy , DiGeronimo Robert , Migita Darren , Barry Dwight , Johnson James B , Rutman Lori , Vora Surabhi 
Published: May 2024

OBJECTIVES:
Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization.

DESIGN:
A quality improvement study using a prospective cohort design with historical controls.

SETTING:
Four hundred seven-bed free standing quaternary care academic children’s hospital.

PATIENTS:
All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022.

INTERVENTIONS:
Unit-specific standard approaches to iNO initiation and weaning.

MEASUREMENTS AND MAIN RESULTS:
Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (–24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings.

CONCLUSIONS:
Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.
Immunogenicity of a bivalent BA.1 COVID-19 booster vaccine in people with HIV in the Netherlands
Authors: Jongkees Marlou J. , Tan Ngoc H. , Geers Daryl , de Vries Rory D. , GeurtsvanKessel Corine H. , Hensley Kathryn S. , Sablerolles Roos S.G. , Bogers Susanne , Gommers Lennert , Blakaj Blerdi , Miranda Afonso Pedro , Hansen Bettina E. , Rijnders Bart J.A. , Brinkman Kees , van der Kuy P. Hugo M. , Roukens Anna H.E. , Rokx Casper 
Published: May 2024

Objective:We evaluated the immunogenicity of a bivalent BA.1 COVID-19 booster vaccine in people with HIV (PWH).Design:Prospective observational cohort study.Methods:PWH aged ≥45 years received Wuhan-BA.1 mRNA-1273.214 and those <45 years Wuhan-BA.1 BNT162b2. Participants were propensity score-matched 1 : 2 to people without HIV (non-PWH) by age, primary vaccine platform (mRNA-based or vector-based), number of prior COVID-19 boosters and SARS-CoV-2 infections, and spike (S1)-specific antibodies on the day of booster administration. The primary endpoint was the geometric mean ratio (GMR) of ancestral S1-specific antibodies from day 0 to 28 in PWH compared to non-PWH. Secondary endpoints included humoral responses, T-cell responses and cytokine responses up to 180 days post-vaccination.Results:Forty PWH received mRNA-1273.214 (N = 35) or BNT162b2 (N = 5) following mRNA-based (N = 29) or vector-based (N = 11) primary vaccination. PWH were predominantly male (87% vs. 26% of non-PWH) and median 57 years [interquartile range (IQR) 53–59]. Their median CD4+T-cell count was 775 (IQR 511–965) and the plasma HIV-RNA load was <50 copies/ml in 39/40. The GMR of S1-specific antibodies by 28 days post-vaccination was comparable between PWH [4.48, 95% confidence interval (CI) 3.24–6.19] and non-PWH (4.07, 95% CI 3.42–4.83). S1-specific antibody responses were comparable between PWH and non-PWH up to 180 days, and T-cell responses up to 90 days post-vaccination. Interferon-γ, interleukin (IL)-2, and IL-4 cytokine concentrations increased 28 days post-vaccination in PWH.Conclusion:A bivalent BA.1 booster vaccine was immunogenic in well treated PWH, eliciting comparable humoral responses to non-PWH. However, T-cell responses waned faster after 90 days in PWH compared to non-PWH.
Improving HIV preexposure prophylaxis uptake with artificial intelligence and automation: a systematic review
Authors: Kamitani Emiko , Mizuno Yuko , Khalil George M. , Viguerie Alex , DeLuca Julia B. , Mishra Ninad 
Published: May 2024

Objectives:
To identify studies promoting the use of artificial intelligence (AI) or automation with HIV preexposure prophylaxis (PrEP) care and explore ways for AI to be used in PrEP interventions.

Design:
Systematic review.

Methods:
We searched in the US Centers for Disease Control and Prevention Research Synthesis database through November 2023; PROSPERO (CRD42023458870). We included studies published in English that reported using AI or automation in PrEP interventions. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using either the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials or an adapted Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies.

Results:
Our search identified 12 intervention studies (i.e., interventions that used AI/automation to improve PrEP care). Currently available intervention studies showed AI/automation interventions were acceptable and feasible in PrEP care while improving PrEP-related outcomes (i.e., knowledge, uptake, adherence, discussion with care providers). These interventions have used AI/automation to reduce workload (e.g., directly observed therapy) and helped non-HIV specialists prescribe PrEP with AI-generated clinical decision-support. Automated tools can also be developed with limited budget and staff experience.

Conclusions:
AI and automation have high potential to improve PrEP care. Despite limitations of included studies (e.g., the small sample sizes and lack of rigorous study design), our review suggests that by using aspects of AI and automation appropriately and wisely, these technologies may accelerate PrEP use and reduce HIV infection.
Associations between epicardial, visceral, and subcutaneous adipose tissue with diastolic function in men with and without HIV
Authors: Goldberg Rachel L. , Peterson Tess E. , Haberlen Sabina A. , Witt Mallory D. , Palella Frank J. , Magnani Jared W. , Brown Todd T. , Lake Jordan E. , Lima Joao A.C. , Budoff Matt J. , Ndumele Chiadi E. , Wu Katherine C. , Post Wendy S. 
Published: May 2024

Background:
People with HIV (PWH) are at greater risk for diastolic dysfunction compared with persons without HIV (PWOH). An increase in visceral adipose tissue is common among PWH and greater visceral adipose tissue is associated with diastolic dysfunction among PWOH. We investigated associations of visceral adipose tissue, subcutaneous adipose tissue, and other fat depots with subclinical diastolic dysfunction among men with and without HIV (MWH and MWOH).

Design:
Cross-sectional analysis of MWH and MWOH in the Multicenter AIDS Cohort Study (MACS).

Methods:
Participants underwent echocardiography for diastolic dysfunction assessment and CT scanning including subcutaneous, visceral, epicardial, and liver adiposity measurements. Diastolic dysfunction was defined by characterizing heart function on antiretroviral therapy0 criteria. Odds for diastolic dysfunction with each measure of adiposity were estimated using multivariable logistic regression.

Results:
Among 403 participants (median age 57, 55% white, median BMI 26 kg/m2), 25% met criteria for diastolic dysfunction and 59% MWH (82% undetectable plasma HIV RNA). Greater epicardial adipose tissue area was associated with higher odds of diastolic dysfunction [odds ratio:1.54 per SD; 95%confidence interval (CI) 1.15–2.05] when adjusted for demographics, HIV serostatus, and cardiovascular risk factors. This association did not differ by HIV serostatus and persisted when excluding MWH who were not virally suppressed. Less subcutaneous adipose tissue was associated with higher odds of diastolic dysfunction. Other adipose depots were not associated with diastolic dysfunction.

Conclusion:
Greater epicardial adipose tissue and less subcutaneous adipose tissue were associated with diastolic dysfunction, regardless of HIV serostatus and viral suppression. Greater epicardial adipose tissue and less subcutaneous adipose tissue observed among PWH may contribute to risk for heart failure with preserved ejection fraction in this population.
A Comprehensive Flap Classification
Authors: Soh Jun Yi , Pannuto Lucia , Kannan Ruben Yap 
Published: May 2024

Abstract
Perforator flaps have progressed massively in the last years. The improved vascular imaging techniques and the use of supermicrosurgery have shifted the practice from the traditional predefined angiosomal flaps to the endless variations of custom-made flaps. In this article, we propose a broadened classification of free-style flaps in 3 categories, the angiosomal, including all traditional perforator flaps and their variations, the extra-angiosomal, including flaps that are manufactured to include tissue from a different angiosome, such as turbocharging or supercharging a flap, and neoangiosomal flaps, which are based on the process of neoangiogenesis on autologous or allogenous tissue, such as the venous flow-through flap and integra flap. With this classification, we hope to help unify the classifications and, by doing so, facilitate the exchange of ideas, techniques and knowledge.
MeSH terms: surgical flap / classification, terminology as topic
Craniofacial Assault Against Women: A National Evaluation Defining At-risk Populations and Outcomes
Authors: Johnstone Thomas , Singh Dylan , Liu Farrah , Silverstein Max , Shah Jennifer , Darrach Halley , Staudenmayer Kristan , Sheckter Clifford , Nazerali Rahim 
Published: May 2024

Introduction:
Few studies have analyzed epidemiologic factor associated with female patients presenting to the emergency department from facial fractures because of assault. Clearly understanding these factors may assist in developing effective strategies to decrease the incidence and sequelae of these injuries.

Objectives:
To determine the epidemiology of facial fractures because of assault in the female population.

Methods:
All female facial fracture visits were queried in the 2019 Nationwide Emergency Department (ED) Sample database. The likelihood of a facial fracture encounter resulting from assault was modeled using logistic regression adjusting for demographics, insurance status, geographic region, location of patient residence, and income. Secondary outcomes analyzed hospitalization costs and adverse events.

Results:
Of all facial fractures 12.4% of female encounters were due to assault were due to assault. Of assaulted females, 72.8% were between the ages of 20 and 40, and Black women experienced a disproportionate share of assault encounters (odds ratio [OR]=2.55; CI, 2.29–2.84). A large portion (46.4%) of encounters occurred in patients living in the lowest quartile of median household income, and 22.8% of patients were uninsured (OR=1.34; CI, 1.09–1.66). Assaulted patients were more likely to have fractures in nasal bone (58.1% vs. 42.5%), orbit (16.8% vs. 10.9%), zygoma (4.1% vs 3.6%), and mandible (8.7% vs. 4.8%) compared with their nonassaulted counterparts.

Conclusions:
Facial fractures were especially common in lower income, uninsured, urban, and Black populations. Examining the patterns of injury and presentation are critical to improve prevention strategies and screening tools, identifying critical patients, and develop a more efficient and effective system to treat and support female patients suffering facial fractures secondary to assault.
A Case of Severe Lethal Allergic Reaction Caused by Iodixanol After Digital Subtraction Angiography
Authors: Xie Yu , Xiong Xuan , Li Bujun , Hu Kai , Yin CaiXia 
Published: May 2024

Background:
Severe lethal allergic reactions triggered by iodixanol following digital subtraction angiography (DSA) are rare. The majority of skin reactions associated with iodixanol were mild, and the prognosis was favorable. Moreover, a case of serious skin adverse events caused by iodixanol has been documented.

Methods:
A 61-year-old woman underwent surgery for a cerebral hemorrhage in another hospital. Upon the surgery, the patient’s state of impaired consciousness did not show any improvement. Head computed tomography angiography on admission: right middle cerebral artery M1 segment enlargement, left posterior cerebral artery P2 stenosis. Following undergoing DSA with iodixanol, the patient experienced severe and fatal drug eruptions, which represents a serious and uncommon complication associated with iodixanol.

Results:
This paper describes the experience in the treatment and nursing of severe allergic reactions. Despite the fact that the patient was discharged automatically and eventually died, there are valuable lessons to be learned from this case that can inform and guide future clinical practices.

Conclusions:
Iodixanol adverse reactions were rare, and severe fatal adverse reactions were seldom reported. Consequently, the authors conclude that the potential adverse reaction risk of iodixanol contrast agent should be taken into consideration in future endeavors, and the skin and allergy of patients should be monitored following DSA. In an allergy, prompt and proactive treatment is essential to prevent worsening and dissemination.
Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons
Authors: Olds Anna , Hirji Sameer , Castillo-Angeles Manuel , Kane Lauren , Romano Jennifer , Herrington Cynthia , Rangel Erika 
Published: May 2024

Objective:
To describe the incidence of and risk factors for pregnancy complications in female cardiothoracic surgeons compared with women of similar sociodemographic profiles.

Background:
Female cardiothoracic surgeons often postpone childbearing, but little is known about their pregnancy outcomes.

Methods:
In 2023, a self-administered survey was distributed to US cardiothoracic surgeons/trainees. Surgeons with ≥1 live birth were queried on maternal work hours during pregnancy and major antenatal pregnancy complications. Male surgeons answered on behalf of non-surgeon childbearing partners (female non-surgeons).

Results:
The study included 255 surgeons (63.53% male; 36.47% female). Compared with female surgeons, male surgeons more often had partners who were not employed outside the home (25.64% vs 13.33%, P<0.001). Female surgeons were older than female non-surgeons at first live birth (34.49±4.41 vs 31.45±4.16, P<0.001), more often worked >60 h/wk during pregnancy (70.33% vs 14.08%, P<0.001), and more often had pregnancy complications (45.16% vs 27.16%, P=0.003; operating room (OR): 1.78, 95% CI: 1.01–3.13). Among female surgeons, 18.28% reduced work hours during pregnancy. During their third trimester, 54.84% worked >6 overnight calls/mo, and 72.04% operated >12 h/wk. Age ≥35 years (OR: 3.28, 95% CI: 1.27–8.45) and operating >12 h/wk during the third trimester (OR: 3.72, 95% CI: 1.04–13.30) were associated with pregnancy complications.

Conclusions:
Female cardiothoracic surgeons are more likely to experience major pregnancy complications than non-surgeon partners of their male peers. Long operative hours during pregnancy and older maternal age are significant risk factors for pregnancy complications. To advance gender equity, policies to protect maternal-fetal health and facilitate childbearing during training and early career are needed.