bluuebunny/crossref_metadata_2025_split huggingface dataset:
SLIM
Authors: Sarwahi Vishal , Visahan Keshin , Hasan Sayyida , Patil Aravind , Grunfeld Matan , Atlas Aaron , Galina Jesse , Ansorge Alexandre , Lo Yungtai , Amaral Terry D. , Dayer Romain 
Published: June 2023

Study Design.
Retrospective cohort studys

Objective.
The objective of this study is to determine differences in outcomes in AIS patients undergoing spinal deformity correction surgery using a posterior spinal fusion approach versus single- and triple-incision minimally invasive surgery (MIS).

Summary of Background Data.
MIS increased in popularity as surgeons focus moved towards soft tissue preservation, but carries technical demands and increased surgical time compared to PSF.

Methods.
Surgeries performed over 2016-2020 were included. Cohorts were formed based upon surgical approach: PSF versus single incision MIS (SLIM) versus traditional MIS (3MIS). There were a total of seven sub-analyses. Demographic, radiographic, and perioperative data were collected for the 3 groups. Kruskal-Wallis and chi-square tests were used for continuous and categorical variables respectively.

Results.
532 patients met our inclusion criteria, 296 PSF, 179 3MIS, and 59 SLIM.
EBL (mL) (P<0.00001) and LOS (P<0.00001) was significantly higher in PSF than in SLIM and 3MIS. Surgical time was significantly higher in 3MIS than PSF and SLIM (P=0.0012).
PSF patients had significantly lower postop T5-T12 kyphosis (P<0.00001) and percent kyphosis change (P<0.00001). Morphine equivalence was significantly higher in the PSF group during total hospital stay (P=0.0042).
SLIM and 3MIS patients were more likely to return to non-contact (P=0.0096) and contact sports (P=0.0095) within six months and reported lower pain scores (P<0.001) at six months post operation.

Conclusion.
SLIM has similar operative time to PSF and is technically similar to PSF, while maintaining the surgical and post-operative outcome advantages of 3MIS.
The Relationship Between Hospital Capability and Mortality in Sepsis: Development of a Sepsis-Related Hospital Capability Index*
Authors: Ofoma Uchenna R. , Deych Elena , Mohr Nicholas M. , Walkey Allan , Kollef Marin , Wan Fei , Joynt Maddox Karen E. 
Published: June 2023

OBJECTIVES:
Regionalized sepsis care could improve sepsis outcomes by facilitating the interhospital transfer of patients to higher-capability hospitals. There are no measures of sepsis capability to guide the identification of such hospitals, although hospital case volume of sepsis has been used as a proxy. We evaluated the performance of a novel hospital sepsis-related capability (SRC) index as compared with sepsis case volume.

DESIGN:
Principal component analysis (PCA) and retrospective cohort study.

SETTING:
A total of 182 New York (derivation) and 274 Florida and Massachusetts (validation) nonfederal hospitals, 2018.

PATIENTS:
A total of 89,069 and 139,977 adult patients (≥ 18 yr) with sepsis were directly admitted into the derivation and validation cohort hospitals, respectively.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We derived SRC scores by PCA of six hospital resource use characteristics (bed capacity, annual volumes of sepsis, major diagnostic procedures, renal replacement therapy, mechanical ventilation, and major therapeutic procedures) and classified hospitals into capability score tertiles: high, intermediate, and low. High-capability hospitals were mostly urban teaching hospitals. Compared with sepsis volume, the SRC score explained more variation in hospital-level sepsis mortality in the derivation (unadjusted coefficient of determination [R
2]: 0.25 vs 0.12, p < 0.001 for both) and validation (0.18 vs 0.05, p < 0.001 for both) cohorts; and demonstrated stronger correlation with outward transfer rates for sepsis in the derivation (Spearman coefficient [r]: 0.60 vs 0.50) and validation (0.51 vs 0.45) cohorts. Compared with low-capability hospitals, patients with sepsis directly admitted into high-capability hospitals had a greater number of acute organ dysfunctions, a higher proportion of surgical hospitalizations, and higher adjusted mortality (odds ratio [OR], 1.55; 95% CI, 1.25–1.92). In stratified analysis, worse mortality associated with higher hospital capability was only evident among patients with three or more organ dysfunctions (OR, 1.88 [1.50–2.34]).

CONCLUSIONS:
The SRC score has face validity for capability-based groupings of hospitals. Sepsis care may already be de facto regionalized at high-capability hospitals. Low-capability hospitals may have become more adept at treating less complicated sepsis.
Blood pressure, arterial stiffness, and cardiovascular risk profiles in 8–12-year-old children following preeclampsia (FINNCARE-study)
Authors: Renlund Michelle A.-K. , Jääskeläinen Tiina J. , Kivelä Anni S.E. , Heinonen Seppo T. , Laivuori Hannele M. , Sarkola Taisto A. 
Published: June 2023

Objectives:
The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is associated with gestational, perinatal and child cardiovascular risk profiles.

Methods:
One hundred eighty-two PE (46 early-onset with diagnosis before 34 gestational weeks, and 136 late-onset) and 85 non-PE children were assessed 8–12 years from delivery. Office and 24-h ambulatory BP, body composition, anthropometrics, lipids, glucose, inflammatory markers, and tonometry-derived pulse wave velocity (PWV) and central BPs were assessed.

Results:
Office BP, central BPs, 24-h systolic BP (SBP) and pulse pressure (PP) were higher in PE compared with non-PE. Early-onset PE children had the highest SBP, SBP-loads, and PP. SBP nondipping during night-time was common among PE. The higher child 24-h mean SBP among PE was explained by maternal SBP at first antenatal visit and prematurity (birth weight or gestational weeks), but child 24-h mean PP remained related with PE and child adiposity after adjustments. Central and peripheral PWVs were elevated in late-onset PE subgroup only and attributed to child age and anthropometrics, child and maternal office SBP at follow-up, but relations with maternal antenatal SBPs and prematurity were not found. There were no differences in body anthropometrics, composition, or blood parameters.

Conclusions:
PE children develop an adverse BP profile and arterial stiffness early in life. PE-related BP is related with maternal gestational BP and prematurity, whereas arterial stiffness is determined by child characteristics at follow-up. The alterations in BP are pronounced in early-onset PE.
Clinical Trial Registration information: https://clinicaltrials.gov/ct2/show/NCT04676295

ClinicalTrials.gov Identifier: NCT04676295
Incidence, prevention, risk factors, and prediction of venous thromboembolism in chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study
Authors: Wei Qi , Wei Zheng-Qiang , Jing Chang-Qing , Li Yong-Xiang , Zhou Dong-Bing , Lin Mou-Bin , He Xian-Li , Li Fan , Liu Qian , Zheng Jian-Yong , Wang Gui-Ying , Tu Shi-Liang , Wang Zhen-Jun , Li Ang , Xiao Gang , Zhuang Jing , Bai Lian , Huang He , Li Yong , Song Wu , Liang Zhong-Lin , Shen Zhan-Long , Liu Fan-Long , Dai Yong , Zhou Xiao-Jun , Dong Ming , Wang Hui , Qiu Jian , Zhou Lei , Li Xin-Xiang , Wang Zi-Qiang , Zhang Hong , Wang Quan , Pang Ming-Hui , Wei Hong-Bo , Hu Zhi-Qian , Yan Yi-Dan , Che Yan , Gu Zhi-Chun , Yao Hong-Wei , Zhang Zhong-Tao ,   and for the CRC-VTE investigators
Published: June 2023

Background:
Venous thromboembolism (VTE) is a common and serious complication after colorectal cancer (CRC) surgery. Few large-sample studies have reported VTE incidence and management status after CRC surgery in China. This study aimed to investigate the incidence and prevention of VTE in Chinese patients after CRC surgery, identify risk factors for developing VTE, and construct a new scoring system for clinical decision-making and care planning.

Methods:
Participants were recruited from 46 centers in 17 provinces in China. Patients were followed up for one month postoperatively. The study period was from May 2021 to May 2022. The Caprini score risk stratification and VTE prevention and incidence were recorded. The predictors of the occurrence of VTE after surgery were identified by multivariate logistic regression analysis, and a prediction model (CRC-VTE score) was developed.

Results:
A total of 1,836 patients were analyzed. The postoperative Caprini scores ranged from 1 to 16 points, with a median of 6 points. Of these, 10.1% were classified as low risk (0-2 points), 7.4% as moderate risk (3-4 points), and 82.5% as high risk (≥5 points). Among these patients, 1,210 (65.9%) received pharmacological prophylaxis, and 1,061 (57.8%) received mechanical prophylaxis. The incidence of short-term VTE events after CRC surgery was 11.2% (95%CI 9.8-12.7), including deep venous thrombosis (DVT) (11.0%, 95%CI 9.6-12.5) and pulmonary embolism (PE) (0.2%, 95%CI 0-0.5). Multifactorial analysis showed that age (≥70 y), history of varicose veins in the lower extremities, cardiac insufficiency, female sex, preoperative bowel obstruction, preoperative bloody/tarry stool, and anesthesia time ≥180 minutes were independent risk factors for postoperative VTE. The CRC-VTE model was developed from these seven factors and had good VTE predictive performance (C-statistic 0.72, 95%CI 0.68-0.76).

Conclusions:
This study provided a national perspective on the incidence and prevention of VTE after CRC surgery in China. The study offers guidance for VTE prevention in patients after CRC surgery. A practical CRC-VTE risk predictive model was proposed.
A Clinical Trial of Treating Androgenic Alopecia with Mesenchymal Stem Cell Suspension Derived from Autologous Hair Follicle
Authors: Gan Yuyang , Du Lijuan , Wang Hailin , Li Kaitao , Fan Zhexiang , Sun Pingping , Zhang Jiaxian , Hu Zhiqi , Miao Yong 
Published: June 2023

Background:
Androgenic alopecia (AGA) is characterized by progressive hair follicle miniaturization. Novel treatments are needed to intervene in the miniaturization process. The authors aimed to evaluate the efficacy, safety, effectiveness, and effective population of autologous hair follicle mesenchymal stem cell therapy for the treatment of advanced AGA in Chinese individuals.

Methods:
Fifty patients ranging in age from 25 to 45 years (average, 32 ± 1.24 years) were included. None of them had ever used minoxidil, finasteride, or other drugs to promote hair growth. Healthy hair follicles were extracted from the occipital area and treated to obtain hair follicle mesenchymal stem cell suspensions. The recipient sites were divided into 2 groups. Nine points were injected in a 1-cm2 area, and 100 µL of solution containing either 1 × 105 cells or normal saline was injected at each point. The follow-up duration was 9 months. Observers were blinded to patient groupings and measurements.

Results:
An increased proportion of terminal hair and hair shaft diameter was observed in the experimental group at 1 month. The effect lasted for 3 months. The hair-thickening effect of advanced miniaturized hair follicles with hair shaft diameter less than 60 µm was more notable than that for above 60 µm. No patient experienced any obvious side effects.

Conclusions:
Hair follicle mesenchymal stem cells were effective in the treatment of advanced AGA in Chinese individuals. A hair shaft diameter of 60 µm can be used as a key index to predict the effectiveness of the therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Comparative Study of Pharyngeal Flap Outcomes between Children with 22q11.2 Deletion Syndrome and Nonsyndromic Cleft Lip and Palate
Authors: Wang Alice T. , Hseu Anne F. , Staffa Steven J. , Clark Roseanne E. , Meara John G. , Nuss Roger C. , Ganske Ingrid M. , Rogers-Vizena Carolyn R. 
Published: June 2023

Background:
Management of velopharyngeal insufficiency (VPI) in 22q11.2 deletion syndrome is challenging. The authors compared pharyngeal flap outcomes in children with 22q11.2 deletion syndrome to those with nonsyndromic cleft lip and palate (CLP) to assess risk of poor speech outcomes and negative sequelae.

Methods:
Children with 22q11.2 deletion syndrome or CLP treated with pharyngeal flap through a multidisciplinary VPI clinic between 2009 and 2020 were retrospectively reviewed. Preoperative and postoperative speech assessments, perioperative characteristics, and complications were identified.

Results:
Thirty-six children with 22q11.2 deletion syndrome and 40 with CLP were included. Age at surgery (P = 0.121), preoperative velopharyngeal competence score (P = 0.702), and preoperative resonance (P = 0.999) were similar between groups. Pharyngeal flaps were wider (P = 0.038) and length of stay longer in the 22q11.2 deletion syndrome group (P = 0.031). On short-term follow-up 4 months after surgery, similar speech outcomes were seen between groups. At long-term follow-up greater than 12 months after surgery, 86.7% of 22q11.2 deletion syndrome versus 100% of CLP (P = 0.122) children had improvement in velopharyngeal function; however, fewer children with 22q11.2 deletion syndrome (60.0%) achieved a completely “competent” velopharyngeal competence score compared with those with CLP (92.6%) (P = 0.016). Nasal regurgitation improved for both groups, with a greater improvement in those with 22q11.2 deletion syndrome (P = 0.026). Revision rate (P = 0.609) and new-onset obstructive sleep apnea (P = 0.999) were similar between groups.

Conclusions:
Children with 22q11.2 deletion syndrome have improved speech after pharyngeal flap, but they may be less likely to reach normal velopharyngeal function over the long term than those with CLP; however, negative sequelae do not differ. Improvement in nasal regurgitation is a uniquely positive outcome in this population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Outcome Comparisons of Two Different Orbicularis Oris Muscle Reconstruction Techniques in Patients with Unilateral Incomplete Cleft Lip
Authors: Zhang Chong , Yao Meilin , Low David W. , Wu Min , Shi Bing , Zheng Qian , Li Chenghao 
Published: June 2023

Background:
The long-term postoperative outcomes of two different orbicularis oris muscle reconstruction techniques in patients with unilateral incomplete cleft lip were compared.

Methods:
Forty-seven patients with unilateral incomplete cleft lip were assessed in this study, where 23 underwent a traditional method of reconstruction and 24 underwent a novel method. Preoperative measurements, postoperative results, and 3-year follow-up outcomes were measured by photographic anthropometric analysis. Five upper lip measurement indices and 8 nostril indices were included.

Results:
The postoperative outcomes showed that the shape of the lip and nose was more symmetric with the new surgical method compared with the conventional technique. Long-term outcomes after 3 years, although characterized by minimal changes during maxillofacial development, showed better maintenance of lip and nostril symmetry in the novel-method group.

Conclusion:
The novel technique seeks to balance the perinasal and perioral muscles, resulting in improved symmetry compared with the traditional reconstruction technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A Simplified Approach for Surgical Correction of Vertical Orbital Dystopia: A 45-Year Retrospective Cohort Study
Authors: Wolfe Erin M. , Ainuz Bar Y. , Ragheb John , Wolfe S. Anthony 
Published: June 2023

Background:
Vertical orbital dystopia (VOD) results in significant facial asymmetry, psychological distress, and poor quality of life in affected patients. The traditional approach (TA) for surgical correction has entailed a standard frontal craniotomy along with circumferential orbital osteotomy, vertical translocation of the orbit, and bone grafting to the lower maxilla. Caution has been expressed regarding its invasive transcranial nature. In this report, the authors describe the limited approach (LA) for simplified surgical correction of VOD, which obviates the need for a standard frontal craniotomy.

Methods:
A 45-year retrospective review was conducted of all patients who underwent surgical correction of VOD, as performed by a single surgeon. Demographic details, procedural characteristics, and complications were compared between patients who underwent correction by the TA and those who underwent correction by the LA. Complications were defined as cerebrospinal fluid leak, infection of the frontal bone, permanent diplopia, permanent ptosis, sudden-onset vision loss, persistent asymmetry, and surgical revision.

Results:
Forty patients met inclusion criteria for correction of true VOD, of which 18 underwent the TA and 22 underwent the LA. Mean length of hospital stay was 5.3 ± 2.3 days and 4.0 ± 1.5 days for the TA and LA cohorts, respectively. Mean follow-up time was 4.9 ± 7.5 years for the TA cohort and 2.6 ± 3.3 years for the LA cohort. The only reported complications were persistent asymmetry in 2 patients in the TA cohort, with 1 patient requiring surgical revision because of undercorrection, whereas the LA cohort exhibited no postoperative asymmetry or need for surgical revision.

Conclusions:
Both the TA and the LA are effective for surgical correction of VOD. The limited craniotomy of the LA reduces exposure of intracranial structures and adequately achieves postoperative symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Integration of the CLEFT-Q Patient-Reported Outcome Tool into a Multidisciplinary Cleft and Craniofacial Clinic: A Proof of Concept
Authors: Salinero Lauren K. , Villavisanis Dillan F. , Cheung Liana , Ferro Daria F. , Folsom Nancy , Cho Daniel Y. , Low David W. , Jackson Oksana , Bartlett Scott P. , Swanson Jordan W. 
Published: June 2023

Summary:
Implementation of patient-reported outcome (PRO) tools has increased internationally in a variety of clinical settings, with emerging evidence suggesting benefits for patient satisfaction, improved patient-provider communication, and management of chronic conditions. However, integrating PROs into clinical workflow remains a barrier to implementation, with common challenges including patient completion, provider review of results, and future accessibility of data. Cleft lip and/or palate presents with a variety of aesthetic, functional, and psychosocial sequelae optimally managed by a multidisciplinary team, and the CLEFT-Q is a validated 12-module PRO that captures patient perception in these domains. Given the emerging proven benefits of using PROs in a clinical setting, the authors integrated the CLEFT-Q PRO at a multidisciplinary cleft and craniofacial clinic at a large, urban, tertiary care center. The authors collaborated with their institution’s electronic health record clinical informatics team to automatically identify eligible cleft lip and/or palate patients and generate the CLEFT-Q PRO before weekly multidisciplinary cleft and craniofacial clinic days. Patient results were automatically scored, compared with age-based normative data, and populated into the electronic health record patient note. CLEFT-Q results were viewed by clinicians during patient visits to initiate module-specific discussion in relation to patient age-based normative results. Patient-specific CLEFT-Q data were also discussed during multidisciplinary cleft and craniofacial team discussions to aid in clinical decision-making. This experience may have applicability to other PRO tools in plastic surgery and other medical specialties where integrating PROs may yield superior patient experience and outcomes.
Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure
Authors: Gupta Samarth , Goil Pradeep , Mohammad Arbab , Escandón Joseph M. 
Published: June 2023

Background:
Finite options exist to address free flap failure. There is a lack of consensus on the standard treatment for secondary reconstruction in such cases. Herein, the authors determined the survival rate of a second flap following a total loss of an initial free flap during head and neck reconstructions and evaluated whether there was a difference in the rate of secondary flap necrosis depending on the timing of reconstruction salvage.

Methods:
The authors retrospectively reviewed 1572 free flaps for head and neck reconstruction from 2010 to 2022. Patients who underwent secondary surgery with flaps after failure of a primary free flap were included. Patients were divided into three groups based on the time for secondary flap reconstruction from the time of primary reconstruction (group A, 0 to 5 days; group B, 6 to 30 days; and group C, >30 days).

Results:
The authors identified 64 cases of complete flap loss after primary reconstruction requiring secondary reconstruction. Pedicled flaps were used in 34.4% of the cases, whereas a second free flap was used in 65.6% of the cases. Overall, the flap failure rate for secondary reconstructions was 6.7% in group A, 35.3% in group B, and 6.7% in group C (P = 0.022). For free tissue transfer, the success rate of a secondary reconstruction was 92.3% in group A, 28.57% in group B, and 93.3% in group C.

Conclusions:
The authors favor an early microsurgical reconstruction (≤5 days) following primary reconstruction in cases of free flap failure. If early reconstruction cannot be performed, a deferred reconstruction with free tissue transfer (>30 days) should be considered.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Deciding Factors of Flow Direction in Lymphovenous Anastomosis for Extremity Lymphedema
Authors: Lin Ying-Sheng , Liu Chia-Ju 
Published: June 2023

Background:
While using lymphovenous anastomosis (LVA) to treat extremity lymphedema, an antegrade lymphatic to vein flow is usually considered to indicate a functional and effective anastomosis. We analyzed the characteristics of lymphovenous anastomoses in patients with extremity lymphedema to look for the deciding factors of the flow direction.

Patients and Methods:
A total of 45 patients (15 arms and 42 legs) receiving LVA for extremity lymphedema were reviewed. Only the anastomoses with intraoperatively confirmed patent flow or clear visualization of vessel lumens during anastomosis were included for analysis. Multivariate logistic regression was used to identify the contributing factors of intraoperative washout phenomenon or venous reflux.

Results:
A total of 105 eligible LVAs were included for analysis. Anastomosis with a more sclerotic lymphatic duct is statistically significantly associated with more venous reflux (Odds ratio = 2.82, p = 0.003). Larger diameter difference between lymphatic duct and recipient vein (Odds ratio = 12.8, p = 0.02) and less sclerotic lymphatic duct (Odds ratio = 0.47, p = 0.03) are statistically significantly associated with more washout phenomenon.

Conclusion:
The deciding factors of flow direction in LVA are difference of diameters between lymphatic duct and recipient vein, and the severity of lymphosclerosis. To obtain favorable antegrade lymph-to-vein flow, a less sclerotic lymphatic duct with larger diameter and a recipient vein with smaller diameter should be chosen for anastomosis.