bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathologic Upstaging of Cutaneous Melanoma After Mohs Micrographic Surgery
Authors: Juhasz Margit , Young Jade N. , Azzawi Soraya , Leitenberger Justin , Bar Anna , Gharavi Nima M. 
Published: December 2023

BACKGROUND
Mohs micrographic surgery (MMS) is used for melanoma in situ (MIS) and thin invasive melanomas, particularly on the head and neck, during which a debulk section is typically prepared. Tumor upstaging occurs if the debulking specimen meets criteria for an increased tumor (T) stage per the American Joint Committee on Cancer 8th edition compared with the initial biopsy. Upstaging can alter survival and recurrence outcomes, resulting in increased patient morbidity and mortality.

OBJECTIVE
To determine the rate of cutaneous melanoma upstaging during MMS.

MATERIALS AND METHODS
A multicenter study was performed. Information from electronic medical records from 3 dermatologic surgeons performing MMS for cutaneous melanoma were logged from January 1, 2017 to December 31, 2021. Deidentified information regarding patient demographics and tumor characteristics was recorded.

RESULTS
Three-hundred and ten cases of cutaneous melanoma treated with MMS were identified. 2.3% of cases were upstaged, ranging from T1a to T3a. No significant risk factors for upstaging were identified.

CONCLUSION
Our data demonstrate a lower rate of cutaneous melanoma upstaging during MMS than the current literature. Differences may be accounted for because of differing patient populations, cutaneous melanoma detection at an earlier clinical stage, and evolving melanoma histologic criteria.
Clinical and Optical Coherence Tomography Correlation of Vascular Conditions Treated With a Novel, Variable-Sequenced, Long-Pulsed, 532 and 1,064 nm Laser With Cryogen Spray Cooling
Authors: Wang Jordan V. , Bajaj Shirin , Himeles Jaclyn R. , Geronemus Roy G. 
Published: December 2023

BACKGROUNDPatients frequently seek laser treatment for vascular conditions. More recently, a novel 532 and 1,064 nm laser was developed to offer greater flexibility.OBJECTIVEA prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea).MATERIALS AND METHODSSubjects with vascular conditions were enrolled for laser treatments. Clinical evaluations and optical coherence tomography (OCT) imaging were performed.RESULTSThirteen subjects were enrolled. The mean age was 51.3 years, and 92.3% were women. Fitzpatrick skin types I–IV were included. Treatment indications included broken blood vessels, rosacea, port-wine birthmark, and spider angioma. For physician investigator grading, all subjects were graded as improved at both 30-day and 90-day follow-up. Blinded photographic review by 3 independent, blinded physicians had a mean of 89.7% of cases selected correctly with at least 2 of 3 in agreement for 100.0% of cases. Optical coherence tomography imaging showed significant reductions in vessel density (p= .018) and diameter (p= .003) of the superficial vascular plexus. No serious adverse events occurred.CONCLUSIONA novel, variable-sequenced, long-pulsed, 532 and 1,064 nm laser with cryogen spray cooling can safely and effectively improve vascular conditions and lesions as determined by both clinical and OCT evaluation.
Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities
Authors: Sun Chao , Zhao Xingliang , Shi Lei , Fan Xiaofei , Qi Xiaolong 
Published: December 2023

ABSTRACT
There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.
Heparin Dosing During Percutaneous Coronary Intervention and Obesity
Authors: Kreutz Rolf P. , Leon Isaac G. , Bain Eric R. , George Bistees , Phookan Sujoy , Prakash Anjali , Sinha Anjan K. , Breall Jeffrey A. , Zenisek Joseph R. , Frick Kyle A. , Jaradat Ziad A. , Abu Romeh Ibrahim S. , O'Leary Brian , Kalra Ankur , Kumar Ashish , Lee Michael S. , von der Lohe Elisabeth 
Published: December 2023

Abstract:
Unfractionated heparin is the most common anticoagulant used during percutaneous coronary intervention. Practice guidelines recommend an initial weight-based heparin bolus dose between 70 and 100 U/kg to achieve target activated clotting time (ACT) of 250–300 seconds. The impact of severe obesity on weight-based heparin dosing is not well studied. We performed a retrospective analysis of 424 patients undergoing percutaneous coronary intervention who received heparin for anticoagulation. We collected detailed data on cumulative heparin administration and measured ACT values in this cohort. We performed separate analyses to identify clinical predictors that may affect dose–response curves. There was significant variability in dosing with mean dose of 103.9 ± 32-U/kg heparin administered to achieve target ACT ≥ 250 seconds. Women received higher initial heparin doses when adjusted for weight than men (97.6 ± 31 vs. 89 ± 28 U/kg, P = 0.004), and only 49% of patients achieved ACT ≥ 250 s with the initial recommended heparin bolus dose (70–100 U/kg). Lower heparin dose (U/kg) was required in obese patients to achieve target ACT. In multivariate linear regression analysis with ACT as dependent variable, after inclusion of weight-based dosing for heparin, body mass index was the only significant covariate. In conclusion, there is significant variability in the therapeutic effect of heparin, with a lower weight-adjusted heparin dose required in obese patients.
The menopause-related gut microbiome: associations with metabolomics, inflammatory protein markers, and cardiometabolic health in women with HIV
Authors: Wang Yi , Sharma Anjali , Weber Kathleen M. , Topper Elizabeth , Appleton Allison A. , Gustafson Deborah , Clish Clary B. , Kaplan Robert C. , Burk Robert D. , Qi Qibin , Peters Brandilyn A. 
Published: December 2023

Abstract

Objective
This study aimed to identify menopause-related gut microbial features, as well as their related metabolites and inflammatory protein markers, and link with cardiometabolic risk factors in women with and without HIV.

Methods
In the Women's Interagency HIV Study, we performed shotgun metagenomic sequencing on 696 stool samples from 446 participants (67% women with HIV), and quantified plasma metabolomics and serum proteomics in a subset (~86%). We examined the associations of menopause (postmenopausal vs premenopausal) with gut microbial features in a cross-sectional repeated-measures design and further evaluated those features in relation to metabolites, proteins, and cardiometabolic risk factors.

Results
Different overall gut microbial composition was observed by menopausal status in women with HIV only. We identified a range of gut microbial features that differed between postmenopausal and premenopausal women with HIV (but none in women without HIV), including abundance of 32 species and functional potentials involving 24 enzymatic reactions and lower β-glucuronidase bacterial gene ortholog. Specifically, highly abundant species Faecalibacterium prausnitzii, Bacteroides species CAG:98, and Bifidobacterium adolescentis were depleted in postmenopausal versus premenopausal women with HIV. Menopause-depleted species (mainly Clostridia) in women with HIV were positively associated with several glycerophospholipids, while negatively associated with imidazolepropionic acid and fibroblast growth factor 21. Mediation analysis suggested that menopause may decrease plasma phosphatidylcholine plasmalogen C36:1 and C36:2 levels via reducing abundance of species F. prausnitzii and Acetanaerobacterium elongatum in women with HIV. Furthermore, waist-to-hip ratio was associated with menopause-related microbes, metabolites, and fibroblast growth factor 21 in women with HIV.

Conclusions
Menopause was associated with a differential gut microbiome in women with HIV, related to metabolite and protein profiles that potentially contribute to elevated cardiometabolic risk.
Lymphatic Mapping in the Repair of Adult-acquired Buried Penis: Proof of Concept
Authors: Marantidis Joanna , Song David , Venkatesan Krishnan , Shaw Nathan M. 
Published: December 2023

Summary:
Adult-acquired buried penis (AABP) is an acquired clinical entity where a normal sized phallus is concealed by prepubic skin, fat, or subcutaneous tissue, often caused by obesity, lymphedema, or trauma. Surgical repair is the standard of care in management of AABP; however, up to 60% of patients have developed bothersome genital lymphedema postoperatively. Despite the rates of postoperative scrotal lymphedema, and lymphedema itself representing a risk for AABP, very little data exist on the role of lymphatic evaluation in this patient population. We present the previously unreported use of indocyanine green (ICG) for lymphatic mapping as an adjunct to buried penis repair. Using 0.1 mL 25 mg per mL of indocyanine green and SPY Portable Handled Imaging, lymph mapping is performed, identifying lymph channels that seem obstructed as possible targets for lymphovenous bypass. In addition, lymph mapping can be used as an adjunct to surgical resection so as to not disrupt the intact channels, reducing the risk of postoperative lymphedema. Through this article, we offer emerging clinical insight into the possible use of lymphovenous bypass, particularly in patients with AABP due to lymphedema or those who experience lymphedema as a complication of AABP repair.
Precision of a new SS-OCT biometer to measure anterior segment parameters and agreement with 3 instruments with different measurement principles
Authors: Venkataraman Abinaya Priya , Domínguez-Vicent Alberto , Selin Paulina , Brautaset Rune , Montés-Micó Robert 
Published: December 2023

Purpose:
To evaluate the repeatability of a new swept source optical coherence tomography (SS-OCT)–based biometer to measure anterior segment parameters and to assess the agreement with 3 other imaging devices based on different measurement principles.

Setting:
Unit of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Design:
Prospective, comparative case series.

Methods:
3 consecutive measurements were obtained in unoperated eyes with the Eyestar900 (SS-OCT), Lenstar 900, MS-39, and Sirius. The following anterior segment parameters were evaluated: central corneal thickness (CCT), corneal diameter (CD), aqueous depth (AQD), and corneal power metrics. The repeatability limit (Rlim), coefficient of variation (CoV), and a repeated measures Bland-Altman analysis were performed.

Results:
74 eyes of 74 participants were measured. The Rlims for CCT, CD, and AQD were lower than 10 μm, 0.3 mm, and 0.10 mm for all devices, respectively. The corresponding CoVs for these parameters never exceeded 1.2%. The Rlim for the corneal power metrics never exceeded 0.60 diopter (D) for any of the instruments. Lenstar showed the best agreement with the MS-39 to measure CCT, CD, and AQD (limit of agreement interval, LoA: 15.54 μm, 0.55 mm, and 0.16 mm, respectively). The mean difference for keratometry parameters was lower than 0.3 D for all device comparisons, and the LoA interval ranged between 0.52 D and 1.21 D.

Conclusions:
The repeatability for measuring anterior segment parameters was good, and the agreement among all the instruments was good for CD and AQD measurements. However, for CCT and keratometer parameters, the instruments cannot be used interchangeably due to large LoA interval.
Development of a radiomics-based model to predict occult liver metastases of pancreatic ductal adenocarcinoma: a multicenter study
Authors: Zhao Ben , Xia Cong , Xia Tianyi , Qiu Yue , Zhu Liwen , Cao Buyue , Gao Yin , Ge Rongjun , Cai Wu , Ding Zhimin , Yu Qian , Lu Chunqiang , Tang Tianyu , Wang Yuancheng , Song Yang , Long Xueying , Ye Jing , Lu Dong , Ju Shenghong 
Published: December 2023

Background:
Undetectable occult liver metastases block the long-term survival of pancreatic ductal adenocarcinoma (PDAC). This study aimed to develop a radiomics-based model to predict occult liver metastases and assess its prognostic capacity for survival.

Materials and Methods:
Patients who underwent surgical resection and were pathologically proven with PDAC were recruited retrospectively from five tertiary hospitals between January 2015 and December 2020. Radiomics features were extracted from tumors, and the radiomics-based model was developed in the training cohort using LASSO-logistic regression. The model’s performance was assessed in the internal and external validation cohorts using the area under the receiver operating curve (AUC). Subsequently, the association of the model’s risk stratification with progression-free survival (PFS) and overall survival (OS) was then statistically examined using Cox regression analysis and the log-rank test.

Results:
A total of 438 patients (mean [standard deviation] age, 62.0 [10.0] years; 255 [58.2%] male) were divided into the training cohort (n = 235), internal validation cohort (n = 100), and external validation cohort (n = 103). The radiomics-based model yielded an AUC of 0.73 (95% confidence interval [CI]: 0.66-0.80), 0.72 (95% CI: 0.62-0.80), and 0.71 (95% CI: 0.61-0.80) in the training, internal validation, and external validation cohorts, respectively, which were higher than the preoperative clinical model. The model’s risk stratification was an independent predictor of PFS (all P < 0.05) and OS (all P < 0.05). Furthermore, patients in the high-risk group stratified by the model consistently had a significantly shorter PFS and OS at each TNM stage (all P < 0.05).

Conclusion:
The proposed radiomics-based model provided a promising tool to predict occult liver metastases and had great significance in prognosis.
Low back pain-driven inpatient stays in the United States: a nationwide repeated cross-sectional analysis
Authors: Chen Lingxiao , Sun Qingyu , Chou Roger , Anderson David B. , Shi Baoyi , Chen Yujie , Liu Xinyu , Feng Shiqing , Zhou Hengxing , Ferreira Manuela L. 
Published: December 2023

Background:
Low back pain (LBP)-driven inpatient stays are resource-intensive and costly, yet data on contemporary national trends are limited.

Materials and methods:
This study used repeated cross-sectional analyses through a nationally representative sample (US National Inpatient Sample, 2016–2019). Outcomes included the rate of LBP-driven inpatient stays; the resource utilization (the proportion of receiving surgical treatments and hospital costs) and prognosis (hospital length of stay and the proportion of nonroutine discharge) among LBP-driven inpatient stays. LBP was classified as overall, nonspecific, and specific (i.e. cancer, cauda equina syndrome, vertebral infection, vertebral compression fracture, axial spondyloarthritis, radicular pain, and spinal canal stenosis). Analyses were further stratified by age, sex, and race/ethnicity.

Results:
292 987 LBP-driven inpatient stays (weighted number: 1 464 690) were included, with 269 080 (91.8%) of these for specific LBP and 23 907 (8.2%) for nonspecific LBP. The rate of LBP-driven inpatient stays varied a lot across demographic groups and LBP subtypes (e.g. for overall LBP, highest for non-Hispanic White 180.4 vs. lowest for non-Hispanic Asian/Pacific Islander 42.0 per 100 000 population). Between 2016 and 2019, the rate of nonspecific LBP-driven inpatient stays significantly decreased (relative change: 46.9%); however, substantial variations were found within subcategories of specific LBP-significant increases were found for vertebral infection (relative change: 17.2%), vertebral compression fracture (relative change: 13.4%), and spinal canal stenosis (relative change: 19.9%), while a significant decrease was found for radicular pain (relative change: 12.6%). The proportion of receiving surgical treatments also varied a lot (e.g. for overall LBP, highest for non-Hispanic White 74.4% vs. lowest for non-Hispanic Asian/Pacific Islander 62.8%), and significantly decreased between 2016 and 2019 (e.g. for nonspecific LBP, relative change: 28.6%). Variations were also observed for other outcomes.

Conclusions:
In the US, the burden of LBP-driven inpatient stays (i.e. rates of LBP-driven inpatient stays, resource utilization, and prognosis among LBP-driven inpatient stays) is enormous. More research is needed to understand why the burden varies considerably according to the LBP subtype (i.e. nonspecific and specific LBP as well as subcategories of specific LBP) and the subpopulation concerned (i.e. stratified by age, sex, and race/ethnicity).
Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage
Authors: Scherer Florian , Beule Achim Georg , Lütkenhöner Bernd , Heitkötter Felix , Rudack Claudia 
Published: December 2023

Objective
To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage.

Study Design
Randomized crossover experiment.

Setting
Tertiary referral center.

Participants
Sixty healthy participants.

Intervention
Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage (“S”), the nasion reference montage (“N”), and the nasion reference montage with a more lateral active electrode (“L”). Upgaze was standardized to 35 degrees.

Main Outcome Measures
Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability.

Results
All electrode montages showed detection rates greater than 90%. Latencies for “L” were shorter than for “S” and “N.” Amplitudes and SNR for “S” and “N” were higher than for “L,” whereas the values for “S” and “N” did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for “L” and 89.8% for “N.” All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR.

Conclusions
Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.
Variability in Perioperative Steroid Therapy Regimen for Cochlear Implantation as It Relates to Hearing Preservation
Authors: Derdzakyan Nicole A. , Lava Christian X. , Hakimi Amir A. , Johns J. Dixon , Kim H. Jeffrey , Hoa Michael 
Published: December 2023

Hypothesis
We aimed to identify practice trends and association between physician training and administration of perioperative steroids for cochlear implantation (CI) as it relates to hearing preservation.

Background
Perioperative steroid therapy regimens are postulated to protect residual hearing and improve hearing preservation outcomes in CI.

Methods
A 27-question online survey was developed by the senior authors using the Qualtrics Survey Tool, then distributed via email from September to November 2022 to otolaryngologists specializing in otology or neurotology and who practice in the United States or Canada.

Results
The survey was sent to 463 physicians, 162 (35.0%) of whom completed the survey. One hundred forty-four (31.1%) responses underwent analysis. All physicians administering preoperative steroids (n = 31) prefer preoperative oral prednisone. Of 143 physicians administering intraoperative steroids, 54.5% prefer intraoperative intravenous dexamethasone. More than half (77.6%) of 85 physicians administering postoperative steroids prefer postoperative oral prednisone. Postoperative steroid administration (p < 0.006) and taper utilization (p < 0.041) were greater among physicians who complete greater than 40 CIs annually (n = 47 [71.2%]; n = 30 [49.2%]) than physicians who complete up to 40 CIs annually (n = 37 [48.7%]; n = 20 [31.3%]), respectively. Physicians practicing for 5 to 20 years after residency are more prevalent in using postoperative steroid tapers than physicians practicing for fewer than 5 years after and more than 20 years after residency (n = 37 [51.4%] versus n = 14 [25.5%], p < 0.001).

Conclusion
Consensus is needed about the optimal steroid treatment for CI patients.

Level of Evidence
4.
An Investigation of the Impact of Expanding High-Deductible Health Plans on Patient Decision for Cochlear Implant Surgery and Postoperative Outcomes
Authors: Africa Robert E. , Quinlan Brian P. , McKinnon Brian J. 
Published: December 2023

HypothesisAfter the expansion of high deductibles, patients will delay cochlear implant (CI) surgery to the end of the year, and the risk of postoperative known risks will increase.BackgroundThe Affordable Care Act was associated with increased enrollment in high-deductible health plans (HDHPs), which resulted in rising health insurance deductibles. Health insurance plans can cover a patient's cost of healthcare once the deductible is met. Patients have been shown to be economic rational decision makers and make decisions based on cost rather than health. They wait for their deductible to be met, typically at the end of the year, then proceed to have costly care. The goal of this study was to evaluate the impact of rising health insurance deductibles on the rate and postoperative outcomes of cochlear implantation and to assess changes by the Tax Cuts and Jobs Act.MethodsTriNetX was used to accumulate summary data on patients who obtained a CI between 2005 and 2022 at the beginning (quarter 1) and the end of the year (quarter 4) from the electronic medical records of 75 healthcare organizations. The trends in average rate of cochlear implantation and resultant postoperative known risks or complications were statistically evaluated.ResultsAfter expansion of HDHPs, the rate of cochlear implantation between quarter 4 (19 cases per year) and quarter 1 (17 cases/year) was similar (p= 0.18). For all patient groups, the case volume significantly increased. Between quarter 4 and quarter 1, postoperative tinnitus was more common in the beginning of the year (risk ratio, 0.68; 95% confidence interval, 0.46–0.99).ConclusionsThe number of patients receiving CIs significantly increased despite the expansion of HDHPs. Tinnitus was a rare postoperative known risk in the beginning of the year. Patients are less likely concerned about cost of CI surgery because of the impact of hearing loss on quality of life.