bluuebunny/crossref_metadata_2025_split huggingface dataset:
The changing use and program costs of HIV-related laboratory testing over 20 years in an HIV cohort
Authors: Dalere Jessica , Lang Raynell , Krentz Hartmut B. , Beckthold Brenda , Gill M. John 
Published: August 2023

Purpose of review
The improved health of persons with HIV (PWH) resulting from antiretroviral therapy (ART) has led to recommendations for reduced laboratory monitoring. We studied, for all PWH in care over 20 years at the Southern Alberta Clinic (SAC), Canada, the changing use and results of HIV-specific laboratory testing [i.e., CD4+ testing, plasma HIV viral load (PVL), and genotypic antiretroviral resistance testing (GART)].
In this descriptive retrospective longitudinal cohort observational study, we examined HIV-specific laboratory testing for all PWH from 2000 to 2020 within the context of HIV-related health outcomes, program costs, and mortality.

Recent findings
The number of PWH in care increased from 755 in 2000 to 2050 in 2020. Annual CD4+ testing per PWH increased from 2.7 per person in 2000 peaking to 3.5 in 2005 but decreasing to 1.4 by 2020. Annual PVL tests per PWH gradually decreased from 3.2 in 2000 to 2.0 in 2020. GART increased from 93 tests in 2000 to 315 in 2008 decreasing to 127 in 2020. Patients received GART at baseline, and after a viral breakthrough when indicated. Viral suppression rates for the population increased from 66 to 96%; median CD4+ cell count increased from 443 to 470 cells/μl, and overall morbidity decreased from 9.2 to 2.0% by 2020, respectively. Annual per patient laboratory costs decreased from a high of $302 in 2008 to $161 by 2020.

Summary
The reduced annual laboratory surveillance per PWH associated with modern ART resulted in modest cost savings and no apparent loss in quality of HIV care.
Medium Definition Liposuction Abdominoplasty
Authors: Borille Giuliano , Pereira Filho Gustavo , Zancanaro Mariana , Giannini Renato , Reynosso Luis , Avalos Victor , Nahas Fabio 
Published: August 2023

Background:
Not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen. Medium definition liposuction, together with the removal of abdominal skin, can recreate an adequate connection between the skin/subcutaneous components and the myo-aponeurotic layer, resulting in the perception of muscle definition.

Methods:
Over a period of 36 months, 351 patients underwent medium definition liposuction associated with abdominoplasty performed by a single surgeon (G.B.). All patients underwent an evaluation through digital photographs by two independent senior plastic surgeons, using an objective grading system for aesthetic outcomes proposed by Strasser, 12 months after the operation.

Results:
According to the Strasser Scale, 326 patients (93%) were considered to have good and excellent results. Twenty-two patients (6.2%) had moderate/mediocre results‚ and three patients (0.8%) had poor results. The overall complication rate was 4.8%.

Conclusion:
Medium definition liposuction associated with abdominoplasty has been shown to be effective, safe, and reproducible for most patients.
Superficially Herniated Loop of Facial Artery: A Potential Trap for the Unsuspecting Practitioner
Authors: von Haven Haley N. , Soares Danny J. 
Published: August 2023

Summary:
The anatomy of the facial artery is complex and prone to significant variations, rendering it susceptible to vascular injury secondary to injectable treatments. Despite the known variation in the course and branching pattern of this important arterial conduit, significant anomalies in the depth of the artery, including occurrences of vessel herniation, are not as well characterized. We describe an instance of a superficially herniated loop of facial artery presenting as a buccal mass erroneously targeted with an injectable suspension of triamcinolone.
What Does “Dr. Google” Show Patients Searching for Breast Reconstruction Outcomes Photographs?
Authors: Nicklaus Krista M. , Gonzalez Xiomara T. , Sachdev Koushalya , Liu Jun , Chopra Deepti , Hoffman Aubri S. , Hanson Summer E. , Markey Mia K. , Reece Gregory P. 
Published: August 2023

Background:
Many women with breast cancer search the internet for photographs of their potential reconstruction outcomes, but little is known about the quality, variety, and relevance of images patients are viewing.

Methods:
Breast reconstruction outcome photographs identified by a Google Images search were assessed based on the American Society of Plastic Surgeons/Plastic Surgery Foundation photographic guidelines. Information such as source metadata, breast reconstruction procedure information, and subject demographics was collected from the photographs. Additional analyses were conducted to assess whether nipple reconstruction or tattooing occurred and was disclosed, whether a symmetry procedure was performed and disclosed, and whether donor site scarring is visible in abdominal flap photographs.

Results:
We acquired and analyzed 114 photograph sets. Although a variety of images were readily available, the majority of photograph sets did not follow photographic guidelines or provide sufficient information. Most photograph sets (60%) indicated symmetry procedures when a symmetry procedure was evident, but only 40% of photograph sets disclosed a nipple procedure when a nipple procedure was evident. Only 40% of abdominal flap photographs showed donor site scarring. Subject demographics were largely missing: 50% of photograph sets included subject age, 3% included race or ethnicity, and 12% included weight or BMI.

Conclusions:
Although breast reconstruction outcome photographs shown by “Dr. Google” represent a variety of reconstruction types, they typically lack information that a patient needs to assess self-applicability. Patients may benefit from discussion with their healthcare team about the strengths and limitations of breast reconstruction outcome photographs available on the internet.
Release of Severe Postburn Contracture of Index Finger with Two-stage Reconstruction
Authors: Buja Zejnë 
Published: August 2023

Summary:
Postburn contractures are the result of deep burns that are not treated properly and promptly. Severe contractures require more than one surgery to be completely relieved. Their surgical treatment is very difficult and challenging for reconstructive surgeons. The author presents a case with severe postburn contracture of the index finger especially at the DIP joint with an angle of 110 degrees, which was released with a full skin graft in two stages of reconstruction. The application of this procedure enables the complete release of severe contractures and protects the fingers from their loss as a result of the shortening of vascular structures.
Complications after Nonoperative Management of Hamate Fractures
Authors: Ta Canhnghi N. , Finley Zachary , Medvedev Gleb A. 
Published: August 2023

Background:
Hamate fractures are an infrequent injury and are often missed or have a delayed diagnosis with potential for significant patient morbidity. There is a relative paucity in the literature involving large population studies of hamate fractures and subsequent complications. Gaining a better understanding of complications associated with nonoperative management will help guide the decision for operative intervention.

Methods:
The PearlDiver patient records database was used to query for patients who sustained a hamate fracture using ICD-9 and ICD-10 codes. Postinjury complications within 1 year of diagnosis were assessed using ICD-9 and ICD-10 codes for diagnoses of complications.

Results:
A total of 1120 patients who sustained a hamate hook or body fracture met inclusion and exclusion criteria and were included in the study. Patients who were managed nonoperatively showed a nonunion rate of 2%, ulnar neuropathy rate of 1.7%, and tendon rupture rate of 0.2%. In a subanalysis using only ICD-10 codes to distinguish between hook and body fractures, hook fractures demonstrated a nonunion rate of 2.2%, ulnar neuropathy rate of 2.7%, and tendon rupture rate of 0%, while body fractures had a nonunion rate of 1.2%, ulnar neuropathy rate of 1%, and tendon rupture rate of 0%.

Conclusion:
The current study shows very low rates of nonunion, ulnar neuropathy and tendon rupture after nonoperative management of hamate fractures.
Association between anterior chamber biometry and posterior capsular defects
Authors: Arad Tschingis , Engel Xenia , Ackermann Hanns , Schmack Ingo , Kohnen Thomas 
Published: August 2023

Purpose:
To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction.

Setting:
University Eye Hospital, Goethe University Frankfurt, Germany.

Design:
Population-based study.

Patients and methods:
Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values.

Results:
A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences (P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 μm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT (P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29).

Conclusions:
In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.
Efficacy of non-opioid analgesics and regional techniques for perioperative pain management in laparoscopic gynecological surgery: a systematic review and network meta-analysis
Authors: Ding Xinyun , Ma Yuan , Ma Yue , Chen Congmin , Zhang Xiaohui , Duan Qianwen , Ma Yuqing 
Published: August 2023

Background:
The optimal approach for perioperative pain management in laparoscopic gynecological surgery is unclear due to a lack of comprehensive analysis, which limits the development of evidence-based ERAS protocols. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.

Materials and Methods:
This study conducted a systematic literature search in PubMed, Embase, CENTRAL, Web of Science, and CINAHL from inception to December 3, 2021, and updated on August 19, 2022. Randomized controlled trials comparing the perioperative use of non-opioid analgesics and regional techniques in adults undergoing elective laparoscopic gynecological surgery under general anesthesia were included in the analysis, either alone or in combination. The co-analgesic interventions during the perioperative period for the intervention and control groups of each eligible study were also considered. We assessed the risk of bias using the Risk of Bias 2 tool and evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) approach. Bayesian network meta-analysis was used to estimate the efficacy of the analgesic strategies. The primary outcomes were pain score at rest and cumulative oral morphine milligram equivalents at 24 hours post-operatively.

Results:
Overall, 108 studies with 9582 participants and 35 different interventions were included. Compared with inert treatments, combinations of two or more interventions showed better efficacy and longer duration in reducing post-operative pain and opioid consumption within 24 hours than monotherapies, and showed stepwise enhanced effects with increasing analgesic modes. In combination therapies, regional techniques that included peripheral nerve blocks (PNBs) and intraperitoneal local anesthetics, in combination with non-opioid systemic analgesics, or combining local anesthetics with adjuvant drugs, were found to be more effective. Monotherapies were found to be mostly ineffective. The most effective PNBs were found to be ultrasound-guided transversus abdominis plane block with adjuvant and ultrasound-guided quadratus lumborum block.

Conclusions:
These results provide robust evidence for the routine use of regional techniques in combination with non-opioid analgesics in perioperative pain management. However, further better quality and larger trials are needed, considering the low confidence levels for certain interventions.
Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes
Authors: Plotsker Ethan L. , Stern Carrie S. , Graziano Francis D. , Rubenstein Robyn N. , Vingan Perri S. , Haglich Kathryn , Monge Jasmine , Disa Joseph J. , Mehrara Babak J. , Dayan Joseph H. , Allen Robert , Matros Evan , McCarthy Colleen , Nelson Jonas A. 
Published: August 2023

Background:
Textured implants have been linked to breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants.

Methods:
Complication rates and BREAST-Q scores were compared between (1) asymptomatic patients who underwent conversion from textured to smooth implants (n = 224), (2) symptomatic patients who underwent conversion from textured to smooth implants (n = 83), (3) patients who underwent explantation without replacement (n = 44), and (4) patients who underwent replacement with autologous reconstruction (n = 33). Linear regression examined PROs controlling for clinical and surgical variables.

Results:
Overall complication rates in 384 patients (637 implants) differed across groups (P = 0.034), with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in Satisfaction with Breasts (P < 0.05). Autologous reconstruction patients had significant improvements in Satisfaction with Breasts sustained after 3 months postoperatively (P < 0.01) and Sexual Well-being sustained after 6-months postoperatively (P < 0.05). Patients who underwent removal without replacement had lower Physical Well-being of the Chest scores at 1 year or more than the other groups.

Conclusions:
Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A 9-Year Review of Ethics Complaints to the American Society of Plastic Surgeons
Authors: Makar Katelyn G. , Bajaj Anureet K. , Park Julie E. , Preminger B. Aviva , Vercler Christian J. 
Published: August 2023

Background:
The American Society of Plastic Surgeons (ASPS) provides an avenue for filing formal complaints regarding unethical behavior of members. These complaints are investigated by the ethics committee and referred to the judicial council if a violation may have occurred.

Methods:
A review of complaints filed with the ASPS from 2013 through 2021 was performed. Data surrounding both complaints and complainant type were reviewed, as well as region of complaint origin. Categories of violations resulting in formal investigations and judicial council referrals were also reviewed.

Results:
A total of 584 complaints were filed with the ASPS ethics committee from 2013 through 2021, which was nearly 100 fewer than from a previous review of 2004 through 2008. Twenty-one percent of complaints were formally investigated by the ethics committee, and 26% of these were referred to the judicial council. The most common complaint investigated was related to advertising or misleading communications; the most common complaint referred to the judicial council was regarding expert testimony. Most complaints were filed by ASPS members.

Conclusions:
The total number of complaints filed over time has decreased significantly, the reasons for which are unclear. Evolution of culture and thought likely had an impact, not only on specific behaviors but also on the likelihood of reporting those behaviors. It remains incumbent on plastic surgeons to use the self-regulating mechanisms available to maintain the autonomy plastic surgery enjoys as a profession.
Revision Phalloplasty: Evaluation, Algorithms, and Techniques for Salvage after Major Complications
Authors: Keller Patrick R. , Chen Mang L. , Ovadia Steven A. , Reiche Erik , Safa Bauback , Coon Devin 
Published: August 2023

Background:
Phalloplasty is among the most complex and technically demanding reconstructive procedures. As a larger pool of surgeons perform this difficult procedure, more patients will present with major complications. There are few published data on the comprehensive evaluation and management of these patients, particularly those needing correction of multiple ongoing complications, which may require consideration of starting over with a new microsurgical procedure versus salvage of the existing flap.

Methods:
A literature review on complications of phalloplasty was conducted in combination with drawing upon the experience of 2 high-volume phalloplasty teams (Johns Hopkins/Harvard and GU Recon Clinic/Buncke Clinic) in treating patients with severe postsurgical issues. The purpose was to analyze critical factors and develop algorithms for secondary revision.

Results:
Common complications of phalloplasty include urethral strictures and fistulas, diverticula, excess bulk, phalloplasty malposition, hypertrophic or keloidal scarring, and partial or total flap loss. In severe cases, local flaps or free flaps may be required for reconstruction. The decision to revise the existing neophallus or start over with a new flap for phalloplasty is particularly critical. Multidisciplinary team collaboration is essential to develop comprehensive plans that will resolve multiple concomitant problems while meeting patient goals for a functional and aesthetic neophallus.

Conclusions:
Preserving the original flap for phalloplasty is ideal when feasible. Additional local or free flaps are sometimes necessary in situations of significant tissue loss. In severe cases, complete redo phalloplasty is required. The algorithms proposed provide a conceptual framework to guide surgeons in analyzing and managing severe complications after phalloplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Frailty and pre-frailty phenotypes increase the odds of abnormal cognitive impairment screens in people living with HIV
Authors: Makinson Alain , Allavena Clotilde , Abulizi Xian , Slama Laurence , Case Antoine , Trouillet Marion Bourgey , Blondel Guillaume Martin , Geny Christian , Leclercq Pascale , Cazanave Charles , Bonnet Fabrice , Naqvi Alissa , David-Chevallier Perla , Arvieux Cédric , Katlama Christine , Cabie André , Andriantsoanirina Valérie , Blain Hubert , Meyer Laurence 
Published: August 2023

Objective:
Evaluate whether pre-frail and frail PLWH have a higher risk of cognitive impairment on screens.

Methods:
Analysis of PLWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) <26 was compared in frail/pre-frail versus robust PLWH.

Results:
A total of 503 PLWH were enrolled with a median age of 73 years, IQR [71–77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. 294 (58.5%) PLWH had a MoCA score <26; 182 (36%) a MoCA score ≤ 23. Frailty, pre-frailty, and robustness were found in 13.1%, 63.6% and 23.3% participants, respectively. PLWH with a MoCA < 26 had a significantly higher risk of being frail/prefrail, this before (OR = 2.31 [95% CI: 1.50, 3.57]), and after adjustment for confounders (OR = 1.80, [1.07–3.01]). The risk of being frail/prefrail in patients with a MoCA ≤ 23 was higher (adjusted OR = 2.75, [95%CI: 1.46–5.16]). Other factors independently associated with a MoCA < 26 were older age, birth outside of France, and a lower education level and being diabetic.

Conclusions:
Abnormal MoCA screens were frequent in our cohort of PLWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PLWH. Frailty/pre-frailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PLWH with controlled disease.
Frequency of Atypical Pulmonary Manifestations of COVID-19 Patients on Chest CT-scan: A cross-sectional study
Authors: Borji Soheila , Isavand Pouria , Azami Mobin , Ghafouri Ehsan 
Published: August 2023

AbstractBackgroundChest CT examination is significant in COVID-19 diagnosis due to its high sensitivity. Although typical chest CT findings have been discussed thoroughly in the literature throughout the pandemic, we aimed to investigate the prevalence of the atypical conclusions during the start of the Omicron variant insurgency and compare the results to studies conducted before its outbreak.Methods606 confirmed COVID-19 cases were included in this study based on inclusion and exclusion criteria during January and February 2022. Demographic information of patients, including age and sex, was recorded. The computed tomography (CT) examination was carried out using a 100-slice scanner (Philips Brilliance 6 CT Scanner). One radiology attending and one resident evaluated SARS-CoV-2 RT-PCR-positive patients for atypical pulmonary CT findings. The obtained data were evaluated using R software version 4.1.1.Results55% of patients were female, and the median age was 56 (IQR: 42, 69) 59% of patients had atypical findings on their pulmonary CT examination. These findings showed that pleural abnormalities were the most frequent atypical findings, with pleural thickening being the most common (17%). The double halo sign represented the least frequent atypical sign (0.2%).ConclusionAtypical findings were more prevalent in this study than its predecessors, while we acknowledge that other factors, such as study design and patient population, could have impacted it. The presence of atypical signs generally was not correlated with specific demographic groups, while some of these signs were more frequent in some groups.