bluuebunny/crossref_metadata_2025_split huggingface dataset:
Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study
Authors: Anderson Diana C. , Warner Paige E. , Smith Matthew R. , Albanese Marissa L. , Mueller Ariel L. , Messervy John , Renne B. Christian , Smith Samuel J. 
Published: January 2025

Objectives:
The ICU built environment—including the presence of windows—has long been thought to play a role in delirium. This study investigated the association between the presence or absence of windows in patient rooms and ICU delirium.

Design:
Retrospective single institution cohort study. Delirium was assessed with the Confusion Assessment Method for the ICU.

Setting and Patients:
ICU patients between January 1, 2020, and September 1, 2023, were categorized into windowed or nonwindowed groups based on their ICU room design. The primary outcome was the presence or absence of delirium at any time during the patient’s ICU stay. Secondary outcomes included the presence of delirium during the first 7 days of the ICU stay, hospital length of stay, ICU length of stay, in-hospital mortality, pain scores, and Richmond Agitation-Sedation Scale scores.

Interventions:
None.

Measurements and Main Results:
A total of 3527 patient encounters were included in the final analysis, of which 1292 distinct patient encounters were admitted to a room without windows (37%). Delirium was observed in 21% of patients (460/2235) in windowed rooms and 16% of patients (206/1292) in nonwindowed rooms. In adjusted analyses, patients in windowed rooms were associated with an increase in the odds of the presence of delirium (odds ratio, 1.29; 95% CI, 1.07–1.56; p = 0.008). Patients in windowed rooms were found to have longer hospital (adjusted hazard ratio [aHR], 0.94; 95% CI, 0.87–1.00) and ICU length of stay (aHR, 0.93; 95% CI, 0.87–1.00) compared with patients in the nonwindowed rooms, although this was not statistically significant in adjusted analyses (p = 0.06 and 0.05, respectively). No statistically significant difference was observed in other secondary outcomes.

Conclusions:
The current study provides insightful information regarding associations between a component of the ICU built environment, specifically the presence or absence of windows, and the frequency of delirium.
Investigation of Teicoplanin Trough Concentrations and Safety Following High-Dose Loading in a Pediatric Population
Authors: Okuzono Sayaka , Yamada Takaaki , Motomura Yoshitomo , Kanemasa Hikaru , Ishimura Masataka , Koga Yuhki , Torisu Hiroyuki , Kanno Shunsuke , Ieiri Ichiro , Ohga Shouichi 
Published: January 2025

Background:
Therapeutic drug monitoring–informed teicoplanin dosage adjustments are recommended for safe and effective use. The authors' group previously reported that only half of children reached the recommended blood concentration range at the standard teicoplanin loading dose. It has been suggested that higher loading doses are necessary; however, the usefulness and safety of high-dose loading in pediatric patients in clinical practice are unknown.

Methods:
This retrospective cohort study was conducted between January 2018 and June 2021 using electronic medical records. The analysis included 2- to 16-year-old patients treated with teicoplanin who met the eligibility criteria. We assessed the trough concentration of teicoplanin and its safety after high-dose loading in pediatric patients.

Results:
Overall, 86 patients received a high-dose loading regimen (15 mg/kg every 12 hours for 3 doses, followed by 10 mg/kg once daily). Notably, 55 of the 86 patients (64%) achieved the target trough concentration (>15 mg/L) at significantly higher rates without increasing the incidence of organ damage compared with the standard loading regimen. Multivariate analysis revealed significant differences in age and renal function as factors that inhibited the attainment of the target trough concentration. Simulation analysis using a nomogram stratified by age and renal function revealed that the predicted teicoplanin trough levels were within the target trough values in 73% of patients.

Conclusions:
High-dose teicoplanin loading safely increases trough blood concentrations in the pediatric population. For further optimization, the dose selection should be stratified according to age and renal function.
Mondor’s disease of the penis: a common presentation of an uncommon disease
Authors: Lodhia Jay , Mremi Alex , Maro Nyamhanga Nsaho , Shirima Denis , Mbwambo Orgeness , Ngowi Bartholomeo Nicholaus 
Published: January 2025

Background:
Penile Mondor’s disease (PMD) is a rare clinical condition with an estimated incidence of 1.39%, though the true incidence may be higher as it is often self-limiting. Many patients may not seek medical attention due to stigma, potentially leading to untreated psychological distress and sexual dysfunction.

Case presentation:
We report the case of a young man who presented with a cord-like swelling on his penile shaft, persisting for three months. The swelling was accompanied by mild pain during erection and was initially managed with oral paracetamol. Due to ongoing symptoms and increasing anxiety, the patient sought medical attention. Surgical excision of the swelling was performed, and histopathological analysis confirmed thrombosis of the dorsal penile vein, consistent with a diagnosis of Mondor’s disease (MD) of the penis. The patient had an uneventful recovery, with no recurrence observed at the 2-month follow-up.

Clinical discussion:
The pathogenesis of MD of the penis remains unclear, though trauma to the penile shaft, such as external compression, is considered a primary risk factor. While management is generally conservative, surgery may be warranted in persistent or severe cases.

Conclusion:
Clinicians should consider MD in the differential diagnosis of penile swelling, as it may be a sign of an underlying vascular condition. Early recognition and appropriate management can help alleviate symptoms and reduce psychological distress.
Surgical Dressing Cosmesis in the Immediate Postoperative Setting: A Crowdsourcing-based Study
Authors: Clark Alexa , Su Shannon , Wang Jennifer , Shauly Orr , Losken Albert , Brooks Kendall , Cuzzone Daniel 
Published: January 2025

Background:
Postoperative dressings expedite wound healing and decrease the rate of infection. Options for wound dressings vary based on cost, time to apply, method of wound healing, and availability at the hospital; however, a significant difference in postoperative complications between each type has not been found. As such, this study evaluates patient cosmetic preferences for various wound dressings as it relates to early postoperative satisfaction.

Methods:
A cross-sectional study was conducted using an online crowdsourcing service that connects research studies to participants. The survey asked users to rate images of various wound dressings. Steri-Strips, Dermabond PRINEO (Johnson & Johnson, Ethicon, Inc.), gauze, surgical tape, and metal staples were the materials assessed. The ratings, based on cleanliness, compactness, and aesthetics, culminated in an average cosmetic score for each dressing.

Results:
Controlled for demographics, Steri-Strips and staples were the highest rated dressing types by participants and may correlate with increased patient satisfaction in the immediate postoperative period. Gauze was highly rated for aesthetics and cleanliness but averaged lower scores due to dressing bulk. Dermabond and surgical tape had the lowest and second lowest cosmetic score, respectively.

Conclusions:
Although cost, availability, and time to apply are common factors surgeons evaluate when picking a dressing, cosmetic preference is another consideration. Allowing the patient to participate in dressing selection may give them more perceived autonomy and increase immediate postoperative satisfaction. Limitations of this study include limited lighting/positioning standardization of dressing photographs. This analysis does not consider opinions on later wound healing or scarring using the chosen material.
Postoperative Outcomes in Prepectoral Versus Retropectoral Immediate Implant-based Breast Reconstruction Across Body Mass Index Categories
Authors: Zinner Gauthier , Martineau Jérôme , Lam Giang Thanh , Correia Daniel , Kalbermatten Daniel F. , Oranges Carlo M. 
Published: January 2025

Background:
Prepectoral (PP) immediate implant-based breast reconstruction (IBBR) is gaining popularity over the retropectoral (RP) breast reconstruction technique. This study aims to compare complication rates across different body mass index (BMI) groups in patients undergoing PP or RP IBBR.

Methods:
A monocentric retrospective analysis was conducted on patients who underwent mastectomy and IBBR from January 2018 to December 2023. Preoperative characteristics, BMI, type of mastectomy procedure, PP or RR implant placement, and postoperative outcomes were collected and analyzed.

Results:
A total of 217 patients were included, representing 276 IBBRs. The overall complication rate on a per breast basis was 26.4%. The overall complication rate did not differ across BMI groups (P = 0.314) and between PP and RP IBBR (P = 0.8083). In the PP group, anemia rate increased with low BMI (odds ratio [OR] 0.0215, P = 0.033) and skin complications were more frequent with higher BMI (OR 0.0428, P = 0.0389). In the RP group, higher BMI was correlated with a higher seroma rate in the RP IBBR group (OR 1.2045, P = 0.0334) and a longer hospital length of stay (coefficient 0.248, adjusted R² 0.082, SD 0.098, P = 0.014).

Conclusions:
PP IBBR was associated with a significantly higher rate of anemia in patients with low BMI, and a significantly higher rate of skin complications in high BMI. RP IBBR was associated with higher seroma rate and longer hospital length of stay in patients with higher BMI.
Instagram Versus Reality: Who Are Actually Plastic Surgeons?
Authors: Singh Nikhi P. , Holohan Mary M. , Harmon Cameron , Fallah Kasra N. , Gross Jeffrey , Patel Aadarsh , Boyd Carter J. , Greives Matthew R. , de la Torre Jorge , Gordillo Gayle , King Timothy W. 
Published: January 2025

Background:
Instagram has become one of the most powerful marketing tools available to plastic surgeons because patients have increasingly turned to online resources to find physicians. Within, we review the online presence of self-ascribed plastic surgeons in the United States to identify potential misinformation and dishonest advertising.

Methods:
The Inflact database was queried for the search terms: “plastic surgeon/surgery,” “plastic and reconstructive surgeon/surgery,” “aesthetic surgeon/surgery,” and “cosmetic surgeon/surgery.” US physician account information, history of medical training, American Board of Plastic Surgery (ABPS) certification status, and posts were reviewed.

Results:
In total, 1399 physicians practicing within the United States were identified. Most attended medical school in the United States (93%), a minority received integrated plastic surgery training in the United States (14%), and the majority attended general surgery residency in the United States (57%) followed by independent plastic surgery residency in the United States (50%). Altogether, 1141 individuals were explicitly listed as “plastic surgeons” on Instagram, nearly a quarter of these (325 individuals, 28%) were not certified by the ABPS, and nearly a fifth (251 individuals, 22%) received no training in plastic surgery.

Conclusions:
Nearly one-third of “plastic surgeons” on Instagram are not certified through the ABPS. This is detrimental to the reputation of plastic surgery and has the potential to create broader consequences and may lead to patients mistakenly receiving care from unqualified physicians. It is paramount that plastic surgeons create a united front against such endeavors through advocacy efforts within the American Society of Plastic Surgeons.
Reshaping Our Understanding of Sensation and Pain Following Breast Reduction Surgery
Authors: Remy Katya , Cetrulo Curtis L. , Hyland Colby J. , Baker Riley , Reaman Anna , Vyas Krishna , Gfrerer Lisa , Austen William G. , Carruthers Katherine H. 
Published: January 2025

Background:
This study evaluated the sensory and breast pain outcomes in inferior versus superomedial pedicle breast reduction.

Methods:
Twenty patients undergoing the inferior pedicle technique were matched to 20 patients undergoing the superomedial pedicle technique based on age, BMI, and resection weight. Patients were evaluated preoperatively and postoperatively at 1, 3, 6, and 12 months. Monofilament testing was performed on the nipple-areola complex (NAC) and surrounding breast. Patient-reported outcomes included nipple and breast sensation (5-point Likert scale), pain intensity (0–10), and the Patient-reported Outcome Measurement Information System Neuropathic Pain Quality scale.

Results:
At the NAC, mean monofilament values and patient-reported sensation were significantly better in the inferior versus the superomedial pedicle group at 1 and 3 months postoperatively (P < 0.05) and comparable at 6 and 12 months (P > 0.05). At 12 months, 72.5% of patients reported complete (5 of 5) nipple sensation (77.5% inferior versus 67.5% superomedial, P > 0.05). At the breast, the mean monofilament values and patient-reported sensation were similar between pedicle groups throughout follow-up. At 12 months, 82.5% of the patients reported complete (5 of 5) breast sensation (85.0% inferior versus 80% superomedial, P > 0.05). Rates of postoperative breast pain were similar between groups throughout follow-up (P > 0.05). At 12 months, 25% of patients reported breast pain, with neuropathic qualities in 85% of cases.

Conclusions:
The inferior pedicle may allow for earlier restoration of quantitative and patient-reported NAC sensation, but long-term sensation is comparable between techniques. A quarter of patients reported persistent breast pain regardless of the pedicle type.
Treatment Considerations for Pyoderma Gangrenosum After Reduction Mammoplasty in an Unsuspecting Patient Demographic
Authors: Pluta Natalia A. , Kemp Tamara L. , Rivard Shayna C 
Published: January 2025

Summary:
Pyoderma gangrenosum (PG) is a rare, often idiopathic, noninfectious inflammatory neutrophilic dermatitis that causes painful ulcerative cutaneous papillomatous lesions. PG often mimics surgical infection, wound dehiscence, and postoperative cellulitis, leading to high rates of misdiagnosis and mistreatment. Here, a healthy 17-year-old adolescent girl with congenital breast asymmetry, macromastia, and a history of only mild intermittent autoimmune conditions developed an open wound along her inferior left breast incision 2 weeks after reduction mammoplasty. With continued enlargement and development of new ulcerative lesions despite appropriate local wound care, clinical suspicion for PG was raised. Standard treatment with oral prednisolone and topical tacrolimus led to incomplete resolution, and subsequent regression on attempts to taper the corticosteroid. Transition to oral cyclosporine with continued daily topical tacrolimus ultimately led to complete healing. This case underscores the need for a high clinical suspicion for PG in nonhealing ulcerative lesions after breast surgery, in addition to the importance of timely initiation of immunomodulatory agents and modification of the regimen if incomplete resolution is encountered.
Structural and load-dependent arterial stiffness across the adult life span
Authors: Xing Changyang , Xu Lei , Li Fan , Xie Xiujing , Guan Xiangping , Zhan Xiaojun , Chen Wu , Yang Hengli , Wang Xiangzhu , Wang Yingli , Li Jinsong , Zhou Qi , Mu Yuming , Zhou Qing , Ding Yunchuan , Zheng Yu , Wu Yu , Sun Xiaofeng , Li Hua , Zhang Chaoxue , Zhao Cheng , Qiu Shaodong , Yan Guozhen , Yang Hong , Mao Yinjuan , Zhan Weiwei , Ma Chunyan , Gu Ying , Xie Mingxing , Jiang Tianan , Yuan Lijun ,   the Study Investigators†
Published: January 2025

Background:
The arterial stiffening is attributed to the intrinsic structural stiffening and/or load-dependent stiffening by increased blood pressure (BP). The respective lifetime alterations and major determinants of the two components with normal aging are not clear.

Methods:
A total of 3053 healthy adults (1922 women) aged 18–79 years were enrolled. The carotid intima–media thickness, diameter, and local BPs were automatically determined by the radio frequency ultrasound system. The Peterson and Young elastic moduli were then calculated to represent total arterial stiffness. Structural stiffness was recalculated at a reference BP of 120/80 mmHg with established models. Load-dependent stiffness was the difference between total and structural stiffness.

Results:
Both structural and load-dependent stiffness increased with aging, with much larger changes in the structural components. The age-related increasing rates were higher in women for the structural stiffness than men (P < 0.05), but similar for the load-dependent stiffness. The clinical characteristics and arterial stiffness were widely correlated, but most correlations were quite weak (r < 0.3) other than BPs. Multiple regression analyses adjusted for sex, age and other clinical correlates showed that structural stiffness increased with pulse pressure (PP) and load-dependent stiffness increased with mean arterial pressure (MAP), respectively.

Conclusion:
The age-related arterial stiffening is mainly caused by the intrinsic structural stiffening, which demonstrated significant age–sex interaction. BPs were the major clinical determinants of arterial stiffness, with PP and MAP associated with different arterial stiffness components. The differentiation of the structural and load-dependent arterial stiffness should be highlighted for the optimal vascular health management.
Supplemental Operational Guidance for Minimizing Potential Inhalation Doses to Workers and Volunteers at Community Reception Centers and Public Shelters
Authors: Mauro John , Porrovecchio Joseph , Amann William , Marschke Stephen , Brightwell Michael S. , Davison Ron , DeMore Duane , Mangel Amy , Anspaugh Lynn , Salame-Alfie Adela , Ansari Armin 
Published: January 2025

Abstract
In the event of a nuclear explosion in an urban environment, contaminated persons may be directed to Community Reception Centers (CRC) and/or public shelters. This paper is a companion document to a previous paper that addresses the inhalation hazard to workers at a CRC from resuspension of fallout from the evacuees. To limit the inhalation hazard evacuees must be screened to prevent severely contaminated persons from entering a CRC. The suggested screening level is 10,000 dpm cm−2 and rapid methods of screening arriving evacuees are presented. Practical advice is provided on methods that can be used to limit contamination within a CRC. These methods include alterations to heating and cooling systems and the implementation of monitoring strategies to guard against unexpected increases in airborne activity levels.
Implementation of Stochastic Gradient Descent in an Automated Glow Peak Identification Software for Multiple Thermoluminescent Dosimeter Types
Authors: Noey Jordan D. , Stewart Colin J. , Yu Wenjin , Kearfott Kimberlee J. 
Published: January 2025

Abstract
A glow-curve analysis code was previously developed in C++ to analyze thermoluminescent dosimeter glow curves using automated peak detection while a first-order kinetics model. A newer version of this code was implemented to improve the automated peak detection and curve fitting models. The Stochastic Gradient Descent Algorithm was introduced to replace the prior approach of taking first and second-order derivatives for peak detection. Additionally, early stopping mechanisms were invoked to improve the previously used Levenberg-Marquardt Algorithm employed for curve fitting. The two software versions were compared through glow curve analysis of different thermoluminescent dosimeter materials and calculation of the corresponding figures of merit. Overall improvements were shown, namely an increase in the number of peaks detected and a reduction of the mean figure of merit by approximately 46%.
Correlation of Anterior Segment Optical Coherence Tomography and Slit-Lamp Imaging in Infectious Keratitis
Authors: Elzawahry Farida , Rossi Costanza , Said Dalia , Dua Harminder S. 
Published: January 2025

Purpose:
Anterior segment optical coherence tomography (AS-OCT) is increasingly being used to complement slit-lamp biomicroscopy in the evaluation of corneal infections. Our purpose was to analyze, compare, and correlate the clinical signs elicited by these 2 methods in patients with infectious keratitis (IK).

Methods:
Slit-lamp photomicrographs (diffuse and slit beam) and AS-OCT scans were obtained from 20 consecutive patients (21 eyes) with IK. AS-OCT horizontal line scans representing the top, middle, and bottom of the lesions were analyzed and compared with findings seen on slit-lamp photographs. Epithelial defects, thickness, irregularity; presence of infiltrate and its depth; corneal edema or melting; vascularization; Descemet membrane detachment; and presence of keratic precipitates were analyzed with both imaging techniques. AS-OCT features included hyperreflectivity, hyporeflectivity, shadowing, and tissue morphology. Statistical analysis was performed using GraphPad Prism 8.2.1.

Results:
AS-OCT was significantly more likely to detect corneal thickening (P < 0.001), epithelial hyperplasia (P = 0.027), infiltrate depth (P < 0.001), presence of inflammatory plaque (P = 0.0002), DM-endothelial complex undulations (P < 0.001), keratic precipitates (P = 0.0006), and Descemet membrane detachment (0.000), than slit-lamp imaging.

Conclusions:
AS-OCT can be a helpful adjunctive test in the evaluation of patients with IK. AS-OCT complements slit-lamp biomicroscopy and photography in the diagnosis and monitoring of IK and may serve an important role in telemedicine compared with slit-lamp photography alone.
Efficacy and Safety of Secondary Surgical Treatment for Refractory Recurrent Corneal Erosion
Authors: Ahn Hyunmin , Kim Young Jun , Seo Kyoung Yul , Chung Jae Lim 
Published: January 2025

Purpose:
To investigate the efficacy and safety of secondary surgical intervention of combined phototherapeutic keratectomy (PTK) with alcohol delamination and peripheral anterior stromal puncture (ASP) for refractory recurrent corneal erosion (RCE).

Methods:
This retrospective comparative study defined refractory RCE as cases persisting for more than 6 months after primary surgical intervention. A total of 115 eyes from 115 patients with refractory RCE, treated either with (n = 92) or without (n = 23) the secondary surgical treatment combining PTK and ASP between January 2021 and January 2023, were included. The Kaplan–Meier survival analysis method was used to determine the intervention's efficacy.

Results:
The mean age was 34.4 ± 10.8 years, with a predominance of male patients (60%). Over a follow-up period exceeding 1 year, the recurrence rate was markedly lower at 27.2% in the group undergoing secondary surgical treatment compared with 69.6% in those receiving conservative treatment. Kaplan–Meier survival analysis revealed significantly reduced recurrence rates in the surgical group versus the conservative treatment group (log-rank test, P = 0.007). Notably, 96% of recurrences in the surgical cohort occurred within the first 6 months postintervention, with no recurrences observed after 9 months. At the final follow-up, 12% necessitated further surgical procedures 6 months after the secondary intervention. The study reported no significant surgical complications.

Conclusions:
The secondary surgical approach combining PTK with alcohol delamination and ASP presents a viable and safe treatment alternative for patients with refractory RCE, demonstrating a significant reduction in recurrence rates.