bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Basilar Invagination
Authors: Botelho Ricardo Vieira , Alves Oscar L. , de Sá Carneiro Geraldo , Chen Zan , Yaman Onur , Parthiban Jutty , Visocchi Massimiliano , Klekamp Jörg , Goel Atul , Zileli Mehmet 
Published: February 2025

Study Design.
A systematic literature review and consensus using Delphi method.

Objective.
This review aims to outline the therapeutic criteria and clarify the best surgical options for the different types of basilar invagination (BI).

Summary of Background.
BI is a complex developmental malformation for which many surgical remedies have been proposed without clear consensus.

Material and Methods.
Using PubMed, the authors reviewed the literature on the surgical treatment of BI published from 2011 to 2022 looking at different surgical options. A panel of spine surgeons and members of the WFNS Spine Committee used the Delphi technique to assess the strength of literature, elaborate, and vote on statements regarding the surgical management of BI.

Results.
Thirteen recommendations were issued covering the most relevant topics related to the surgical treatment of BI. Posterior fossa decompression alone is an option to treat BI without instability. Most cases of BI and AAI can be treated by C1-C2 fixation. In selected cases, distraction of the atlantoaxial joint may be required. Current evidence is lacking which technique is better to correct irreducible BI. OCF can be used in case of atlas assimilation, dysgenesis of C1 lateral mass, in irreducible cases, odontoidectomy and revision of failed C1-C2 fixation. Complications of the OCF may reach up to 50%. The role for anterior fusion for treatment of BI need to be better assessed by further studies. In the setting of irreducible anterior compression caused by BI, the anterior odontoidectomy can be indicated supplemented by C1-C2/occipital-cervical fusion.

Conclusions.
There are multiple surgical options for basilar invagination depending on the existence of compression, AAD or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.
The Maastricht Intensive Care COVID Cohort: A Critical Appraisal of the Predefined Research Questions
Authors: Wintjens Marieke S.J.N. , Aydeniz Eda , van Rosmalen Frank , Driessen Rob G.H. , Hulshof Anne-Marije , Bergmans Dennis C.J.J. , van Kuijk Sander M.J. , van der Horst Iwan C.C. , van Bussel Bas C.T. ,   Maastricht Intensive Care COVID (MaastrICCht) collaborators
Published: February 2025

IMPORTANCE:
A review of the study processes and protocols afterward by the researchers themselves is scarce.

OBJECTIVES:
The present study aimed to evaluate the study design and the process of data collection of the Maastricht Intensive Care COVID (MaastrICCht) cohort during the COVID-19 pandemic. This evaluation provides information about the quality of the predefined questions and contributes to transparency in science.

DESIGN, SETTING, AND PARTICIPANTS:
Critical appraisal of studies using data from the MaastrICCht cohort.

MAIN OUTCOMES AND MEASURES:
Evaluation of the process of study design and data collection during the COVID-19 pandemic, focusing on the research process and results.

RESULTS:
From March 2020 to April 2023, all patients diagnosed with COVID-19 admitted to the ICU at Maastricht University Medical Center + (n = 544) were included in the MaastrICCht cohort. In total, 37 studies were carried out until April 2024. Fifteen studies addressed 11 of the 13 predetermined research questions, whereas 22 additional studies were performed based on the initial research questions described in the design. Furthermore, 10 studies were conducted with other researchers in national and international collaboration as a response to new arising questions based on evidence that appeared relevant during the pandemic.

CONCLUSIONS AND RELEVANCE:
Our critical appraisal indicated that using a study protocol enabled many publications and (inter)national collaborations, although formulating pertinent research questions in the context of a novel disease appeared daunting. Despite this, most questions were successfully addressed, whereas few were resolved by other researchers or lost importance due to the expanding body of knowledge.
Association of Omega-3 Status With Long-Term Risk of Hospitalization for Sepsis
Authors: Narayan Deo , Vlasschaert Caitlyn , Day Andrew G. , Norman Patrick , Rauh Michael J. , Maslove David M. 
Published: February 2025

Objectives:
Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Despite decades of clinical trials, there are no specific treatments; care of the nearly 50 million annual cases worldwide is limited to antimicrobials and supportive measures. A primary prevention strategy may therefore be of value. We hypothesized that higher premorbid omega-3 fatty acid levels would be associated with a reduced incidence of sepsis.

Design:
Population-based cohort study.

SETTING:
Retrospective data from the United Kingdom (U.K. Biobank).

Patients:
Two hundred seventy-three thousand three hundred twenty-five participants from the U.K. Biobank.

Interventions:
None.

Measurements and Main Results:
Our exposure was baseline estimated omega-3 index (eO3I), modeled both categorically in quartiles, and continuously with restricted cubic splines. Our outcome measure was hospital admission with an International Classification of Diseases, 10th Edition code consistent with sepsis. The median (interquartile range) baseline eO3I was 6.0% (4.8–7.3%). Over a mean follow-up period of 13 years, 9241 participants experienced hospitalization with sepsis. In our adjusted model, compared with the lowest eO3I quartile, participants had lower risks of sepsis incidence in the second quartile (hazard ratio [HR], 0.88; 95% CI, 0.86–0.91; p < 0.001), third quartile (HR, 0.80; 95% CI, 0.78–0.83; p < 0.001), and fourth quartile (HR, 0.75; 95% CI, 0.73–0.77; p < 0.001). When analyzed as a continuous variable, increasing eO3I was associated with a decreasing risk of sepsis (p < 0.001).

Conclusions:
In this population-based cohort study, baseline eO3I was inversely associated with subsequent sepsis incidence. Given that omega-3 levels can be increased with dietary supplementation, primary prevention should be explored to mitigate the burden of sepsis.
Cognitive Frailty for Young Breast Cancer Survivors After Chemotherapy: Implication for the Design of Health Education Materials
Authors: Jiang Lulu , Liu Yanyan , Wiley Joshua , Zhang Chengrui , Wang Xiyi , Hu Yun 
Published: February 2025

Background:
As the most common cancer among women globally, breast cancer often leads to accelerated frailty in younger survivors, particularly during chemotherapy, causing cognitive impairments. This highlights the urgent need for tailored health education materials to address these challenges.

Objective:
To analyze cognitive load in young breast cancer survivors (YBCSs) after chemotherapy and contribute to the development of more tailored and effective health education materials for this population.

Methods:
Cognitive load theory informed a semistructured interview guide to investigate the challenges YBCSs face when engaging with health education materials.

Results:
Eleven participants aged 18–45 years were interviewed. Based on cognitive load theory, 4 themes were identified as follows: symptom burden, impairment of working memory, decrease the intrinsic cognitive load, and decrease the extraneous cognitive load.

Conclusions:
YBCSs frequently experience cognitive burden due to chemotherapy and perimenopause, which can trigger adverse personal states that lead to working memory overload and depletion. They prefer health education materials that offer credible, relevant information presented in modern formats, particularly short videos lasting around 10 seconds. However, excessive transient information and interactive elements may create unnecessary cognitive load.

Implications for Practice:
Developing health education materials should focus on conciseness, visual appeal, and small, digestible segments to ease cognitive load. Incorporating storytelling and relatable scenarios can significantly boost engagement and comprehension.

What is Foundational:
This model, informed by cognitive load theory, could be used as the basis of educational materials of greater care usefulness for these younger survivors of breast cancer.
Updated Review of Cellular Dermatofibroma: Benign or Not?
Authors: Le Nicholas T. , Fung Maxwell A. , Eisen Daniel B. 
Published: February 2025

BACKGROUND
Cellular dermatofibromas (CDFs) are uncommon benign fibrous histiocytomas with histologic patterns resembling malignancies. Despite their benign nature, CDFs can recur and metastasize. Physicians are uncertain about the management of CDF, given its resemblance to dermatofibrosarcoma protuberans.

OBJECTIVE
This review aims to review CDF's clinical and histologic features, differentiate it from similar presenting malignancies, and discuss treatments and outcomes for better clinical management.

MATERIALS AND METHODS
In April 2024, a PubMed and Google Scholar search was completed using “cellular dermatofibroma” through the University of California Davis Medical School's library databases. The search included meta-analyses, randomized controlled trials, observational studies, reviews, and case studies published within the past 70 years. References from retrieved articles were utilized as additional resources.

RESULTS
Clinical signs of CDF include firm, skin-colored to hyperpigmented lesions usually larger than 2 cm, typically on extremities. Currently, there are no definitive indicators for CDF recurrence or metastasis. Diagnosis requires microscopic and histopathologic examination, with surgical excision as the preferred treatment. Recurrence is not uncommon, while metastasis is rare.

CONCLUSION
CDFs often develop in young/middle-aged adults with a tendency to recur and in rare cases can metastasize. Future studies could explore lesion characteristics that are associated with potential for recurrence and metastasis.
Fibrinolytic activity in infants undergoing cardiac surgery on cardiopulmonary bypass with routine tranexamic acid
Authors: Siemens Kristina , Parmar Kiran , Harris Julia , Hunt Beverley J. , Tibby Shane M. 
Published: February 2025

BACKGROUND
Fibrinolytic activity contributes to bleeding after cardiopulmonary bypass (CPB).

OBJECTIVE
Our objectives were, in a group of infants undergoing cardiac surgery with CPB: to document the extent of peri-operative fibrinolysis using rotational thromboelastometry (ROTEM) and standard biomarkers; to compare the agreement between these fibrinolytic measures; to assess whether fibrinolytic activity is associated with early postoperative mediastinal bleeding and assess whether supplementation with fibrinogen concentrate affected fibrinolysis.

DESIGN
Prospective cohort, mechanistic substudy, nested within the FIBrinogen CONcentrate (FIBCON) randomised controlled trial.

SETTING
Single centre, tertiary paediatric cardiac surgery and paediatric intensive care units.

PATIENTS
Ninety infants (median age 6.3 months) undergoing cardiac surgery, who all received routine intra-operative tranexamic acid. The infants were randomised to receive either an individualised dose of fibrinogen concentrate (n = 60) or placebo (n = 30) during CPB.

MAIN OUTCOME MEASURES
We measured the ROTEM variable maximum clot lysis (ML), and fibrinolytic biomarkers including plasmin-antiplasmin (PAP) and tissue plasminogen activator antigen (tPA-Ag). Blood was sampled pre-CPB, on-CPB and post-CPB, and 4 h after PICU admission.

RESULTS
tPA-Ag, PAP and ROTEM ML increased significantly after CPB despite the use of tranexamic acid. The two fibrinolytic biomarkers t-PA and PAP, correlated (P = 0.001) but neither correlated with ROTEM ML. Early postoperative blood loss was inversely associated with PAP levels. Each 100 μg l−1 rise in PAP was associated with a 7.9% reduction in mean blood loss. Fibrinogen concentrate supplementation as expected did not affect tPA-Ag but was temporally associated with an increase in PAP levels and a decrease in ROTEM fibrinolytic activity.

CONCLUSION
Fibrinolysis is activated after paediatric cardiac CPB surgery as indicated by increased tPA-Ag and ROTEM ML. The substantial increase in tPA-Ag post-PICU admission is probably accompanied by a similar rise of plasminogen activator inhibitor 1 (PAI-1) as part of the acute phase response to surgery, thereby limiting clinical fibrinolysis. Supplementation of fibrinogen concentrate was associated with increased PAP activity and less clinical bleeding, consistent with the known role for fibrinogen in being a substrate for plasmin.

TRIAL REGISTRATION
ISCTRN:50553029, Eudract:2013-003532-68.
Adverse drug reactions in pulmonology
Authors: Horwitz Henrik , Jørgensen Theis Guldager , Heerfordt Ida Marie , Olsen Rasmus Huan 
Published: February 2025

Summary
This study investigates the adverse reactions observed in pulmonary medicine. We used data from the Adverse Drug Event Manager (ADEM) of the Capital Region of Denmark from 2013 to 2024. Antibiotic drugs were the most common causes of adverse reactions reported but with very different side effect profiles. We observed a wide range of signals related to angioedema and Angiotensin Converting Enzyme (ACE) inhibitors as well as interstitial lung disease and nitrofurantoin and methotrexate. These findings were aligned with existing literature. Although the system captured well known adverse drug reactions, it struggled to detect new safety signals.
Risk Factors for Ectropion After Lower Eyelid and Cheek Reconstruction Following Mohs Micrographic Surgery
Authors: Rames Jess D. , Rames Melissa M. , Yu Caroline Y. , Sanchez Figueroa Nicole , Akpala Christeebela O. , Hussein Sara , Demer Addison M. , Sharaf Basel A. , Wagner Lilly H. 
Published: February 2025

Background:
Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery.

Methods:
We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses.

Results:
A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36–13.6], P = 0.01), larger size (1.07 [1.03–1.13], P < 0.001), and negative orbital vector (12.11 [2.65–65.42], P = 0.002) were independent risk factors for ectropion development.

Conclusions:
Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.
Implant-based Cryopreserved Autologous Free Nipple Grafting for Breast Reconstruction: The ICEBERG Technique
Authors: Patel Sonia S. , Lu Nathan E. , Xia Thomas , Mailey Brian A. 
Published: February 2025

Summary:
Nipple creation is generally the final step of breast reconstruction. However, patients many times forego this procedure due to reconstructive fatigue. Herein, we describe a technique of harvesting the nipple–areola complex as a full-thickness skin graft during the initial mastectomy with direct-to-implant reconstruction, storing the harvested nipple tissue at −80°C, and then placing the nipple as a skin graft 2 weeks after the initial mastectomy. This method, termed the implant-based cryopreserved autologous free nipple grafting for breast reconstruction technique, serves as a feasible and shorter alternative to traditional procedures. The implant-based cryopreserved autologous free nipple grafting for breast reconstruction technique can, therefore, reduce the longevity of the reconstructive journey for patients.
In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT
Authors: Moser Lukas Jakob , Klambauer Konstantin , Diaz Machicado Maria Carolina , Frey Diana , Mergen Victor , Eberhard Matthias , Nowak Tristan , Schmidt Bernhard , Flohr Thomas , Distler Oliver , Alkadhi Hatem 
Published: February 2025

Purpose
The aim of this study was to determine in a prospective patient study the accuracy of areal bone mineral density (aBMD) measurements with spectral localizer radiographs obtained with a clinical photon-counting detector computed tomography (PCD-CT) scanner in comparison with dual-energy x-ray absorptiometry (DXA).

Methods
In this institutional review board–approved, prospective study, 41 patients (15 females, 26 males; mean age 61.3 years, age range 35–78 years) underwent PCD-CT of the abdomen with a spectral localizer radiograph (tube voltage 140 kVp, tube current 30 mA) and DXA within a median of 45 days. aBMD values were derived for lumbar vertebrae L1–L4 from both methods and were compared with linear regression, Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman plots. T-scores were calculated on a patient level and were compared between methods.

Results
DXA and spectral localizer radiographs showed strong correlation in aBMD measurements (R = 0.97, P < 0.001) and patient level T-scores (R = 0.99, P < 0.001). There was a strong agreement between aBMD from both methods (ICC, 0.96; 95% CI, 0.94–0.97). Bland-Altman analysis revealed a very small mean difference in aBMD between methods (mean absolute error 0.019 g/cm2) with narrow limits of agreement (−0.083 g/cm2 to 0.121 g/cm2). Similarly, there were small differences in regard to the T-score (mean absolute error 0.156) with narrow limits of agreement (−0.422 to 0.734) between methods. ICCs indicated an excellent agreement between T-scores from DXA and spectral localizer radiographs (ICC, 0.98; 95% confidence interval, 0.95–0.99).

Conclusions
Our prospective patient study indicates that spectral localizer radiographs obtained with a clinical PCD-CT system enable accurate quantification of the lumbar bone areal mineral density. This opens up the opportunity for opportunistic screening of osteoporosis in patients who undergo CT for other indications.
A Case of McCune Albright Syndrome With Rare Extensive Polyostotic Fibrous Dysplasia
Authors: Ganesan Harinee , Madivanane Vasanth , Dhayalane Kabilash , Sainath Ragire , Goyal Harish 
Published: February 2025

Abstract
McCune-Albright syndrome is characterized by a triad of café au lait macules, polyostotic fibrous dysplasia (FD), and endocrine abnormalities. Bilateral and extensive presentation of FD is rarely reported. We report an interesting case of 24-year-old woman presenting with multiple episodes of slip and fall, sustaining multiple fractures with history of precocious puberty and skin complaints. On evaluation with 99mTc-MDP bone scan, all the long bones, ribs, pelvic bones, frontal bone, and maxilla showed deformities and increased osteoblastic activity, suggesting extensive polyostotic FD. Thus emphasizing the crucial role of 99mTc-MDP bone scan in the diagnosis of extensive FD and guides in understanding of the polyostotic involvement.
Surgical Complications After Fronto-orbital Advancement for Craniosynostosis: Analysis of a National Database
Authors: Lee Anna D. , Gomez Diego A. , Le Elliot L. H. , Palmer Skyler K. , French Brooke , Nguyen Phuong D. , Mathes David W. , Khechoyan David Y. 
Published: February 2025

Background:
Fronto-orbital advancement (FOA) is the standard surgical intervention for patients with craniosynostosis and associated fronto-orbital dysmorphology. Although previous studies have provided insights into center-specific complications, comprehensive, large-scale analyses remain limited. This study utilizes a national database to address these gaps, offering a large-scale perspective on FOA outcomes.

Methods:
Patients aged 0 to 16 years who underwent FOA from 2007 to 2015 were identified using the PearlDiver database. Patients were divided into early (0–5 y) and late (6–16 y) groups. Complications were identified using a combination of ICD and CPT codes. Intraoperative complications, including hematoma/hemorrhage, cerebrovascular infarction, and cardiac arrest, were defined as those occurring within 48 hours of the procedure. Postoperative complications analyzed at intervals of 0, 30, 90, 180, and 365 days post-operation included cerebrospinal fluid leak, hardware-related complications, hemorrhage, seizure, surgical site infection, wound dehiscence, and death. Summary statistics were conducted utilizing Bellwether software in PearlDiver.

Results:
A total of 2026 patients underwent FOA, with a mean of 1.5 years in the younger cohort (n=1905) and 9.0 years in the older cohort (n=121). Although rare, hemorrhage was the most common intraoperative complication. One-year postoperative complications were predominantly related to wound dehiscence and surgical site infection in the younger (5.10%) and older (14.1%) cohorts. The 1-year reoperation rate was 7.2% for the younger cohort and 19.0% for the older cohort.

Conclusions:
FOA is a safe operation with an overall low complication rate. However, older patients demonstrate a higher rate of reoperations, emphasizing the need to identify the optimal timing for FOA in patients with craniosynostosis.
Novel Robotic Valvuloplastic Esophagogastrostomy Technique After Proximal Gastrectomy: A Safety and Feasibility Study
Authors: Amini Neda , Kinoshita Takahiro , Arrieta Manuel , Yoshida Mitsumasa , Nagata Hiromi , Habu Takumi , Komatsu Masaru , Yura Masahiro 
Published: February 2025

Background:
Esophagogastrostomy is one of the reconstruction techniques after proximal gastrectomy, but reflux and esophagitis are significant concerns. We introduced a new robotic valvuloplasty technique (single-flap), taking advantage of robotic surgery to address these issues and simplify the technique, especially for tumors with esophageal invasion.

Methods:
Between March 2022 and March 2024, patients who underwent robotic proximal gastrectomy with the single-flap technique were included. Based on the difficulty of the surgery, patients were divided into 2 groups: one with esophageal invasion requiring anastomosis in the mediastinum and the second group with tumors in the upper third of the stomach requiring anastomosis in the abdomen.

Results:
A total of 22 patients were included: 13 in the esophageal invasion group and 9 in the upper stomach group. The median size of esophageal invasion was 2 cm (1 to 3 cm). The median operative time was 320 minutes (esophageal invasion 326 vs. upper stomach 280 min, P=0.51), with a median blood loss of 35 g (31 vs. 38 g, P=0.19). No postoperative mortality, anastomotic leaks, reflux symptoms, or pancreatic fistulas were observed. Eighteen patients underwent endoscopic evaluation, and no sign of esophagitis was detected. Five patients (22.7%) developed grade III strictures requiring endoscopic balloon dilation (esophageal invasion 32.1% vs. upper stomach 22.2%; P=0.96).

Conclusions:
Robotic proximal gastrectomy with single-flap valvuloplastic esophagogastrostomy is a safe and feasible option for gastroesophageal junction tumors with up to 3 cm of esophageal invasion.