bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Colonic Neoplasia Surgical Complications: A Machine Learning Approach
Authors: Nwaiwu Chibueze A. , Perla Krissia Rivera , Abel Logan B. , Sears Isaac J , Barton Andrew T. , Peterson Race C. , Liu Yao Z. , Khatri Ishaani S , Sarkar Indra N. , Shah Nishit 
Published: February 2024

BACKGROUND:
A range of statistical approaches have been used to help predict outcomes associated with colectomy. The multifactorial nature of complications suggest that machine learning algorithms may be more accurate in determining postoperative outcomes by detecting nonlinear associations, which are not readily measured by traditional statistics.

OBJECTIVE:
The aim of this study was to investigate the utility of machine learning algorithms to predict complications in patients undergoing colectomy for colonic neoplasia.

DESIGN:
Retrospective analysis using decision tree, random forest, and artificial neural network classifiers to predict postoperative outcomes.

SETTINGS:
National Inpatient Sample database (2003-2017).

PATIENTS:
Adult patients who underwent elective colectomy with anastomosis for neoplasia.

INTERVENTIONS(S) IF ANY:
N/A.

MAIN OUTCOME MEASURES:
Performance was quantified using sensitivity, specificity, accuracy, and area-under-the-curve-receiver-operator-characteristic to predict the incidence of anastomotic leak, prolonged length of stay, and inpatient mortality.

RESULTS:
A total of 14,935 patients (4,731 laparoscopic, 10,204 open) were included. They had an average age of 67±12.2 years and 53% were female. The three machine learning models successfully identified patients who developed the measured complications. Although differences between model performance were largely insignificant, the neural network scored highest for most outcomes: predicting anastomotic leak, area-under-the-curve-receiver-operator-characteristic 0.88/0.93 (open/laparoscopic, 95% CI, 0.73-0.92/0.80-0.96); prolonged length of stay, area-under-the-curve-receiver-operator-characteristic 0.84/0.88 (open/laparoscopic, 95% CI, 0.82-0.85/0.85-0.91); and inpatient mortality, area-under-the-curve-receiver-operator-characteristic 0.90/0.92 (open/laparoscopic, 95% CI, 0.85-0.96/0.86-0.98).

LIMITATIONS:
The patients from the National Inpatient Sample database may not be an accurate sample of the population of all patients undergoing colectomy for colonic neoplasia and does not account for specific institutional and patient factors.

CONCLUSIONS:
Machine learning predicted postoperative complications in patients with colonic neoplasia undergoing colectomy with good performance. Though validation using external data and optimization of data quality will be required, these machine learning tools show great promise in assisting surgeons with risk-stratification of perioperative care to improve postoperative outcomes. See Video Abstract.
Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair
Authors: Davies Alex , Davies Amy , Main Barry , Wren Yvonne , Deacon Scott , Cobb Alistair , McLean Neil , David David , Chummun Shaheel 
Published: February 2024

Background:
There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae.

Methods:
The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula.

Results:
Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53–3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26–1.80).

Conclusions:
The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.
Histopathologic Analysis of a Recalcitrant Calcaneal Wound Treated Using a Synthetic Hybrid-scale Fiber Matrix
Authors: Harder Justin G. , Hernandez Evan J. , MacEwan Matthew M. , Sallade Emily R. , Warraich Irfan , Gaschen Paul , MacKay Brendan J. 
Published: February 2024

Summary:
Traditionally, full-thickness wounds with exposed structures are treated with flap coverage or dermal regenerative templates. Most dermal regenerative templates are biologic in origin, but recently synthetic options have become available. One such product is a synthetic hybrid-scale fiber matrix (SHSFM). In this case, SHSFM was used to treat a recalcitrant calcaneal wound. After the wound granulated, it was biopsied, and histopathologic analysis was conducted. A 16-year-old woman involved in a motor vehicle collision sustained multiple traumatic injuries which were stabilized. Postoperatively, she developed a calcaneal infection and associated wound, which developed into a chronic, nonhealing wound. Failed treatments included removal of hardware, multiple debridements, and advanced wound therapies. An SHSFM was then trialed, which led to granulation of the wound without infection. Despite wound healing, the patient subsequently elected to undergo a below-the-knee amputation due to pain and functional disability from posttraumatic ankle arthritis. The heel was biopsied at the time of amputation for analysis. Pathologists noted excellent granulation tissue formation and complete coverage of the wound surface area and 75% of the wound depth, which included epithelialization and decreasing inflammation at wound edges. Collagen deposition and numerous interspersed blood vessels were present. Foreign material and bacteria were absent. No osteomyelitis was observed. This analysis provided the opportunity to investigate the in vivo regenerate from a novel synthetic SHSFM. Given the uniqueness and challenges presented in this case, the usage of this relatively new product warrants further investigation with larger populations and assorted wound etiologies.
Early Results on the Efficacy of Demineralized Bone Matrix, Bone Morphogenic Protein, and Freeze-dried Bone Chips in Alveolar Cleft Repair
Authors: Marquez Jessica L. , Sudduth Jack , DeMay Henning , Kuo Keith , Battistini Andrea , Yamashiro Duane K. , Siddiqi Faizi A. , Gociman Barbu 
Published: February 2024

Background:
Conventional treatment for alveolar cleft repair is done using autologous iliac crest alveolar bone graft (ABG). However, this method may not be ideal in all patients. Analysis of the efficacy of a mixture of demineralized bone matrix (DBX), bone morphogenic protein (rhBMP-2), and freeze-dried bone chips (FDBC) as an alternative for alveolar cleft repair was performed.

Methods:
Consecutive patients from August 2019 to June 2022 undergoing early alveolar cleft repair, concomitant hard palate and alveolar cleft repair, secondary alveolar cleft repair, and regrafting from a previously failed ABG were analyzed. Computed tomography scans were performed to evaluate graft take at least 6 months postoperatively. Images were reviewed and scored. Alveolar graft height and graft thickness were recorded. A standardized scoring system was developed, with a score of 0 representing no graft take and 3 representing best possible graft take.

Results:
Fifty-five consecutive alveolar clefts (43 patients) were identified as having undergone ABG and satisfied all the other inclusion criteria. Of these, 29 underwent first time ABG and 26 underwent redo ABG. The mean graft height and graft thickness recorded for all clefts was 2.2 and 2.0, respectively.

Conclusions:
Early results evaluating the efficacy of ABG using DBX, rhBMP-2, and FDBC show feasibility in regard to both graft height and thickness when using a maxillary computed tomography scan to measure the bone graft take. These results suggest that DBX, rhBMP-2, and FDBC may act as a versatile bone graft material in cleft care, although further studies are needed to determine long-term outcomes.
Exploring a novel class tryptophan hydroxylase 1 inhibitor derived from Sambucus williamsii Hance for the osteoporosis treatment
Authors: Zhu Yu-Xin , Tang Zi-Ling , Lu Lu , Qiu Zuo-Cheng , Pan Dabo , Yu Yang , Xiao Hui-Hui , Wong Man-Sau 
Published: February 2024

Objective:
Gut-derived serotonin strongly inhibits bone formation by inhibiting osteoblast proliferation. Our previous study demonstrated that the lignan-rich fraction prepared from Sambucus willimasii Hance, a folk herbal medicine used to treat bone fractures and joint diseases in China, exerted bone-protective effects, and its actions were modulated by suppressing the synthesis of gut-derived serotonin via the inhibition of intestinal tryptophan hydroxylase 1 (TPH-1). However, there is no direct evidence for the action of lignans on TPH-1. This study aimed to verify the direct action of lignans on the TPH-1 and its influence on serotonin synthesis and bone properties.

Methods:
Molecular docking and surface plasmon resonance were performed to determine the affinities of lignans to TPH-1. The cell viability and the protein activity and expression of TPH-1 were measured in RBL2H3 cells. The serum serotonin level and bone mineral density upon lignan treatment in ovariectomized mice were determined.

Result:
The lignans showed high binding scores and binding affinities to TPH-1, inhibited the activity and protein expression of TPH-1, suppressed the serum serotonin levels in ovariectomized mice as well as promoted bone mineral density.

Conclusion:
This is the first study to report that lignans are novel TPH-1 inhibitors and that these lignans could be potential agents for the management of serotonin-related diseases, including osteoporosis.
Lacrimal Gland Adenocarcinoma Clinicopathologic Features and Outcomes Compared With Those of Lacrimal Gland Adenoid Cystic Carcinoma
Authors: Goldberg Hila , Jiang Xinyang , Fan Janet , Zhao Jiawei , Ning Jing , Williams Michelle , Frank Steven , Moreno Amy , Gunn Brandon , Ferrarotto Renata , Esmaeli Bita 
Published: February 2024

Purpose:
Lacrimal gland (LG) adenocarcinomas (ACs) are rare, with limited data. We compared clinicopathologic features and local recurrence, distant metastasis, and survival rates between LG AC and LG adenoid cystic carcinoma (ACC).

Methods:
The records of LG AC patients treated from 2008 to 2022 and LG ACC patients treated from 1998 to 2022 at the same center were retrospectively reviewed.

Results:
The study included 20 patients with AC; 10 de-novo AC, 10 ex-pleomorphic AC; and 51 ACC patients. The median age at diagnosis was 61 years for de-novo AC, 54 years for ex-pleomorphic AC, and 45 years for ACC. All groups had male predominance. The initial T category was T2 in 50% (5/10) of de-novo ACs; 60% (6/10) of ex-pleomorphic ACs; and 59% (30/51) of ACCs. Perineural invasion was present in 33% (5/15) of ACs and 90% (45/50) of ACCs (p < 0.001). Of the 20 AC patients, 14 had eye-sparing surgery; 4 had orbital exenteration; and 2 had unresectable disease. All AC patients received postoperative radiotherapy and 15 (75%) received concurrent chemotherapy. Fourteen AC patients were tested for human growth factor receptor 2 expression, and 10 (71%) were human growth factor receptor 2 positive; 5 received human growth factor receptor 2-targeted therapy. AC and ACC had similar 5-year recurrence rates (20% and 33%, respectively, p = 0.31) and metastasis rates (20% and 34%, respectively, p = 0.30). de-novo AC, ex-pleomorphic AC, and ACC had similar 5-year disease-specific survival rates (80%, 79%, and 81%, respectively, p > 0.99).

Conclusions:
LG AC and ACC have similar baseline clinicopathologic features, except that perineural invasion is more common in ACC, and similar recurrence, metastasis, and survival rates. Human growth factor receptor 2-targeted therapy may be appropriate in some patients with LG AC.
A Simple Procedure of Fascia-Fat Grafting and Blepharoplasty as a Single-Stage Procedure for the Correction of Sunken Eyelids in Vietnamese Population
Authors: Hoang Thanh Tuan , Nguyen Kim Thanh 
Published: February 2024

Purposes:
Upper sunken eyelids, which are characterized by the hollowness of the upper eyelids, often cause a poor aesthetic appearance. Herein, we present a simplified technique using fascia-fat grafts for volume augmentation combined with blepharoplasty as a single-stage procedure.

Methods:
From January 2021 to December 2021, 30 patients with sunken eyelids visiting our clinic for hollow eyelid treatment underwent a fascia-fat grafting derived from the inguinal crease combined with simultaneous eyelid reconstruction. A modified classification of sunken eyelids that was more suitable for the Asian population was proposed.

Results:
Postoperatively, edema and ptosis were transient and addressed thanks to proper massage and compresses. Two cases had scar fibers leading to a slight tension of upper eyelids at 6-month follow-up. This event was addressed by triamcinolone acetonide injections at 4–6-week intervals with satisfactory results. The orbital volume of all patients was satisfying and stable up to 12 months after the surgery. The satisfaction rate was 100% and 88.8% in group 1 and group 2, respectively, at 12-month follow-up.

Conclusions:
Fascia-fat grafting combined with blepharoplasty as a single-stage procedure was a simplified method that did not require varied types of surgical tools but brought satisfactory results. This method facilitated the routine procedure and eased surgeons in the clinical practices.
Body mass index and the risk of abdominal aortic aneurysm presence and post-operative mortality: a systematic review and dose-response meta-analysis
Authors: Wu Yihao , Zhang Hao , Jiang Deying , Yin Fanxing , Guo Panpan , Zhang Xiaoxu , Zhang Jian , Han Yanshuo 
Published: February 2024

Background:
The clinical data regarding the relationships between body mass index (BMI) and abdominal aortic aneurysm (AAA) are inconsistent, especially for the obese and overweight patients. The aims of this study were to determine whether obesity is associated with the presence of AAA and to investigate the quantitative relationship between BMI and the risk of AAA presence and post-operative mortality.

Materials and Methods:
PubMed, Web of Science and Embase databases were used to search for pertinent studies updated to December 2023. The pooled relative risk (RR) with 95% confidence interval (CI) was estimated by conventional meta-analysis based on random effects model. Dose-response meta-analyses using robust-error meta-regression (REMR) model were conducted to quantify the associations between BMI and AAA outcome variables. Subgroup analysis, sensitivity analysis and publication bias analysis were performed according to the characteristics of participants.

Results:
18 studies were included in our study. The meta-analysis showed a higher prevalence of AAA with a RR of 1.07 in patients with obesity. The dose-response meta-analysis revealed a non-linear relationship between BMI and the risk of AAA presence. A “U” shape curve reflecting the correlation between BMI and the risk of post-operative mortality in AAA patients was also uncovered, suggesting the “safest” BMI interval [28.55, 31.05] with the minimal RR.

Conclusions:
Obesity is positively but nonlinearly correlated with the increased risk of AAA presence. BMI is related to AAA post-operative mortality in a “U” shaped curve, with the lowest RR observed among patients suffering from overweight and obesity. These findings offer a preventive strategy for AAA morbidity and provide guidance for improving the prognosis in patients undergone AAA surgical repair.
Modified Mustardé and Superolateral Periosteal Flaps for Full-Thickness Defects of Medial and Central Lower Eyelid
Authors: Ongkasuwan Pattana 
Published: February 2024

Background
Reconstructing full-thickness defects involving 50% to 75% of the horizontal length of the lower eyelid after medial and central full-thickness block resection can be challenging. As a disadvanatge, 1-stage reconstructions may require a free graft reconstruction of the posterior lamella. In addition, 2-stage reconstructions are associated with several complications, including erythema, and the eye must be temporarily closed after surgery.

Methods
The present study describes a single-surgeon retrospective case series. Five patients diagnosed with basal cell carcinoma underwent wide full-thickness block resection with optimal excision margins (3–5 mm). Subsequently, 1-stage reconstruction was performed using the modified Mustardé flap, incised using the transconjunctival approach. This flap comprised the skin, muscle, tarsus, and conjunctival flap raised from the lateral canthus through a lateral cantholysis procedure, and then extended to the lateral cheek. The flap was medially transposed to cover the medial and central lower eyelid defect. The superolateral periosteal flap was harvested from the superolateral orbital rim attached to the lateral border of the tarsus of the modified Mustardé flap. The lateral forniceal conjunctiva was released from the retractor and advanced superiorly to cover the inner surface.

Results
The study included 3 men and 2 women, with a mean age of 71 years (range, 62–90 years). Histological evaluations confirmed tumor-free margins in all cases. The average follow-up duration was 20 months (6–60 months), with no tumor recurrence. None of the patients developed long-term complications, such as ectropion, entropion, lagophthalmos, trichiasis, symblepharon, erythema, wound dehiscence, or flap necrosis. All patients had minimal scarring, and no secondary surgical interventions were necessary.

Conclusions
This case series demonstrates the efficacy of the combined modified Mustardé and superolateral periosteal flaps in 1-stage reconstruction of full-thickness defects involving 50% to 75% of the horizontal length of the medial and central lower eyelid without compromising functional and aesthetic outcomes.
Quantifying Perioperative Risks for Antireflux and Hiatus Hernia Surgery
Authors: Liu David S. , Wong Darren J. , Goh Su Kah , Fayed Aly , Stevens Sean , Aly Ahmad , Bright Tim , Weinberg Laurence , Watson David I. ,   on behalf of the PROTECTinG Antireflux Surgery study group
Published: February 2024

Objective:
Using a comprehensive Australian cohort, we quantified the incidence and determined the independent predictors of intraoperative and postoperative complications associated with antireflux and hiatus hernia surgeries. Additionally, we performed an in-depth analysis to understand the complication profiles associated with each independent risk factor.

Background:
Predicting perioperative risks for fundoplication and hiatus hernia repair will inform treatment decision-making, hospital resource allocation, and benchmarking. However, available risk calculators do not account for hernia anatomy or technical aspects of surgery in estimating perioperative risk.

Methods:
Retrospective analysis of all elective antireflux and hiatus hernia surgeries in 36 Australian hospitals over 10 years. Hierarchical multivariate logistic regression analyses were performed to determine the independent predictors of intraoperative and postoperative complications accounting for patient, surgical, anatomical, and perioperative factors.

Results:
A total of 4301 surgeries were analyzed. Of these, 1569 (36.5%) were large/giant hernias and 292 (6.8%) were revisional procedures. The incidence rates of intra- and postoperative complications were 12.6% and 13.3%, respectively. The Charlson Comorbidity Index, hernia size, revisional surgery, and baseline anticoagulant usage independently predicted both intraoperative and postoperative complications. These risk factors were associated with their own complication profiles. Finally, using risk matrices, we visualized the cumulative impact of these four risk factors have on the development of intraoperative, overall postoperative, and major postoperative complications.

Conclusions:
This study has improved our understanding of perioperative morbidity associated with antireflux and hiatus hernia surgery. Our findings group patients along a spectrum of perioperative risks that informs care at an individual and institutional level.
Cumulus: A federated EHR-based learning system powered by FHIR and AI
Authors: McMurry Andrew J. , Gottlieb Daniel I. , Miller Timothy A. , Jones James R. , Atreja Ashish , Crago Jennifer , Desai Pankaja M. , Dixon Brian E. , Garber Matthew , Ignatov Vladimir , Kirchner Lyndsey A. , Payne Philip R. O. , Saldanha Anil J. , Shankar Prabhu R. V. , Solad Yauheni V. , Sprouse Elizabeth A. , Terry Michael , Wilcox Adam B. , Mandl Kenneth D. 
Published: February 2024

ABSTRACTObjectiveTo address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app ‘listener’ that accesses standardized data across the SMART/HL7 Bulk FHIR Access application programming interface (API).MethodsWe advance a model for scalable, federated, data sharing and learning. Cumulus software is designed to address key technology and policy desiderata including local utility, control, and administrative simplicity as well as privacy preservation during robust data sharing, and AI for processing unstructured text.ResultsCumulus relies on containerized, cloud-hosted software, installed within a healthcare organization’s security envelope. Cumulus accesses EHR data via the Bulk FHIR interface and streamlines automated processing and sharing. The modular design enables use of the latest AI and natural language processing tools and supports provider autonomy and administrative simplicity. In an initial test, Cumulus was deployed across five healthcare systems each partnered with public health. Cumulus output is patient counts which were aggregated into a table stratifying variables of interest to enable population health studies. All code is available open source. A policy stipulating that only aggregate data leave the institution greatly facilitated data sharing agreements.Discussion and ConclusionCumulus addresses barriers to data sharing based on (1) federally required support for standard APIs (2), increasing use of cloud computing, and (3) advances in AI. There is potential for scalability to support learning across myriad network configurations and use cases.