bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory and Postoperative Outcomes in Early-onset Scoliosis Patients Treated With Vertical Expandable Prosthetic Titanium Rib: Single-center Experience of 20 Years
Authors: Ramírez Norman , Lugo Elyette , Camacho Lyanne , Ibañéz Mary K. , Ramírez Nicole , Quiñones-Rodríguez Jailene I. , Olivella Gerardo 
Published: February 2025

Background:
This study examines the long-term effectiveness and safety of the vertical expandable prosthetic titanium rib (VEPTR) device, developed in 1989 to treat early-onset scoliosis (EOS) and thoracic insufficiency syndrome (TIS). Specifically, it assesses VEPTR outcomes over 20 years in a single center, focusing on spine deformity correction, pulmonary function, weight percentile changes, and complication rates.

Methods:
A retrospective analysis was conducted on 36 patients from the EOS clinic who underwent VEPTR implantation without prior spine surgery, with at least 2 years of follow-up. Data collected included age, sex, weight, height, BMI, weight percentiles, comorbidities, radiographic parameters, pulmonary function tests, and complications. Weight percentile (WP) was calculated as preoperative WP and last follow-up WP. Coronal and sagittal deformities were measured preoperatively, immediately postimplantation, and at the last follow-up. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) and were correlated with weight percentile changes. Complications were classified using established criteria.

Results:
The mean age at VEPTR implantation was 86±34 months, with most cases attributed to neuromuscular scoliosis (56%). The initial coronal Cobb angle improved from 59±18 to 32±14 degrees postimplantation but increased to 60±25 at the final follow-up. Sagittal angles showed similar trends. Pulmonary function tests indicated a decline in FVC and FEV1 over time. There was no correlation between weight percentile changes and pulmonary function changes. Complication rates were high, affecting 63% of patients, which included hardware prominence, device migration, and infections as the most common.

Conclusions:
Although VEPTR devices initially corrected spinal deformities, their long-term benefits are limited as the correction becomes less pronounced over time. Expected improvement in pulmonary function is not observed. A different approach to treating EOS and TIS is necessary, as the significant complication rates challenge the implants’ effectiveness.

Level of evidence.
Level III.
A Novel Approach to Intermediate Cleft Rhinoplasty Utilizing a Pedicled Fibrofatty Flap
Authors: Lasky Sasha , Moshal Tayla , Jolibois Marah , Roohani Idean , Jimenez Christian , Manasyan Artur , Naidu Priyanka , Nagengast Eric S. , Magee William P. 
Published: February 2025

Summary:
Patients with cleft lip ± palate may experience psychosocial issues related to their secondary cleft nasal deformities. These concerns can be addressed earlier instead of being required to wait until skeletal maturity. A novel early rhinoplasty intervention utilizing a dorsal fibrofatty pedicled flap is performed by the senior author to address nasal aesthetics in patients with secondary nasal deformities. This study aimed to describe this novel intermediate rhinoplasty technique and to evaluate improvement of nasal aesthetics. A retrospective review of patients with unilateral and bilateral cleft lip who underwent open rhinoplasty by a single surgeon at less than 10 years old from 2008 to 2023 was conducted. To evaluate aesthetic improvement, preoperative and postoperative photographs of patients were graded by 2 reviewers utilizing the Asher-McDade Aesthetic Index. Paired t tests compared preoperative and postoperative Asher-McDade Aesthetic Index nasal form and nasal deviation scores. A total of 43 patients underwent early rhinoplasty utilizing this technique at an average age of 5.5 ± 1.1 years. Compared with preoperative photographs, postoperative photographs of patients demonstrated a significant improvement in nasal form (P < 0.001) and nasal deviation (P < 0.001). No intraoperative or postoperative complications were reported. Only 1 (2.3%) patient underwent revisional surgery. Long-term follow-up will assess the finalized revision rate. This technique is a safe and valuable tool in patients who benefit from earlier treatment of secondary cleft nasal deformities due to significant asymmetry and psychosocial concerns.
Monitoring and Management of Infection following Prepectoral Implant-based Breast Reconstruction: Retrospective Analysis of Conservative Treatment Versus Implant Removal
Authors: Walz Solange N. , Martineau Jérôme , Kalbermatten Daniel F. , Oranges Carlo M. 
Published: February 2025

Background:
Infection following implant-based breast reconstruction (IBBR) represents a major complication, potentially leading to prosthesis removal. However, no clear protocol for its prevention and management exists. This study aimed to evaluate the efficacy of conservative treatment methods in preventing implant removal and analyze factors responsible for implant loss in the context of prepectoral IBBR.

Methods:
A single-institution retrospective review chart of patients undergoing immediate prepectoral IBBR for breast cancer between October 2020 and January 2024 was performed. The inclusion criteria were the presence of at least one of the following postoperative complications: seromas, cellulitis, clinically suspected prosthesis infection, and confirmed periprosthetic infection. A comparative analysis between patients with successful conservative treatment (ultrasound-guided aspiration and antibiotic therapy) and patients undergoing implant removal was performed.

Results:
A total of 219 immediate prepectoral IBBR cases were identified, 38 of which met inclusion criteria. Implant removal was required in 11 cases, whereas implant retention was achieved in 27 patients with conservative treatment. Implants were invariably removed when bacterial cultures were positive (P < 0.05). Conversely, when pathogens were not identified, the likelihood of implant removal decreased significantly (P < 0.05). Conservative treatment allowed implant salvage in all patients presenting with postoperative seroma alone, without other associated complications (P < 0.05).

Conclusions:
This study suggests that when bacterial cultures are positive, implant removal is unavoidable. Conversely, noninfected seromas correlated with implant salvage. Infections from Bacillus pumilus and Corynebacterium pseudodiphtheriticum are reported for the first time.
Long-Term Outcomes of a 360-Degree Intracorneal Ring Implantation for Keratoconus: A 10-Year Follow-Up
Authors: Khorrami-Nejad Masoud , Jadidi Khosrow , Hasan Zeinab Fadhil , Aghamolaei Hossein , Sattar Abed Qaysser , Majdi Ali 
Published: February 2025

Purpose:
To evaluate the long-term visual, refractive, and tomographic outcomes of a 360-degree intracorneal ring implant for treating keratoconus (KC).

Methods:
This historical cohort study included 29 eyes of 29 patients with KC who underwent MyoRing implantation. Uncorrected and best-corrected distance visual acuity, refraction, keratometry, and corneal thickness were evaluated preoperatively and at 5 and 10 years postoperatively.

Results:
Significant improvements were observed in all outcome measures at 5 and 10 years postoperatively compared with the preoperative values (P < 0.001). Uncorrected distance visual acuity improved from 1.25 ± 0.34 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.36 ± 0.24 logMAR at 5 years but showed regression to 0.48 ± 0.35 logMAR at 10 years. Corrected distance visual acuity similarly showed improvement from 0.50 ± 0.24 logMAR preoperatively to 0.18 ± 0.12 logMAR at 5 years, with some regression to 0.25 ± 0.22 logMAR at 10 years. Spherical equivalent improved from −9.38 ± 4.09 diopters (D) preoperatively to −2.70 ± 1.54 D at 5 years but regressed to −3.29 ± 2.22 D at 10 years. Although corneal flattening was observed at 5 years, a slight steepening trend was noted at 10 years. Corneal thickness exhibited an increase after 5 years (P < 0.001), but this trend reversed by the 10-year mark.

Conclusions:
MyoRing implantation demonstrated significant initial improvements in visual, refractive, and tomographic outcomes in patients with KC; however, some regression toward preoperative values was observed by the 10-year follow-up. This highlights the importance of continued monitoring to assess the long-term impact of the implant and to manage any potential late effects.
Somatosensory and clinical profiles of patients with spine-related and clinical framework-based neck–arm pain
Authors: Kapitza Camilla , Ballenberger Nikolaus , Luedtke Kerstin , Schmid Annina B. , Tampin Brigitte 
Published: February 2025

Abstract
Spine-related neck–arm pain is heterogeneous and may present on a spectrum between nociceptive and neuropathic pain. A recently developed mechanism-based clinical framework for spine-related pain distinguishes between spinally referred pain without neurological deficits (somatic referred pain, heightened nerve mechanosensitivity, radicular pain), with neurological deficits (radiculopathy), and mixed-pain presentations. This study investigated differences in somatosensory and clinical profiles of patients with unilateral spine-related neck–arm pain grouped according to the clinical framework. Patients (n = 113) underwent a clinical examination, after which they were classified into a subgroup(s). They completed questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, pain catastrophizing scale, Depression, anxiety, and stress scale), neuropathic pain (Douleur neuropathique 4), and central sensitization features (Central Sensitization Inventory). Standardized quantitative sensory testing (QST) was performed over the maximal pain area and contralateral side. The radiculopathy group showed a significant loss of function on the symptomatic vs asymptomatic side in cold (P = 0.024) and warm detection (P = 0.004), thermal sensory limen (P = 0.001), mechanical detection (P = 0.001), increased windup ratio (P = 0.014), and cold hyperalgesia (P = 0.049). No other subgroup showed significant side differences in QST parameters. Symptom descriptors, such as burning (P < 0.031), tingling (P < 0.018), pins and needles (P < 0.031), numbness (P < 0.016), spontaneous pain (P < 0.001), and electric pain/shock (P < 0.026) were more common in the radicular/radiculopathy groups compared with the somatic/mechanosensitivity groups. There were no differences in psychosocial parameters between the groups. The phenotypic profiles support the construct of the clinical examination and patient classification and its application in clinical practice according to a clinical framework for spine-related pain.
International consensus recommendations for the RAPID procedure in liver transplantation
Authors: Malagó Massimo , Line Pål-Dag , Balci Deniz 
Published: February 2025

Introduction:
Since its beginning in 1963, Liver Transplantation (LT) has significantly advanced, now including transplant oncology. As indications broaden, donor supply reduces. The two-stage RAPID procedure (initially abbreviated as “Resection And Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy”) has emerged to address the use of small-for-size (SFS) grafts. However, a comprehensive evaluation of RAPID is essential given its novelty, scarcity, and diverse outcomes reported.

Methods:
The RAPID Consensus International Society of Liver Surgeons (ISLS) 2023 Zurich initiative established evidence around the RAPID procedure using the Danish Model of Consensus. Engaging an international community of specialists, the initiative ensured multidisciplinary involvement and used the GRADE framework to evaluate the quality of evidence and grade the recommendations.

Results:
Comprehensive discussions and debates led to internationally recognized recommendations addressing perioperative measures for RAPID. Key recommendations highlighted the significance of standardized nomenclature, specific indications, graft criteria, surgical techniques, optimal interstage timings, and measures to manage potential complications.

Conclusion:
The consensus provides recommendations for the RAPID procedure, emphasizing transparency and outcome reporting. Establishing dedicated registries can improve care standards which may ensure the benefits of RAPID by maximizing patient safety and improving outcomes.
What Stage of Intraoperative Margin Reflex Distance Should be Used as a Guide in Blepharoptosis Repair?
Authors: Kokubo Kenichi , Katori Nobutada , Hayashi Kengo , Fujiwara Bunrei , Oi Kousuke , Ikeda Hiroaki , Hayashi Ayato 
Published: February 2025

Levator aponeurosis advancement is one of the most well-known surgical procedures performed for blepharoptosis globally. Nevertheless, a patient’s condition at 6 months after surgery is difficult to accurately predict before or during levator aponeurosis advancement. This study aimed to determine which margin reflex distance (MRD) during levator aponeurosis advancement strongly correlates with MRD at 6 months after surgery. This study included 126 eyelids of 63 patients who underwent bilateral levator aponeurotic advancement for acquired ptosis and were followed up for >6 months. Frontal-view photographs were taken in the sitting position for all patients before surgery, during surgery (at the time of levator aponeurosis fixation to the tarsal plate, at the time of double eyelid formation, and at the time immediately after surgery), and at 1, 3, and 6 months after surgery. Subsequently, the MRD was measured using a photograph displayed on the personal computer screen. The time of double eyelid formation showed a higher correlation with all time points (1, 3, and 6 mo after surgery) than the time of levator aponeurosis fixation and the time immediately after surgery. In particular, the correlation coefficients at 6 months after surgery were 0.243 (P=0.006) when the levator aponeurosis was fixed, 0.348 (P=0.000063) when the double eyelid was created, and 0.278 (P=0.002) immediately after surgery. The MRD at the time of double eyelid formation during surgery is important for determining postoperative eyelid opening.
Effects of Peripheral Nerve Block on Perioperative Recovery Following Major Thoracic and Abdominal Surgery
Authors: Zhang Zhen , Li Chen , Xu Zhen-Zhen , Ma Jia-Hui , Wang Dong-Xin 
Published: February 2025

Objective:
To test the hypothesis that peripheral nerve block (PNB) use might be associated with improved perioperative outcomes following major surgery.

Summary Background Data:
PNB has been used to improve postoperative analgesia.

Methods:
This was a retrospective cohort study with propensity score matching. We included patients aged ≥65 years who underwent major (≥2 h) non-cardiac thoracic and abdominal surgery under general anesthesia. Data were analyzed according to whether patients received PNB or not during anesthesia. Our primary outcome was the length of hospital stay; secondary outcomes included occurrence of major complications in hospital after surgery.

Results:
A total of 1,915 patients were included in the full cohort, of whom 1,316 received PNB and 599 did not; 1,174 patients remained in the cohort after matching, with 587 in each group. Length of hospital stay after surgery was shorter in patients who received PNB than in those who did not (7 days [5 to 9] with PNB vs. 7 days [5 to 11] without PNB: HR 1.15, 95% CI 1.02 to 1.29, P=0.012). When compared with patients who did not receive PNB, those who received PNB developed fewer major complications during hospital stay (RR 0.41, 95% CI 0.30 to 0.58, P<0.001). Patients with PNB required less supplemental analgesia within 72 h (RR 0.70, 95% CI 0.59 to 0.84, P<0.001).

Conclusions:
Use of PNB was associated with shortened length of hospital stay and reduced major complications in older patients after major non-cardiac thoracic and abdominal surgery, possibly due to improved analgesia.
Multimodality Therapy Including Pleurectomy/Decortication in Pleural Mesothelioma: Long-Term Outcomes in 152 Consecutive Patients A Retrospective Cohort Study
Authors: Lang-Lazdunski Loïc , Zhi Zhang Yu , Nicholson Andrew G 
Published: February 2025

Objective:
Evaluate the long-term outcomes of pleurectomy decortication, systemic chemotherapy and prophylactic radiotherapy in pleural mesothelioma (PM).

Summary background data:
There is no known cure for PM and cytoreductive surgery remains controversial.

Methods:
Retrospective analysis of a cohort of patients treated consecutively between October 2004 and October 2019. Patients with PM were referred to our clinic and those with favorable prognostic factors and with completely resectable disease were selected for trimodality therapy. Our treatment protocol involved total pleurectomy decortication (P/D) and hyperthermic intrapleural povidone-iodine, prophylactic chest wall radiotherapy and systemic chemotherapy. 18FDG-PET-CT was used routinely to diagnose disease recurrence. Further systemic therapies were administered when appropriate. Survival and prognostic factors were analyzed using the Kaplan-Meier method and univariate and multivariate Cox regressions.

Results:
152 consecutive patients had P/D performed with curative intent. Median age was 64 years and the male/female ratio was 123/29. Thirty-one patients (20.4%) had received chemotherapy preoperatively. Thirty-five patients (23%) underwent extended resections. Sixty-four patients (42%) suffered a postoperative complication, but 90-day mortality was nil. Histological types were epithelioid in 107 patients (70.4%) and non-epithelioid in 45 (29.6%). Pathological stages were: I:88, II: 0, III: 63, and IV:1 (8th TNM classification). Six patients (4%) did not receive systemic chemotherapy and three (2%) no radiotherapy, postoperatively. Seventy-four patients (48.7%) received further systemic therapies for relapse. Median overall survival was 31.7 months, 35.0 months for epithelioid and 18.3 months for non-epithelioid histology. Histological type was the only predictor of overall survival, independent of resection status, pathological stage, or lymph node status, on multivariate analysis.

Conclusions:

P/D is a safe and well-tolerated procedure resulting in no mortality and acceptable morbidity. Most patients can receive radiotherapy and systemic chemotherapy in due time and receive further therapies on relapse, resulting in prolonged survival mainly in those with early-stage epithelioid mesothelioma.
The Diabetes Remission Index (DRI)
Authors: Ghusn Wissam , Ma Pearl , Vierkant Robert A. , Mundi Manpreet , Fehervari Matyas , Ikemiya Kayla , Hage Karl , Acosta Andres , Camilleri Michael , Abu Dayyeh Barham , Higa Kelvin , Ghanem Omar M. 
Published: February 2025

Objective:
To develop and validate two predictive models, the Diabetes Remission Index (DRI) and the Weight Loss-Adjusted Diabetes Remission Index (W-DRI), for assessing type 2 diabetes (T2D) remission following metabolic and bariatric surgery (MBS).

Summary Background Data:
Metabolic and bariatric surgery, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), is highly effective in achieving T2D remission, but outcomes vary across populations. Predicting remission remains critical for individualized patient care and optimizing surgical outcomes. Existing tools focus on general outcomes, and a specific model incorporating weight loss data has been lacking.

Methods:
This multicenter, retrospective cohort study included patients with T2D and overweight/obesity (BMI ≥27 kg/m²) who underwent RYGB or SG between 2008 and 2018. Institution 1 (I-1) data (n=503) was used to develop and internally validate the models, while Institution 2 (I-2) data (n=409) was used for external validation. The DRI model incorporated preoperative variables, and the W-DRI model additionally included post-surgical weight loss. Predictive accuracy was assessed using AUC, calibration plots, and stratified analyses.

Results:
In I-1, 44.7% of patients achieved T2D remission, with a DRI model AUC of 0.80. In I-2, 52.6% achieved remission, with a model AUC of 0.78. Incorporating weight loss improved W-DRI predictive accuracy (AUC: 0.82 in I-1, 0.79 in I-2). Calibration plots demonstrated strong agreement between predicted and observed remission rates. An online DRI and W-DRI calculator is available via the Mayo Clinic webpage: https://newsnetwork.mayoclinic.org/dri-calculator/.

Conclusions:
The DRI and W-DRI models accurately predict T2D remission post-MBS, enabling personalized patient care and informed decision-making. Further validation across diverse populations is warranted.
Efficient and Secureµ-Training andµ-Fine-Tuning for Edge-Based TinyML Personalization with Future-Guided Self-Distillation
Authors: Huang Zhaojing , Yu Leping , Herbozo Contreras Luis Fernando , Kavehei Omid 
Published: February 2025

AbstractThis study presents a novel approach for training and fine-tuning machine learning models for bio-signal analysis on edge medical devices. The proposed technique applies to various physiological signals, with electrocar-diogram (ECG) data used as a case study. Our methodology integrates full training with a novel technique termedµ-Training, in which a compact model’s encoder and decoder layers are frozen while the middle layer remains trainable. We evaluate the effectiveness of this approach across different stages, including full training,µ-Training, andµ-Fine-Tuning. The model’s performance is assessed using in-sample data from the Telehealth Network of Minas Gerais (TNMG) dataset and out-of-sample testing on the China Physiological Signal Challenge 2018 (CPSC) dataset. Results indicate that the combined training approach matches or outperforms traditional full training and fine-tuning while significantly enhancing computational efficiency. Additionally, the model is deployed on an edge device forµ-Fine-Tuning, demonstrating its capability even in resource-constrained environments. We utilize Radxa Zero hardware for demonstration and deployment, though the method is compatible with a range of edge devices. We further investigated model size optimization to identify the optimal cost-efficiency trade-off and integrated a novel self-distillation technique, which improves performance across almost all metrics. Our findings show that this approach boosts computational efficiency and resource utilization—making it promising for real-time bio-signal processing on edge devices. Self-distilledµ-Training also has potential beyond medical and TinyML applications. To demonstrate its effectiveness, we integrated self-distilledµ-Training into the standard procedure and found it outperforms conventional training.