bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipoabdominoplasty: What We Have Implemented and What We Have Modified over 26 Years
Authors: Cárdenas-Camarena Lázaro , Reyes-Herrera Martín Fernando , Vargas-Flores Edgar , López-Fabila Daniel Atl , Robles-Cervantes José Antonio 
Published: February 2023

Summary:
Lipoabdominoplasty is one of the most commonly performed procedures in body-contouring surgery. We present a retrospective study of our 26 years of experience to improve the results and assure the greatest possible safety in lipoabdominoplasty. We include all of our female patients who underwent lipoabdominoplasty performed from July 1996 to June 2022, dividing the patients into two groups: group I underwent circumferential liposuction avoiding abdominal flap liposuction for the first 7 years, and group II underwent circumferential liposuction including abdominal flap liposuction for the subsequent 19 years, pointing out the differences in the processes, results, and complications of both groups. Over a period of 26 years, 973 female patients underwent lipoabdominoplasty: 310 in group I and 663 in group II. Ages were very similar; however, weight, BMI, amount of liposuction material, and weight of the abdominal flap removed were higher in group I. Twenty percent of patients in group I were obese compared to 7% in group II. The average amount of liposuction in group I was 4990 mL compared to 3373 mL in group II and 1120 g of abdominal flap in group I versus 676 g in group II. Minor and major complications were 11.6% and 1.2% in group I versus 9.2% and 0.6% in group II, respectively. In our more than 26 years of performing lipoabdominoplasty, we have maintained most of our initial procedures. These processes have allowed us to perform surgery safely and effectively with a low morbidity rate.
A Multicenter Noninferiority Study Comparing Safety and Effectiveness of Hyaluronic Acid Fillers for Correction of Nasolabial Folds in Chinese Subjects
Authors: Li Wenzhi , Li Bi , Hofmann Matthias , Klein Gudrun , Xie Hongfu 
Published: February 2023

Background:
Hyaluronic acid fillers are the preferred choice for minimally invasive facial volume restoration. In this study, a split-face design was used to compare the effectiveness and safety results of Belotero Balance Lidocaine (BEL) and Restylane (RES, control) to investigate whether BEL is noninferior compared with RES in nasolabial fold (NLF) correction.

Methods:
This was a prospective, controlled clinical study in Chinese subjects. Subjects with symmetrical moderate NLFs according to the Wrinkle Severity Rating Scale were randomized to receive BEL in one NLF and RES in the other. The primary objective was to investigate whether BEL is noninferior compared with RES after being injected mid-dermally in moderate NLFs after 6 months. Secondary objectives included responses at other visits and pain sensation. Treatment-emergent adverse events (TEAEs) were assessed.

Results:
A total of 220 subjects were enrolled. The Wrinkle Severity Rating Scale response rates at month 6 were 62.9% for BEL versus 64.9% for RES, demonstrating noninferiority. The secondary endpoints supported this. Significantly reduced pain scores were observed for BEL versus RES. For both products, injection site nodule and bruising were the most frequent treatment-emergent adverse events at the injection site. All treatment-related treatment-emergent adverse events were mild.

Conclusions:
The study showed that BEL is effective and well tolerated for correction of moderate NLFs in Chinese subjects. Noninferiority of BEL was demonstrated compared with RES, and regardless of applied pain treatment, a further reduction in injection pain was observed in BEL.
Burden of fatty liver and hepatic fibrosis in persons with HIV: A diverse cross-sectional US multicenter study
Authors: Gawrieh Samer , Lake Jordan E. , Debroy Paula , Sjoquist Julia A. , Robison Montreca , Tann Mark , Akisik Fatih , Bhamidipalli Surya S. , Saha Chandan K. , Zachary Kimon , Robbins Gregory K. , Gupta Samir K. , Chung Raymond T. , Chalasani Naga , Corey Kathleen E. 
Published: February 2023

Background & Aims:
The current prevalence of fatty liver disease (FLD) due to alcohol-associated (AFLD) and nonalcoholic (NAFLD) origins in US persons with HIV (PWH) is not well defined. We prospectively evaluated the burden of FLD and hepatic fibrosis in a diverse cohort of PWH.

Approach & Results:
Consenting participants in outpatient HIV clinics in 3 centers in the US underwent detailed phenotyping, including liver ultrasound and vibration-controlled transient elastography for controlled attenuation parameter and liver stiffness measurement. The prevalence of AFLD, NAFLD, and clinically significant and advanced fibrosis was determined. Univariate and multivariate logistic regression models were used to evaluate factors associated with the risk of NAFLD. Of 342 participants, 95.6% were on antiretroviral therapy, 93.9% had adequate viral suppression, 48.7% (95% CI 43%–54%) had steatosis by ultrasound, and 50.6% (95% CI 45%–56%) had steatosis by controlled attenuation parameter ≥263 dB/m. NAFLD accounted for 90% of FLD. In multivariable analysis, old age, higher body mass index, diabetes, and higher alanine aminotransferase, but not antiretroviral therapy or CD4+ cell count, were independently associated with increased NAFLD risk. In all PWH with fatty liver, the frequency of liver stiffness measurement 8–12 kPa was 13.9% (95% CI 9%–20%) and ≥12 kPa 6.4% (95% CI 3%–11%), with a similar frequency of these liver stiffness measurement cutoffs in NAFLD.

Conclusions:
Nearly half of the virally-suppressed PWH have FLD, 90% of which is due to NAFLD. A fifth of the PWH with FLD has clinically significant fibrosis, and 6% have advanced fibrosis. These data lend support to systematic screening for high-risk NAFLD in PWH.
Sharps Injury Rates Reported Among US Workers
Authors: Kennedy Erika J. , Hendricks Kitty J. , Casey Megan 
Published: February 2023

ObjectiveTo examine sharps injury (SI) rates among US workers treated in hospital emergency departments.MethodsA national probability-based sample of approximately 67 US hospital emergency departments from the National Electronic Injury Surveillance System—Occupational Supplement was used to examine annual national estimates of SI rates (number of injuries/10,000 full-time equivalents) for US workers from 2006 to 2020.ResultsAmong the general US worker population, the 25- to 34-year age group experienced the highest annual SI rate. Health care industry workers experienced SI rates up to 16 times the rate of all US workers.ConclusionYounger age (≤34 years) is associated with increased SI risk. Tailored prevention efforts should be developed to address the specific needs of these workers, especially among health care workers. Continual occupational surveillance will maximize the health and safety of US workers.
Pediatric musculoskeletal infections
Authors: Hannon Megan , Lyons Todd 
Published: February 2023

Purpose of review
The aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease.

Recent findings
In the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella, leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections. Efforts to improve early detection have lead to improving rapid lab diagnostic testing; however, more advanced diagnostics such as arthrocentesis for septic arthritis and MRI for osteomyelitis and pyomyositis, remain the gold standard. Shorter and narrowed antibiotic courses, with appropriate transition to outpatient oral treatment provide effective infection clearance and reduction in complications of disease.

Summary
Advances in diagnostics, including pathogen identification as well as imaging continues to improve our ability to diagnose and treat these infections, although still lack ability to provide definitive diagnosis without more invasive nor advanced techniques.
Communication Frameworks for Palliative Surgical Consultations
Authors: Blumenthaler Alisa N. , Robinson Kristen Ashlee , Hodge Caitlin , Xiao Lianchun , Lilley Elizabeth J. , Griffin James F. , White Michael G. , Day Ryan , Tanco Kimberson , Bruera Eduardo , Badgwell Brian D. 
Published: February 2023

Objective:
To evaluate whether patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios.

Background:
Identifying the patient’s preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making.

Methods:
In a video-vignette–based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed 2 videos depicting a physician-patient encounter in a palliative surgical scenario, in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options. The primary outcome was the patients’ preferred video surgeon.

Results:
One hundred fifty-five patients were approached to participate; 66 were randomized and 58 completed the study (mean age 55.8 ± 13.8 years, 60.3% males). 22 patients (37.9%, 95% CI: 25.4%–50.4%) preferred the surgeon using the BC/WC framework, 21 (36.2%, 95% CI: 23.8%–48.6%) preferred the surgeon using the R/B framework, and 15 (25.9%, 95% CI: 14.6%–37.2%) indicated no preference. High trust in the medical profession was inversely associated with a preference for the surgeon using BC/WC framework (odds ratio: 0.83, 95% CI: 0.70–0.98, P = 0.03). The BC/WC framework rated higher for perceived surgeon’s listening (4.6 ± 0.7 vs 4.3±0.9, P = 0.03) and confidence in the surgeon’s trustworthiness (4.3 ± 0.8 vs 4.0 ± 0.9, P = 0.04).

Conclusions:
Surgeon use of the BC/WC communication framework was not universally preferred but was as acceptable to patients as the traditional R/B framework and rated higher in certain aspects of communication. A preference for a surgeon using BC/WC was associated with lower trust in the medical profession. Surgeons should consider the BC/WC framework to individualize their approach to challenging clinical discussions.
Differences in Sexual and Physical Abuse History by Presenting Chief Complaint in an Outpatient Urogynecology Population
Authors: Hansbarger Molly , Ackenbom Mary , Shepherd Jonathan P. 
Published: February 2023

Importance
One in 3 women experience sexual or physical violence in their lifetimes. Health consequences for survivors are numerous, including urogynecologic symptoms.

Objectives
We aimed to determine prevalence and factors that predict a history of sexual or physical abuse (SA/PA) in outpatient urogynecology, specifically whether the chief complaint (CC) predicts a history of SA/PA.

Study Design
This cross-sectional study analyzed 1,000 newly presenting patients to 1 of 7 urogynecology offices in western Pennsylvania from November 2014 to November 2015. All sociodemographic/medical data were retrospectively abstracted. Univariable and multivariable logistic regression analyzed risk factors based on known associated variables.

Results
One thousand new patients had a mean age of 58.4 ± 15.8 years with a body mass index (BMI) of 28.8 ± 6.5. Nearly 12% reported a history of SA/PA. Patients with CC of pelvic pain were more than twice as likely to report abuse compared with all other CCs (odds ratio [OR], 2.690; 95% confidence interval [CI], 1.576–4.592). Prolapse was the most common CC (36.2%) but had the lowest prevalence of abuse (6.1%). Nocturia was an additional urogynecologic variable predictive of abuse (OR, 1.162 per nightly episode; 95% CI, 1.033–1.308). Increasing BMI and decreasing age both increased the risk of SA/PA. Smoking conferred the highest likelihood of abuse history (OR, 3.676; 95% CI, 2.252–5.988).

Conclusions
Although those with a CC of prolapse were less likely to report abuse history, we recommend routine screening for all women. Pelvic pain was the most common CC among women reporting abuse. Special efforts should be made to screen those at higher risk with complaints of pelvic pain who are younger, smokers, with higher BMI, and with increased nocturia.
d-Mannose for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen: A Randomized Controlled Trial
Authors: Lenger Stacy M. , Chu Christine M. , Ghetti Chiara , Durkin Michael J. , Jennings Zoe , Wan Fei , Sutcliffe Siobhan , Lowder Jerry L. 
Published: February 2023

Importance
Further research is needed to determine whether d-mannose plus vaginal estrogen therapy (VET) is beneficial over VET alone for recurrent urinary tract infection (rUTI) prevention.

Objective
The aim of this study was to evaluate d-mannose efficacy for rUTI prevention in postmenopausal women using VET.

Study Design
We conducted a randomized controlled trial comparing d-mannose (2 g/d) with control. Participants were required to have a history of uncomplicated rUTIs and to remain on VET throughout the trial. They were followed up 90 days for incident UTIs. Cumulative UTI incidences were calculated by the Kaplan-Meier method and compared by Cox proportional hazards regression. For the planned interim analysis, P < 0.001 was considered statistically significant. Futility analysis was performed by generating post hoc conditional power for multiple scenarios.

Results
We evaluated 545 patients for frequent/recurrent UTIs from March 1, 2018, to January 18, 2020. Of these women, 213 had culture-proven rUTIs, 71 were eligible, 57 enrolled, 44 began their planned 90-day study period, and 32 completed the study. At interim analysis, the overall cumulative UTI incidence was 46.6%; 41.1% in the treatment arm (median time to first UTI, 24 days) and 50.4% in the control arm (median, 21 days); hazard ratio, 0.76; 99.9% confidence interval, 0.15–3.97. d-Mannose was well tolerated with high participant adherence. Futility analysis suggested the study lacked power to detect the planned (25%) or observed (9%) difference as statistically significant; the study was halted before conclusion.

Conclusions

d-Mannose is a well-tolerated nutraceutical, but further research is needed to determine whether d-mannose in combination with VET has a significant, beneficial effect beyond VET alone in postmenopausal women with rUTIs.
Carbohydrate Loading and Aspiration Risk in Bariatric Patients: Safety in Preoperative Enhanced Recovery Protocols
Authors: Huang Estella Y , Li Jonathan Z , Chung Daniel , Jacobsen Garth R , Sandler Bryan J , Wadhwa Anupama , Said Engy , Robbins Kimberly , Horgan Santiago , Broderick Ryan C 
Published: February 2023

Background:
Enhanced recovery protocols (ERPs) have been developed to improve perioperative outcomes, however there is ongoing concern for aspiration with recent oral intake in patients with obesity, who may be predisposed to impaired GI motility and greater gastric volumes. We aim to study the safety of a 300mL pre-op carbohydrate loading drink prior to bariatric surgery.

Methods:
Data was collected prospectively from patients undergoing primary bariatric surgery. All bariatric patients at our institution are prescribed a proton pump inhibitor (PPI) for 4 weeks prior to surgery and undergo a screening pre-op EGD before surgery with a traditional 8-hour fast (NOCARB), followed by an intraoperative day-of-surgery EGD with carbohydrate loading (CARB) 2-4 hours prior to incision. Gastric volumes and pH are measured after being endoscopically suctioned via direct visualization during both settings.

Results:
We identified 203 patients, 94 patients (46.3%) in the CARB group, and 109 patients (53.7%) in the NOCARB group. The patients were 82.3% female with a mean age of 42.8 years and average BMI of 41.7 kg/m2. There was no difference in gastric volume between NOCARB and CARB (17.0 versus 16.1mL, p=0.59). The NOCARB group had lower pHs than the CARB group (2.8 versus 3.8, p=0.001). Subset analysis of 23 patients who had measurements on both screening and intra-op EGD revealed less gastric volumes in CARB patients (13.3 versus 18.3, p<0.0001).

Conclusion:
When included in an ERP, PPI use and preoperative carbohydrate loading 2-4 hours before bariatric surgery does not increase aspiration risk based on gastric volumes and pH and should be strongly considered in all eligible bariatric patients.
Athlete deaths during the COVID-19 vaccination campaign: contextualisation of online information
Authors: Binkhorst Mathijs , Goldstein Daniel J. 
Published: February 2023

AbstractBackground and aimLay people and medical professionals have suggested a link between (mRNA) COVID-19 vaccination and a purported increase in sudden cardiac arrest (SCA) and death (SCD) among athletes. We aimed to compare the athlete death rate in 2021-2022 with pre-pandemic estimates and investigate the role of vaccination.MethodsA comprehensive, much referenced, publicly available list of health issues, emergencies, and SCA/SCD in athletes from January 2021 to December 2022 was analysed. Demographic data, country, type of sport, vaccination status, and possible association between reported medical events and vaccination were evaluated for the complete set of athletes. The following data were specifically assessed for cases of SCD in young US athletes and compared to matched data from pre-pandemic studies: average annual SCD number, mean age, male/female ratio, sports with highest death toll, cause and scene of death, and relation to exercise. Descriptive statistics were used.ResultsThe list contained 1653 entries. (Former) athletes, aged 5-86 years, from 99 countries, participated in 61 different sports. In multiple cases, causes of and circumstances surrounding medical events were irretrievable. Many cases involved non-cardiovascular, exercise-unrelated aetiologies. Vaccination details were scarce. In 63 (3.8%) cases, including 9 fatal events, there was a plausible association with COVID-19 vaccination. In US athletes aged 9-40 (mean 22.7) years, 166 SCD cases were identified (average 83/year), mainly in males (83%) and in football (39.8%) and basketball (16.9%). Main causes of death were non-cardiovascular exercise-unrelated (22.9%) or unknown (50.6%). Deaths primarily occurred at rest (32.5%) or under unknown circumstances (38.6%). SCD characteristics were similar to those of two pre-pandemic studies with comparable datasets.ConclusionSCD rate among young US athletes in 2021-2022 was comparable to pre-pandemic estimates. There is currently no evidence to substantiate a link between (mRNA) COVID-19 vaccination and SCD in (young) athletes.
Predicting seizure outcome after epilepsy surgery: do we need more complex models, larger samples, or better data?
Authors: Eriksson Maria H , Ripart Mathilde , Piper Rory J , Moeller Friederike , Das Krishna B , Eltze Christin , Cooray Gerald , Booth John , Whitaker Kirstie J , Chari Aswin , Sanfilippo Patricia Martin , Caballero Ana Perez , Menzies Lara , McTague Amy , Tisdall Martin M , Cross J Helen , Baldeweg Torsten , Adler Sophie , Wagstyl Konrad 
Published: February 2023

AbstractObjectiveThe accurate prediction of seizure freedom after epilepsy surgery remains challenging. We investigated if 1) training more complex models, 2) recruiting larger sample sizes, or 3) using data-driven selection of clinical predictors would improve our ability to predict post-operative seizure outcome. We also conducted the first external validation of a machine learning model trained to predict post-operative seizure outcome.MethodsWe performed a retrospective cohort study of 797 children who had undergone resective or disconnective epilepsy surgery at a single tertiary center. We extracted patient information from medical records and trained three models – a logistic regression, a multilayer perceptron, and an XGBoost model – to predict one-year post-operative seizure outcome on our dataset. We evaluated the performance of a recently published XGBoost model on the same patients. We further investigated the impact of sample size on model performance, using learning curve analysis to estimate performance at samples up toN=2,000. Finally, we examined the impact of predictor selection on model performance.ResultsOur logistic regression achieved an accuracy of 72% (95% CI=68-75%, AUC=0.72), while our multilayer perceptron and XGBoost both achieved accuracies of 71% (95% CIMLP=67-74%, AUCMLP=0.70; 95% CIXGBoost own=68-75%, AUCXGBoost own=0.70). There was no significant difference in performance between our three models (allP>0.4) and they all performed better than the external XGBoost, which achieved an accuracy of 63% (95% CI=59-67%, AUC=0.62;PLR=0.005,PMLP=0.01,PXGBoost own=0.01) on our data. All models showed improved performance with increasing sample size, with limited improvements aboveN=400. The best model performance was achieved with data-driven feature selection.SignificanceWe show that neither the deployment of complex machine learning models nor the assembly of thousands of patients alone is likely to generate significant improvements in our ability to predict post-operative seizure freedom. We instead propose that improved feature selection alongside collaboration, data standardization, and model sharing is required to advance the field.