bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors and Etiologies of Clinical Relapse Among Patients With Ulcerative Colitis in Deep Remission
Authors: Zeina Tanya , Gandhi Shiv , Mittal Akaash , Levy Alexander N. , Weinstock Joel , Singh Siddharth , Jangi Sushrut 
Published: February 2023

Goal:
The objective of this study was to evaluate for potential predictors and etiologies of clinical relapse among patients with ulcerative colitis in deep remission.

Background:
Patients displaying deep (endoscopic and histologic) remission have a decreased cumulative risk of relapse in ulcerative colitis of <10% per year, but predictors and etiologies of relapse in this population are poorly understood.

Materials and Methods:
We performed a retrospective cohort study utilizing electronic medical records at Tufts Medical Center to identify patients in deep remission, classified as having both endoscopic remission (Mayo Endoscopic Score of 0 or 1) and histologic remission (Simplified Geboes Score

0.2). We evaluated the cumulative risk of clinical relapse following attainment of deep remission and examined predictors and etiologies of relapse.

Results:
Among 139 patients with ulcerative colitis in deep remission, the cumulative risk of relapse was <10% and <20% at 1 and 2 years. Patients with complete normalization of mucosa (Geboes=0) and normalization of C-reactive protein (<7.48 mg/dL) at the time of remission were associated with a lower risk of relapse. Discontinuation of therapy was the most commonly identified etiology of relapse.

Conclusions:
Patients in deep remission have a 1-year risk of clinical relapse of <10%, with those demonstrating a non-normalized mucosa or elevated C-reactive protein predictive of persistent relapse risk. Discontinuation of therapy or minor histologic changes may drive relapse among those in deep remission.
Providing a Clear Path to the Direct Admission Process
Authors: Johnson Sarah , Abraham Aney , Lopez Julie A. 
Published: February 2023

OBJECTIVES
The aim of this study was to increase patient safety during care transitions through the development of a new process and electronic screening tool.

BACKGROUND
Direct hospital admissions that are not clinically triaged can put the patient at an increased safety risk.

METHODS
Utilizing the electronic medical record and mnemonic situation, background, assessment, and recommendation (SBAR), an admission module was created to intake direct admission requests by transfer center nurses to ensure clinical triage and accurate bed placement.

RESULTS
One hundred eighty-nine direct admissions met inclusion criteria. Thirteen patients were clinically screened, deemed not stable for the acute care setting, and sent to the emergency department. One direct admission safety event occurred involving a hypoglycemic patient upon arrival. Results indicate the new clinical screening program offered a safer way to directly admit patients to the inpatient setting.

CONCLUSION
Implementation of the electronic SBAR handoff tool meets the Joint Commission standard of care transitions compliance. The significant workflow changes increased patient safety and will be expanded in the future to all service lines.
Facial Fracture Patterns and Severity of Associated Injuries After Motorcycle Accidents
Authors: Chuang Kai-Ti , Chu Yu-Ying , Chen Chien-Tzung , Liao Han Tsung 
Published: February 2023

Background
Motorcycle injuries remain a significant cause of motor vehicle-related morbidity and mortality in Taiwan. Besides, the facial region is a commonly fractured site under motorcycle accidents. To date, there are no trauma mechanism-based studies of facial fractures.

Aim and Objectives
This study aims to determine the facial fracture patterns, the severity of head trauma, and associated injuries by different motorcycle-related trauma mechanisms enabling a greater understanding of its distribution and magnitude.

Methods
This is a retrospective descriptive analysis conducted over a 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. We divided the patient cohort into 3 main trauma mechanisms: single-motorcycle collision (SM group), motorcycle-to-motorcycle collision (MM group), motorcycle-to-vehicle collision (MV group). Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected.

Results
A total of 881 cases were identified that involved facial fractures. Most patients were male (71%), young adult (mean age, 32.49 years), and the most common fracture region is the midfacial fracture (79.5%, 700 victims). Among the 3 groups, the MM group was less likely to sustain severe injuries by trauma score system, less head injury and mortality rate. The MV group and SM group have similar mortality rates but different fracture pattern tendencies. Lower facial fractures were more likely in the MV group, but midface fractures in the SM group. Associated injuries were higher in the MV group.

Conclusions
Our study presents the different trends of fracture patterns and injury under 3 main mechanisms of motorcycle casualties. We document all these data in the hope of providing insights into trauma doctors dealing with motorcycle accidents.
A Comparison Study of Outcomes and Complications Between Marginal Mandibulectomy With or Without Additional Mandibulotomy in Tongue Cancers
Authors: Chiu Ting-Han , Marchi Filippo , Huang Shiang-Fu , Kang Chung-Jan , Liao Chun-Ta , Hung Shao-Yu , Cheong David Chon-Fok , Tsao Chung-Kan 
Published: February 2023

Background
Marginal mandibulectomy with or without additional mandibulotomy could represent the alternatives to avoid segmental mandibulectomy in carefully selected tongue cancers.

Aim and Objectives
This study investigated a subgroup of tongue cancers with suspected involvement to the alveolar bone because of the shallow and deformed mouth floor. We aimed to compare the functional outcomes, postoperative complications, and disease control efficacy between the 2 different marginal mandibulectomy approaches, with or without additional mandibulotomy.

Materials and Methods
A retrospective study of 29 marginal mandibulectomies and 26 combined mandibulotomies for tongue cancer wide excisions and flap reconstruction at Chang Gung Memorial Hospital Linkou Branch during 2014 to 2019 was performed.

Results
The combined mandibulotomy group had more advanced T-status (P < 0.001) and greater tumor diameters (P < 0.001) but not increased preexisting trismus, bone invasions, or positive margins. The additional mandibulotomy increased flap necrosis (P = 0.044), late infections (P = 0.004), and tongue movement limitations (P = 0.044) but not osteoradionecrosis. Osteoradionecrosis was unrelated to the resected mandibular length or the mandibulotomy sites. Feeding tube dependence was greater in the combined group at discharge (P = 0.014), but no long-term differences were noted. Kaplan-Meier overall survival (P = 0.052) and disease-free survival (P = 0.670) were both comparable between the 2 groups.

Conclusions
The combined procedure of mandibulotomy and marginal mandibulectomy in large tongue cancers without bone invasions is associated with increased soft tissue–related complications but not bone-related complications. However, comparable disease control, survival, and long-term tube feeding outcomes were noted.
Reimbursement Trends in Reduction Mammoplasty
Authors: Radparvar Jacob , Dorante Miguel I. , Youssef George , Ganeshbabu Nishanth , Pandya Sonal N. , Guo Lifei 
Published: February 2023

Background
Medicare reimbursement for plastic surgery procedures increased by 2% while inflation increased by 19% in the past decade. Given increasing national breast reduction case volume and the negative impact decreased reimbursements have on surgeon well-being, we sought to evaluate actual surgeon reimbursements for bilateral breast reduction over a decade.

Methods
A retrospective review was performed including all identifiable breast reduction procedures (Current Procedure Terminology 19318) performed at a tertiary academic hospital between October 2011 and September 2021 (fiscal year 2012–2021). The annual number of patients undergoing breast reduction, the payor, and average yearly amounts reimbursed were evaluated and trended over time. Percent change from Medicare average yearly reimbursements was evaluated and trended over time. All values were adjusted to 2021 US dollars.

Results
During our study period, there were 486 bilateral breast reduction procedures with 36 outlier payments; therefore, 450 reimbursements were included in the study. There were 5 payors, and the average adjusted reimbursement amount was $2418.74 ± $1123.83. All private payors had significantly higher average reimbursement than Medicare (P < 0.0001), and Medicare was the only payor with significant decrease in reimbursement over time (−$58.58 per year, 95% confidence interval, −$110.80 to −$6.33, P = 0.033).

Conclusions
Our data demonstrate that a difference exists between public and private payors for bilateral breast reduction procedures. Private payor reimbursements outpaced inflation. Medicare is an unreliable benchmark that may indirectly lead to declining reimbursements over time.
Utilization Fraction of Reduction Mammoplasty Instrument Sets
Authors: Dorante Miguel I. , Barron Sivana L. , Jones Lloyd , Freniere Brian B. , Guo Lifei 
Published: February 2023

Purpose
Healthcare spending will account for 20% of US gross domestic product by 2028. One strategy to address rising costs is evaluating the utilization fraction (UF) of surgical trays. Utilization fraction averages between 13% and 27% among surgical specialties, yet data from plastic surgery are lacking.

Methods
This prospective observational study assessed UF of surgical instruments in all reduction mammoplasty performed at 2 sites in the same healthcare system over a 6-month period. Site 1 is a tertiary hospital and site 2, an outpatient surgical center. Utilization fraction was calculated as percent fraction of used, or if operating surgeons touched them, to opened instruments. A new surgical tray was created by removing instruments not used in 20% of cases. Reprocessing costs and savings were calculated using published reprocessing figures of $0.10 to $0.51 per instrument. Descriptive statistics and parametric variables reported as mean ± standard deviation. Unpaired Student t test was performed to determine statistical significance of findings (P < 0.05).

Results
Four plastic surgeons performed 37 procedures, 11 at site 1 and 26 at site 2. At site 1, 112 instruments are opened in one tray with 53 unique and 59 duplicates. At site 2, 155 instruments are opened in 2 trays with 58 unique, 20 shared, and 77 duplicates. Instrument user did not vary by site (P = 0.446), with 19 ± 3 instruments and 17 ± 3 instruments used per case; however, UF varied significantly (P < 0.0001) with average UF of 16.6% ± 2.8% and 11.5% ± 1.7% at sites 1 and 2, respectively. Estimated reprocessing costs per case are currently $11.20 to $57.12 at site 1 and $15.50 to $79.05 at site 2, with unused instruments accounting for $9.34 to 47.64 and $13.72 to $69.96, respectively. The new surgical tray includes 32 instruments, 18 unique and 14 duplicates, with estimated reprocessing cost of $3.20 to $16.32 per case. Adoption would reduce reprocessing costs by approximately $8.00 to $40.80 and $12.30 to $62.73 per case at sites 1 and 2, respectively.

Conclusions
Despite studying a single, but common, plastic surgery procedure, our findings reveal consistency in excessive appropriation of instruments between sites with values similar to those in the literature. These findings exemplify a cost-saving opportunity at our institution and chance to optimize UF for other high-volume plastic surgery procedures.
Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training
Authors: Oberoi Michelle K. , Reghunathan Meera , Aref Youssef , Dinis Jacob J. , Balumuka Darius , Gosman Amanda 
Published: February 2023

Background
Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows.

Methods
Names and photos of graduated fellows for the past 10 years (2012–2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population.

Results
Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons.

Conclusion
This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.
Public Perception of Ideal Areola Proportions
Authors: Kuruvilla Annet S. , Kumar Anish , Ibelli Taylor J. , Mandelbaum Max , Greer Madison , Henderson Peter W. 
Published: February 2023

Background
In breast reconstruction, mastopexy, and breast reduction procedures, surgeons make decisions about the resulting areola size, and this significantly impacts the overall aesthetic result. Despite the importance of these decisions, little is known about the general population's preferences for areola size. The objective of this study was to survey the global population to better understand the public's perceptions of ideal areola dimensions.

Methods
A survey was developed with 9 different composite diagrams of a female torso (every combination of 3 breast widths and 3 waist widths). In each composite diagram, 6 different areola sizes were shown (areola-to-breast diameter ranging from 1:12 to 6:12). The survey was distributed via the Amazon Mechanical Turk digital platform, and respondents' demographics (sex, age, race/ethnicity, country, and state if located in the United States) and preferences for the most aesthetically pleasing size in each composite diagram were recorded.

Results
Among 2259 participants, with 1283 male (56.8%) and 976 female (43.2%), most participants were between 25 and 34 years old (1012, 44.8%), were from the United States (1669, 73.9%), and identified as White (1430, 63.3%). With 9 breast width and waist width combinations, the respondents were most likely to prefer the 2:12 (32.9%) areola-to-breast ratio (P < 0.0001). The second most commonly preferred ratio was 3:12 (30.6%) (P < 0.0001). Gender subgroup analysis showed that women preferred middle-range ratios, such as 2:12, 3:12, and 4:12 (P < 0.0001). Meanwhile, men were more likely to prefer extreme ratios of 1:12 or 6:12 (P < 0.0001). Across almost all races/ethnicities, 2:12 was significantly the most popular, except among American Indian/Alaskan Native and Middle Eastern where 3:12 was the most preferred (P < 0.0001). Within the top 6 countries (United States, India, Brazil, Italy, Canada, United Kingdom), the United States, India, and Italy preferred 2:12, and Brazil, Canada, and the United Kingdom preferred 3:12 (P < 0.0001).

Conclusions
This study provides the first objective data on public impressions of the ideal areola proportions and can serve as a guide for surgical decision making in breast reconstruction and reshaping procedures.
Aesthetic Sideburn Reconstruction Using an Expanded Hair Bearing Skin Flap With Natural Hairline
Authors: Zhang Tiran , Fan Jincai , Tian Jia , Gan Cheng , Yang Zengjie , Jiao Hu , Han Bing , Liu Liqiang 
Published: February 2023

Background
Hairline is the marginal line of hair growth on the scalp. Patients with sideburn defects, caused by tumor resection, severe infection, or burns, might have low self-esteem and mental stress. The purpose of this article was to explore a surgical method of applying the expanded scalp flap with natural hairline for cosmetic reconstruction of hairline, so as to provide reference for future clinical work.

Methods
In this study, a retrospective analysis was conducted on 23 patients in the plastic surgery ward of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2015 to December 2018, who underwent expanded scalp flap cosmetic reconstruction of the sideburns with natural hairline (14 males and 9 females; average age, 18.7 ± 13.7 years). The follow-up time was 8 to 44 months.

Results
Patient satisfaction rate (scored 4 or more) was 95.7%, with an average score of 4.59. A total of 16 patients were very satisfied, and 6 were satisfied. There were 21 patients who had good flap survival, and 2 patients who had venous congestion at the distal end of the flap. One case relieved voluntarily 3 days postsurgery, and the other case had partial skin necrosis at the distal end, healing phase II. These 2 cases were classified as grade I according to the Clavien-Dindo classification. In 9 of the patients, the reconstructed sideburn presented a natural look with good hair angle and great size and shape, with average scores of 4.61, 4.52, and 4.48. The scars at the donor site were inconspicuous, and there were no complaints (average score, 4.61). The rest of the patients received satisfactory appearances after surgery.

Conclusion
In conclusion, the technique described above presented a fine method for sideburn reconstruction. Based on the achieved aesthetic scores of our study, as well as the high patient satisfaction rate (95.7%), the aforementioned technique is acceptable for both surgeons and patients.
Role of demographic factors and vascular anatomy in successful trans-radial Tiger catheterization in coronary angiography
Authors: Farsavian Ali Asghar , Ghadirzadeh Erfan , Daghestani Maryam , Golshani Samad , Nadi Ghara Ali Asghar 
Published: February 2023

AbstractObjectiveThe use of a single catheter in the trans-radial angiography approach (TRA) is associated with fewer complications. However, there are some discrepancies regarding the effectiveness of these catheters. Catheter selection is crucial in reducing the risk of trauma to the coronary arteries in angiography, so the main objective of the present study was to investigate the success rate of the Tiger single catheter in the right and left coronary angiography in the TRA, in addition to characterizing the role of demographic factors, underlying conditions and vascular anatomy in its success.MethodsThis observational study was conducted on 127 patients with suspected CAD. Demographic data and risk factors were recorded in a checklist. The root diameter of the aortic artery at different sections ejection fraction was measured by transthoracic echocardiography before performing TRA. Coronary anomaly, tortuosity of the radial artery pathway to the aorta, as well as coronary artery take-off and procedure indication, were also recorded during the TRA.ResultsIn this study, 127 patients with a mean age of 59 ± 10.3 were enrolled. Sixty-seven patients (51.5%) were female, and 63 patients (48.5%) were male. Failure was reported only in 5 patients (3.85%). Age, gender, BMI, height, aortic diameter, coronary anomalies, tortuosity, hypertension, dyslipidemia, and smoking had not a significant relationship with successful Tiger catheterization (P > 0.05) but high coronary take-off had (P= 0.004).ConclusionIn cases of high coronary take-off and coronary abnormality, a Tiger catheter can probably benefit the patient with a trans-radial approach.
A longitudinal evaluation of personalized intrinsic network topography and cognitive decline in Parkinson’s disease
Authors: Li Renxi , Pozorski Vincent , Dabbs Kevin , Haebig Maureen , Birn Rasmus , Pletcher Colleen , Wey Alexandra , Barzgari Amy , Theisen Frances , Cox Christopher , Okonkwo Ozioma , Gallagher Catherine 
Published: February 2023

AbstractResting state functional MRI (R-fMRI) offers insight into how synchrony within and between brain networks is altered in disease states. Individual and disease-related variability in intrinsic connectivity networks may influence our interpretation of R-fMRI data.MethodsWe used a personalized approach designed to account for individual variation in the spatial location of correlation maxima to evaluate R-fMRI differences between Parkinson’s disease (PD) patients who showed cognitive decline, those who remained cognitively stable, and cognitively stable controls. We compared fMRI data from these participant groups, studied at baseline and 18 months later, using both Network-based Statistics (NBS) and calculations of mean inter- and intra-network connectivity within pre-defined functional networks.ResultsThe NBS analysis showed that PD participants who remained cognitively stable showed exclusively (at baseline) or predominantly (at follow-up) increased intra-network connectivity, whereas decliners showed exclusively reduced intra-network and inter-(ventral attention and default mode) connectivity, in comparison to the control group. Evaluation of mean connectivity between all ROIs within a priori networks showed that decliners had consistently reduced inter-network connectivity for ventral attention, somatomotor, visual, and striatal networks, and reduced intra-network connectivity for ventral attention network to striatum and cerebellum.ConclusionsThese findings suggest that specific functional connectivity covariance patterns differentiate PD cognitive subtypes and may predict cognitive decline. Further, increased intra and internetwork synchrony may support cognitive function in the face of PD-related network disruptions.Key PointsResting state functional MRI (R-fMRI) can be used to probe changes in brain networks related to disease. Personalized approaches can be used to address spatial variations in R-fMRI correlation maxima influenced by individual variation or brain plasticity in response to disease.Longitudinal R-fMRI from cognitively stable Parkinson’s patients were compared with those who experienced decline as well as controls using a personalized approach.Cognitively stable patients showed increased inter and intra-network synchrony while decliners showed decreases that may have preceded cognitive decline.