bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Single-center Comparison of Surgical Outcomes following Prepectoral and Subpectoral Implant-based Breast Reconstruction
Authors: Villanueva Karie , Patel Harsh , Ghosh Durga , Klomhaus Alexandra , Slack Ginger , Festekjian Jaco , Da Lio Andrew , Tseng Charles 
Published: June 2024

Background:
Prepectoral implant placement continues to gain widespread acceptance as a safe and effective option for breast reconstruction. Current literature demonstrates comparable rates of complications and revisions between prepectoral and subpectoral placement; however, these studies are underpowered and lack long-term follow-up.

Methods:
We performed a retrospective cohort study of patients who underwent immediate two-staged tissue expander or direct-to-implant breast reconstruction at a single center from January 2017 to March 2021. Cases were divided into prepectoral and subpectoral cohorts. The primary outcomes were postoperative complications, aesthetic deformities, and secondary revisions. Descriptive statistics and multivariable regression models were performed to compare the demographic characteristics and outcomes between the two cohorts.

Results:
We identified 996 breasts (570 patients), which were divided into prepectoral (391 breasts) and subpectoral (605 breasts) cohorts. There was a higher rate of complications (P < 0.001) and aesthetic deformities (P = 0.02) with prepectoral breast reconstruction. Secondary revisions were comparable between the two cohorts. Multivariable regression analysis confirmed that prepectoral reconstruction was associated with an increased risk of complications (odds ratio 2.39, P < 0.001) and aesthetic deformities (odds ratio 1.62, P = 0.003).

Conclusions:
This study evaluated outcomes in patients undergoing prepectoral or subpectoral breast reconstruction from a single center with long-term follow-up. Prepectoral placement was shown to have an inferior complication and aesthetic profile compared with subpectoral placement, with no difference in secondary revisions. These findings require validation with a well-designed randomized controlled trial to establish best practice for implant-based breast reconstruction.
Global biomarker trends in triple-negative breast cancer research: a bibliometric analysis
Authors: Wang Xingxin , Li Xuhao , Dong Tiantian , Yu Wenyan , Jia Zhixia , Hou Yi , Yang Jiguo , Liu Yuanxiang 
Published: June 2024

Background:
Triple-negative breast cancer (TNBC) is defined as breast cancer that is negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) in cancer tissue. The lack of specific biomarkers makes the diagnosis and prognosis of TNBC challenging.

Method:
A comprehensive literature review and bibliometric analysis was performed using CiteSpace, VOSviewer and Scimago Graphica.

Results:
TNBC biomarker research has been growing rapidly in recent years, reflecting the enormous academic interest in TNBC biomarker research. A total of 127 journals published relevant studies and 1749 authors were involved in the field, with developed countries such as the United States, France, and the United Kingdom contributing greatly to the field. Collaborative network analysis found that the research in this field has not yet formed good communication and interaction, and the partnership should be strengthened in the future in order to promote the in-depth development of TNBC biomarker research. A comprehensive analysis of keywords and co-cited literature, etc. found that TNBC biomarker research mainly focuses on immune checkpoint markers, microenvironment-related markers, circulating tumor DNA, metabolic markers, genomics markers and so on. These research hotspots will help to better understand the molecular characteristics and biological processes of TNBC, and provide more accurate biomarkers for its diagnosis, treatment and prognosis.

Conclusions:
The bibliometric analysis highlighted global trends and key directions in TNBC biomarker research. Future developments in TNBC biomarker research are likely to be in the direction of multi-omics integration, meticulous study of the microenvironment, targeted therapeutic biomarkers, application of liquid biopsy, application of machine learning and artificial intelligence, and individualized therapeutic strategies. Young scholars should learn and collaborate across disciplines, pay attention to new technologies and methods, improve their data analysis skills, and continue to follow up on the latest research trends in order to meet the challenges and opportunities in the field of TNBC biomarkers.
The Differences of Serum Thrombopoietin Levels Between Acquired Aplastic Anemia and Immune Thrombocytopenia in Pediatric Patients
Authors: Chen Hui , Ma Jie , Ouyang Juntao , Fu Lingling , Ma Jingyao , Yao Jiafeng , Wu Runhui , Chen Zhenping 
Published: June 2024

Thrombopoietin (TPO) is the critical regulator of platelet production. However, the role of TPO in pediatric patients with thrombocytopenic disorders has not been fully elucidated. In the present study, we attempted to investigate serum TPO levels in patients with acquired aplastic anemia (aAA) and immune thrombocytopenia (ITP). We analyzed the endogenous plasma concentration of TPO and platelet count at the time of TPO measurement in 166 patients with aAA and 280 patients with ITP retrospectively. We further observed a correlation between platelet counts and TPO. Serum TPO levels were significantly higher in aAA compared with ITP (1142 vs. 77.99 pg/mL, P<0.001). In patients with aAA, an elevation for TPO levels in very severe AA (VSAA) was seen when compared with non-severe AA (NSAA) (1360 vs. 984.4 pg/mL, P<0.05). In contrast, the circulating TPO levels with chronic ITP (CITP) showed a decrease than newly diagnosed ITP (NITP) and persistent ITP (PITP) (62.28 vs. 81.56 pg/mL, P<0.01, 62.28 vs. 87.82 pg/mL, P<0.05, respectively). There was a negative correlation between platelet counts and TPO levels in aAA (rs=−0.3325, P<0.001) as well as ITP (rs=−0.2570, P<0.001). Especially, TPO levels were inversely correlated with platelet counts in NSAA (rs=−0.3672, P<0.001) and NITP (rs=−0.3316, P<0.001). After grouping by age or sex, there were no statistical differences in aAA or ITP. Serum TPO levels were markedly elevated in pediatric patients with aAA compared with ITP. It was higher in VSAA and lower in CITP, suggesting that serum TPO level could play a role in classifying disease severity or clinical course in aAA and ITP.
Does a delay to surgery for preoperative echocardiogram affect outcomes in patients with hip fracture?
Authors: Saad Bishoy N. , Menken Luke G. , Keller David M. , Rampertaap Yajesh , Tang Alex , Hong Ian S. , Liporace Frank A. , Yoon Richard S. , Jankowski Jaclyn M. 
Published: June 2024

Abstract

Introduction:
Delay to surgery >24 hours has been shown to correlate with mortality rates in patients with hip fracture when left untreated. Many of these patients have multiple comorbidities, including aortic stenosis (AS), and undergo workup for operative clearance, which may delay time to surgery. The purpose of this study was to examine whether preoperative echocardiogram workup affects time to surgery, complications, and mortality after operative fixation for hip fracture.

Methods:
Our institutional hip fracture registry was retrospectively reviewed for inclusion over a 3-year period. Patients who had a preoperative echocardiogram (yECHO) for operative clearance were compared with those who did not (nECHO). Demographic data, time to surgery, overall complication rate, and mortality at 30 days, 90 days, and 1 year were collected.

Results:
Two cohorts consisted of 136 yECHO patients (45.8%) and 161 nECHO patients (54.2%). Thirty-two yECHO patients (23.5%) had AS. Patients in the yECHO cohort were more likely to have a complication for any cause compared with nECHO patients (25.7% vs. 10.6%, P = 0.01) and have a higher mortality rate at 1 year (38.9% vs. 17.4%, P = 0.001). There was no association found between AS and all-cause complication (P = 0.54) or 30-day (P = 0.13) or 90-day mortality rates (P = 0.79). However, patients with AS had a significantly higher mortality rate at 1 year (45.8% vs. 25.1%, P = 0.03).

Conclusion:
This study reinforces the benefits of ensuring less than a 24-hour time to surgery in the setting of a hip fracture and identifies an area of preoperative management that can be further optimized to prevent unnecessary prolongation in time to surgery. Patients with known aortic stenosis are not associated with increased 30-day or 90-day mortality or all-cause complications. Surgical delays in the yECHO cohort were attributed to preoperative medical assessments, including echocardiograms and the management of comorbidities. Therefore, the selective utilization of preoperative echocardiograms is needed and should be reserved to ensure they have a definitive role in guiding the perioperative care of patients with hip fracture.

Level of Evidence:
III.
A paradigm for characterizing motion misperception in people with typical vision and low vision
Authors: Chin Benjamin M. , Wang Minqi , Mikkelsen Loganne T. , Friedman Clara T. , Ng Cherlyn J. , Chu Marlena A. , Cooper Emily A. 
Published: June 2024

SIGNIFICANCE
Motion perception is an essential part of visual function. Understanding how people with low vision perceive motion can therefore inform rehabilitation strategies and assistive technology. Our study introduces the notion of Bayesian biases in motion perception and suggests that some people with low vision are susceptible to these systematic misperceptions.

PURPOSE
We aimed to develop a paradigm that can efficiently characterize motion percepts in people with low vision and compare their responses with well-known misperceptions made by people with typical vision when targets are hard to see.

METHODS
We recruited a small cohort of individuals with reduced acuity and contrast sensitivity (n = 5) as well as a comparison cohort with typical vision (n = 5) to complete a psychophysical study. Study participants were asked to judge the motion direction of a tilted rhombus that was either high or low contrast. In a series of trials, the rhombus oscillated vertically, horizontally, or diagonally. Participants indicated the perceived motion direction using a number wheel with 12 possible directions, and statistical tests were used to examine response biases.

RESULTS
All participants with typical vision showed systematic misperceptions well predicted by a Bayesian inference model. Specifically, their perception of vertical or horizontal motion was biased toward directions orthogonal to the long axis of the rhombus. They had larger biases for hard-to-see (low contrast) stimuli. Two participants with low vision had a similar bias, but with no difference between high- and low-contrast stimuli. The other participants with low vision were unbiased in their percepts or biased in the opposite direction.

CONCLUSIONS
Our results suggest that some people with low vision may misperceive motion in a systematic way similar to people with typical vision. However, we observed large individual differences. Future work will aim to uncover reasons for such differences and identify aspects of vision that predict susceptibility.
Factors Associated With Symptoms of Anxiety and Depression in People Living With HIV in Northeast Brazil
Authors: da Cunha Gilmara Holanda , Fontenele Marina Soares Monteiro , Galvão Marli Teresinha Gimeniz , Dantas Maiara Bezerra , Gomes Maria Elisa Curado , Fechine Francisco Vagnaldo , de Sousa Paiva Simone 
Published: June 2024

Background:
The diagnosis of HIV infection can cause mental disorders or exacerbate existing symptoms because of the stigma, psychological stress, and need for the self-management of the illness. The aim of this study was to determine the prevalence of anxiety and depression symptoms in people with HIV and to identify the associated factors.

Methods:
This is a cross-sectional study. A sample of 385 people living with HIV (PLWH) was interviewed using the Sociodemographic, Epidemiological, and Clinical Form; the Beck Anxiety Inventory; the Beck Depression Inventory; and Pittsburgh Sleep Quality Index. Univariate and multivariate logistic regression analysis were performed. The odds ratio and 95% confidence interval were calculated.

Results:
The prevalence of anxiety was 27.1% and depression was 39.8%. Being female (P = 0.0227), antiretroviral therapy (ART) for 8 years or less (P = 0.0042), and having depression (P < 0.0001) were associated with the occurrence of anxiety. Having a detectable viral load (P = 0.0476), not exercising regularly (P = 0.0070), and having sleep disorders (P = 0.0001) and anxiety (P < 0.0001) were associated with depression. Retired and on leave or sick pay were, respectively, 2.67 and 3.90 times more likely to have depression than those who were employed.

Conclusions:
A considerable percentage of PLWH have anxiety and depression symptoms. Being female, less than 8 years of ART, and depression are associated with anxiety, while detectable viral load, not practicing physical exercise, having sleep disorders, anxiety, and being retired or on leave or sick pay are associated with depression. The study showed important data for health interventions by members of the multidisciplinary team for PLWH.
One-Stage Deep Inferior Epigastric Perforator Flap Salvage of Infected Tissue Expanders
Authors: Sergesketter Amanda R. , Shammas Ronnie L. , Tian William M. , Glenney Anne , Sisk Geoffroy C. , Hollenbeck Scott T. 
Published: June 2024

Background
Tissue expander-based breast reconstruction is associated with high rates of infectious complications, often leading to tissue expander explants and delays in receipt of definitive breast reconstruction and adjuvant therapy. In this study, we describe a single-stage technique where deep inferior epigastric artery perforator (DIEP) flaps are used to salvage actively infected tissue expanders among patients originally planning for free flap reconstruction.

Methods
In this technique, patients with tissue expander infections without systemic illness are maintained on oral antibiotics until the day of their DIEP flap surgery, at which time tissue expander explant is performed in conjunction with aggressive attempt at total capsulectomy and immediate DIEP flap reconstruction. Patients are maintained on 1–2 weeks of oral antibiotics tailored to culture data. Patients undergoing this immediate salvage protocol were retrospectively reviewed, and complications and length of stay were assessed.

Results
In a retrospective series, a total of six consecutive patients with culture-proven tissue expander infections underwent tissue expander removal and DIEP flap reconstruction in a single stage and were maintained on 7–14 days of oral antibiotics postoperatively. Within this cohort, no surgical site infections, microvascular complications, partial flap losses, reoperations, or returns to the operating room were noted within a 90-day period.

Conclusions
Among a select cohort of patients, actively infected tissue expanders may be salvaged with free flap breast reconstruction in a single surgery with a low incidence of postoperative complications. Prospective studies are needed to evaluate the influence of this treatment strategy on costs, number of surgeries, and dissatisfaction after staged breast reconstruction complicated by tissue expander infections.
Improving the Care and Cost of Treating Community-Acquired Stage 3 and 4 Decubitus Ulcers
Authors: Le Paulina B. , Kelly-Brown Joseph , Yturralde Kylee J. , McGreevy Donna J. , Lindler Leslie , Hurley Deborah M. , Friedman Harold I. 
Published: June 2024

Introduction
The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction.

Methods
Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups.

Results
Forty-five encounters met criteria for inclusion. Group 1’s average hospital charges were $500,917, while group 2’s charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively).

Conclusions
The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.
The Impact of Obesity on Success of Immediate Lymphatic Reconstruction for Prevention of Breast Cancer–Related Lymphedema
Authors: Wainwright D'Arcy J. , Le Nicole K. , Weinstein Brielle , West William , Tavares Tina , Panetta Nicholas J. 
Published: June 2024

Background
Breast cancer–related lymphedema (BRCL) is a potential sequela of high-risk breast cancer treatment. Preventive treatment with immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) has emerged as the standard of care; however, there is relatively little known about factors that may contribute to procedural failure.

Methods
A retrospectively maintained, institutional review board–approved study followed patients who underwent ILR at the time of ALND at our tertiary care center between May 2018 and May 2023. Patients who presented for at least one follow-up visit in our multidisciplinary lymphedema clinic met the criteria for inclusion. Patients who developed lymphedema despite ILR and potential contributing factors were further explored.

Results
349 patients underwent ILR at our institution between May 2018 and May 2023. 341 of these patients have presented for follow-up in our multidisciplinary lymphedema clinic. 32 (9.4%) patients developed lymphedema despite ILR. This cohort was significantly more likely to be obese (56% vs 35%, P = 0.04). Multivariate logistic regression demonstrates increased odds of procedural failure in patients with a body mass index (BMI) ≥30 kg/m2 (odds ratio 2.6 [1.2–5.5], P = 0.01).

Conclusion
These data comment upon our institutions outcomes following ILR. Patients who develop lymphedema despite ILR tend to have a higher BMI, with a significantly increased risk in patients with a BMI of 30 or greater. Consideration of these data is critical for preprocedural counseling and may support a BMI cutoff when considering candidacy for ILR going forward, as well as when optimizing failures for secondary lymphedema procedures.
Perioperative Care for Children With Syndromic Craniofacial Synostosis Undergoing Le Fort III Surgery: A Retrospective Cohort Study
Authors: Restivo Andrea , Rondelli Egle , Giani Marco , Moretti Mattia , Fossati Chiara , Rona Roberto , Moretto Alessandra , Biondi Andrea , Mazzoleni Fabio , Foti Giuseppe 
Published: June 2024

Objective:
To present characteristics, surgical variables, complications, and postoperative care in pediatric patients with craniofacial synostosis undergoing Le Fort III osteotomy.

Background:
Craniofacial synostoses are a group of genetic syndromes that result in premature fusion of cranial and facial sutures, leading to craniofacial deformities and associated complications. Midface advancement through Le Fort III osteotomy is the most frequent surgical option for these conditions.

Methods:
Retrospective monocentric cohort study including patients with syndromic craniofacial synostosis who underwent Le Fort III osteotomy between 2009 and 2022 in a specialized referral center. Data collection encompassed surgical time, blood loss, intraoperative transfusions, fluid balance, and postoperative parameters such as duration of invasive mechanical ventilation and intensive care unit (ICU) length of stay.

Results:
Twenty-six children were included in the analysis. The median surgical time was 345 minutes (300–360), with an estimated blood loss of 15 (9.9–24) mL/kg. Patients required a median transfusion of 12.63 (7.1–24.5) mL/kg of packed red blood cells and 19.82 (11.1–33) mL/kg of fresh frozen plasma. Intraoperative fluid balance was + 12.5 (0.8–22.8) mL/kg, with a median infusion of 30.4 (23.9–38.7) mL/kg of crystalloids. All patients were transferred to the ICU after surgery to ensure a safe environment for extubation. The median duration of mechanical ventilation in the ICU was 30 (20.25–45) hours, and postoperative ICU length of stay was 2 (2–4) days, and complications were infrequent, with only one extubation failure recorded.

Conclusion:
Le Fort III osteotomy in craniofacial synostosis patients may be characterized by a complex perioperative course. A multidisciplinary approach in the care of these patients allows for minimizing complications in the perioperative phase. Further research is needed to enhance perioperative management in this unique patient population.