bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast Cancer After Reduction Mammoplasty: A Population-Based Analysis of Incidence, Treatment and Screening Patterns
Authors: Drohan Ashley E. , Quan May Lynn , Birdsell Dale C. , Xu Yuan 
Published: August 2023

Background:
The risk of breast cancer may be decreased in women who undergo reduction mammoplasty. The purpose of this study was to describe the incidence and treatment of breast cancer after reduction mammoplasty and to better understand the use of breast cancer screening modalities in these patients.

Methods:
This population-based retrospective analysis utilized the Discharge Abstract Database held by the Canadian Institute for Health Information and the National Ambulatory Care Reporting System to identify all women aged 20 years or older who underwent reduction mammoplasty in Alberta, Canada. The incidence and treatment of breast cancer were compared among patients who underwent reduction mammoplasty and age-sex-matched controls. Imaging utilization, including the use of mammography, ultrasound, and breast biopsy, was also compared.

Results:
Between 2003 and 2007, 8021 patients over 20 years old underwent reduction mammoplasty in Alberta. Patients were followed for an average of 12.6 years. Eighty-nine (1.1%) patients who underwent reduction mammoplasty developed breast cancer after surgery, compared to 453 (1.9%) controls (P < 0.0001). Among patients diagnosed with breast cancer, there was no difference in patient and tumor characteristics. Women who underwent reduction mammoplasty were more likely to undergo mastectomy for cancer (41.6% vs 1.5%; P < 0.0001) and were more likely to undergo mammography (66.7% vs 58.7%; P < 0.0001), ultrasound (29.2% vs 26.2%; P < 0.0001) and biopsy for benign disease (7.2% vs 6%, P < 0.0001) compared to controls.

Conclusions:
Despite an increased frequency of breast cancer screening, the incidence of breast cancer is lower after reduction mammoplasty compared with women who did not undergo breast reduction. After a diagnosis of breast cancer, surgical treatment patterns differ between groups, whereby mastectomy is more common after reduction mammoplasty.
Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements
Authors: Cirrincione Peter M. , Thakur Ankush , Zucker Colson P. , Wisch Jenna L. , Groisser Benjamin N. , Nguyen Joseph , Mintz Douglas N. , Cunningham Matthew E. , Hresko M. Timothy , Haddas Ram , Hillstrom Howard J. , Widmann Roger F. , Heyer Jessica H. 
Published: August 2023

Background:
Up to 75% of patients with idiopathic scoliosis (IS) report back pain, but the exact contributors are unclear. This study seeks to assess how pain correlates with demographics, radiographic and surface topographic (ST) measurements, and patient-reported outcome measures (PROMs) in patients with IS.

Methods:
Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and Scoliosis Research Society revised (SRS-22r) pain domain from an IRB approved prospectively collected registry containing patients 11 to 21 years old with IS were correlated (Spearman coefficients) with measurements from whole-body EOS radiography and ST scanning, PROMIS 1.0 PROMs, Trunk Appearance Perception Scale (TAPS), and SRS-22r domains. SRS-22r and PROMIS-PI were also compared between different sex, scoliosis severities, and primary curve locations with Mann-Whitney U or Kruskal-Wallis tests, and if significant differences were found, included with the 5 highest univariate correlated variables into stepwise multivariate linear regression models (P<0.05 to enter, P>0.1 to remove) predicting SRS-22r pain and PROMIS-PI.

Results:
One hundred and forty-nine patients (14.5 ± 2.0 y, body mass index 20.6 ± 4.1 kg/m2, 96 (64%) female, mean major coronal curve 40 ± 19 deg, range: 10 deg, 83 deg) reported mean PROMIS-PI of 42.2 ± 10.0 and SRS-22r pain of 4.4 ± 0.6. SRS-22r self-image was the most correlated variable with both SRS-22r pain (rho=0.519) and PROMIS-PI (rho=−0.594). Five variables, none of which were ST or radiographic measures, strongly predicted SRS pain domain (R=0.711, R2=0.505, N=138). Two variables (SRS-22r self-image and SRS-22r function) were utilized by a model correlated with PROMIS-PI (R=0.687, R2=0.463, N=124).

Conclusions:
SRS-22r function and self-image domains were more strongly correlated with SRS-22r pain and PROMIS-PI than any radiographic or ST measurements.

Level of Evidence:
Level II—retrospective study.
Perioperative Complications of Pediatric Orthopaedic Surgery in Sickle Cell Disease
Authors: Lorenzana Daniel , Perkins Crystal A. , Willimon S. Clifton 
Published: August 2023

Background:
Vasoocclusion in sickle cell disease can be precipitated by cold temperatures, hypoxia, infection, dehydration, and stress, all of which can occur in the setting of surgery. The purpose of this study was to identify predictors of perioperative complications among pediatric patients with sickle cell disease undergoing orthopaedic surgery.

Methods:
An institutional review board approved single-center retrospective review was conducted of pediatric patients 21 years of age and younger with SCD who underwent any orthopaedic surgery at a single center between 2009 and 2019. Patient data and procedure-specific information were recorded. Preoperative admission for hydration and/or blood transfusion and preoperative laboratory studies were reviewed. The primary study outcome was postoperative complications within 30 days of surgery requiring an ED visit or hospital admission.

Results:
Ninety-two patients who underwent 118 orthopaedic surgeries were identified. The average age at surgery was 12.0 years (SD 4.8 y). Surgical cases were classified as elective (n=82, 70%), infection (n=26, 22%), and trauma (n=9, 8%). The lower extremity was the most frequent surgical site (n=86, 73%). Sixty surgeries (51%) received a preoperative blood transfusion. There were 19 surgeries with postoperative complications (16%) that required an ED visit or hospital readmission within 30 days of surgery. There were significantly more complications following surgery on the hip as compared with other sites (24% vs. 9%, P=0.04). Four or more ED visits in the past year were associated with an OR of 5.7 for a postoperative complication (P=0.01, 95% CI 1.6–20.5). Patients who had a preoperative blood transfusion had significantly greater rates of complications than those that did not (27% vs. 5%, P<0.01).

Conclusions:
Children with SCD are at increased risk for complications after orthopaedic surgery, and the current study found an overall postoperative complication rate of 16%. Patients undergoing hip surgery had a disproportionate number of complications, with a 5.8-fold increased risk of a postoperative complication. Patients with 4 or more ED visits in the past year had a 5.7-fold increased risk of a complication.

Level of Evidence:
IV Retrospective case series.
Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
Authors: van Haeren Maite M.T. , Raasveld Senta Jorinde , Karami Mina , Miranda Dinis Dos Reis , Mandigers Loes , Dauwe Dieter F. , De Troy Erwin , Pappalardo Federico , Fominskiy Evgeny , van den Bergh Walter M. , Oude Lansink-Hartgring Annemieke , van der Velde Franciska , Maas Jacinta J. , van de Berg Pablo , de Haan Maarten , Donker Dirk W. , Meuwese Christiaan L. , Taccone Fabio Silvio , Peluso Lorenzo , Lorusso Roberto , Delnoij Thijs S.R. , Scholten Erik , Overmars Martijn , Ivancan Višnja , Bojčić Robert , de Metz Jesse , van den Bogaard Bas , de Bakker Martin , Reddi Benjamin , Hermans Greet , Broman Lars Mikael , Henriques José P.S. , Schenk Jimmy , Vlaar Alexander P.J. , Müller Marcella C.A. 
Published: August 2023

OBJECTIVES:
To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO.

DESIGN:
A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications.

SETTING:
Sixteen international ICUs.

PATIENTS:
Adult patients on VA-ECMO or VV-ECMO.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01).

CONCLUSIONS:
The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.
U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation
Authors: Meservey Amber , Krishnan Govind , Green Cynthia L. , Morrison Samantha , Rackley Craig R. , Kraft Bryan D. 
Published: August 2023

Background:
Carbon monoxide (CO) is an endogenous signaling molecule that activates cytoprotective programs implicated in the resolution of acute respiratory distress syndrome (ARDS) and survival of critical illness. Because CO levels can be measured in blood as carboxyhemoglobin, we hypothesized that carboxyhemoglobin percent (COHb%) may associate with mortality.

OBJECTIVES:
To examine the relationship between COHb% and outcomes in patients with ARDS requiring venovenous extracorporeal membrane oxygenation (ECMO), a condition where elevated COHb% is commonly observed.

DESIGN:
Retrospective cohort study.

SETTING:
Academic medical center ICU.

PATIENTS:
Patients were included that had ARDS on venovenous ECMO.

MEASUREMENTS AND MAIN RESULTS:
We examined the association between COHb% and mortality using a Cox proportional hazards model. Secondary outcomes including ECMO duration, ventilator weaning, and hospital and ICU length of stay were examined using both subdistribution and causal-specific hazard models for competing risks. We identified 109 consecutive patients for analysis. Mortality significantly decreased per 1 U increase in COHb% below 3.25% (hazard ratio [HR], 0.35; 95% CI, 0.15–0.80; p = 0.013) and increased per 1 U increase above 3.25% (HR, 4.7; 95% CI, 1.5–14.7; p = 0.007) reflecting a nonlinear association (p = 0.006). Each unit increase in COHb% was associated with reduced likelihood of liberation from ECMO and mechanical ventilation, and increased time to hospital and ICU discharge (all p < 0.05). COHb% was significantly associated with hemolysis but not with initiation of hemodialysis or blood transfusions.

CONCLUSIONS:
In patients with ARDS on venovenous ECMO, COHb% is a novel biomarker for mortality exhibiting a U-shaped pattern. Our findings suggest that too little CO (perhaps due to impaired host signaling) or excess CO (perhaps due to hemolysis) is associated with higher mortality. Patients with low COHb% may exhibit the most benefit from future therapies targeting anti-oxidant and anti-inflammatory pathways such as low-dose inhaled CO gas.
Plasma Nitric Oxide Consumption Is Elevated and Associated With Adverse Outcomes in Critically Ill Patients
Authors: Dony Christina A. , Illipparambil Lijo C. , Maeda Tetsuro , Mroczek Susan K. , Rovitelli Amy , Wexler Orren , Malnoske Michelle , Bice Tristan , Fe Alex Z. , Storms Casey R. , Zhang Jimmy , Schultz Rebecca D. , Pietropaoli Anthony P. 
Published: August 2023

OBJECTIVES:
Impaired nitric oxide (NO) bioavailability may contribute to microvascular dysfunction in sepsis. Excessive plasma NO consumption has been attributed to scavenging by circulating cell-free hemoglobin. This may be a mechanism for NO deficiency in sepsis and critical illness. We hypothesized that plasma NO consumption is high in critically ill patients, particularly those with sepsis, acute respiratory distress syndrome (ARDS), shock, and in hospital nonsurvivors. We further hypothesized that plasma NO consumption is correlated with plasma cell-free hemoglobin concentration.

DESIGN:
Retrospective cohort study.

SETTING:
Adult ICUs of an academic medical center.

PATIENTS AND SUBJECTS:
Three hundred sixty-two critically ill patients and 46 healthy control subjects.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Plasma NO consumption was measured using reductive chemiluminescence and cell-free hemoglobin was measured with a colorimetric assay. Mean (95% CI) plasma NO consumption (µM) was higher in critically ill patients versus healthy control subjects (3.9 [3.7–4.1] vs 2.1 [1.8–2.5]), septic versus nonseptic patients (4.1 [3.8–4.3] vs 3.6 [3.3–3.8]), ARDS versus non-ARDS patients (4.4 [4.0–4.9] vs 3.7 [3.6–3.9]), shock vs nonshock patients (4.4 [4.0–4.8] vs 3.6 [3.4–3.8]), and hospital nonsurvivors versus survivors (5.3 [4.4–6.4] vs 3.7 [3.6–3.9]). These relationships remained significant in multivariable analyses. Plasma cell-free hemoglobin was weakly correlated with plasma NO consumption.

CONCLUSIONS:
Plasma NO consumption is elevated in critically ill patients and independently associated with sepsis, ARDS, shock, and hospital death. These data suggest that excessive intravascular NO scavenging characterizes sepsis and adverse outcomes of critical illness.
Case Report of Candida Parapsilosis Keratitis After Cataract Surgery Leading to Corneal Perforation
Authors: Hwang Brian , Jia Jason , Hwang Frank 
Published: August 2023

Purpose:
The objective of this study was to report and document a rare case of Candida parapsilosis keratitis that occurred following a routine clear corneal incision cataract surgery, ultimately resulting in a perforated corneal ulcer and subsequent need for a penetrating keratoplasty (PK). By presenting this case, the study aims to contribute to the existing literature and raise awareness about the potential risk of C. parapsilosis keratitis as a complication of cataract surgery.

Methods:
In this case report, we describe the presentation and management of a rare fungal infection following routine cataract extraction in an 80-year-old male patient. The patient initially received treatment for suspected endophthalmitis and bacterial keratitis but experienced worsening symptoms, including a small corneal perforation. Upon referral to the clinic, the patient exhibited a fluffy stromal infiltrate near the cataract wound site, an epithelial defect, and a hypopyon. Treatment with compounded topical 1% voriconazole was initiated but did not prevent the progression of the corneal perforation. Attempts to seal the perforation with corneal glue were unsuccessful, leading to the decision to perform a PK. During the surgery, corneal tissue was biopsied and cultured to identify the causative agent.

Results:
Following PK, the corneal cultures revealed the growth of C. parapsilosis, confirming the fungal nature of the infection. The patient was then reinitiated on topical voriconazole for a prolonged course of 7 months. Throughout this period, the patient was closely monitored and followed up in the clinic. Fortunately, there were no recurrences of the fungal lesion during this time.

Conclusions:
No prior cases of a perforated corneal ulcer resulting from C. parapsilosis keratitis after routine cataract surgery have been reported in the literature to our knowledge. Our patient experienced postoperative complications characterized by recurrent inflammation, which was treated with potent and frequent topical steroids. This treatment masked the underlying mycotic infection and contributed to corneal perforation. Ultimately, the patient underwent a successful PK procedure to remove the infectious nidus, followed by an extended 7-month course of topical voriconazole. No recurrence of the lesion was observed. Therefore, clinicians should be vigilant for mycotic keratitis, specifically C. parapsilosis, in patients who display late-onset, persistent inflammation and white plaques at the clear corneal incision site after cataract surgery. The combination of PK and an extended postoperative treatment with topical antifungal agents proves to be an effective strategy for managing corneal perforations caused by C. parapsilosis keratitis.
Relational coordination in value-based health care
Authors: van Staalduinen Dorine J. , van den Bekerom Petra E.A. , Groeneveld Sandra M. , Stiggelbout Anne M. , van den Akker-van Marle M. Elske 
Published: August 2023

BackgroundAn important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched.PurposeThe aim of this study was to examine relational coordination (RC) in VBHC and its antecedents.ApproachA questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell’s Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints).ResultsThe number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC.ConclusionsIn IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships.Practice ImplicationsHospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.
SUCCESSFUL ADJUNCTIVE TREATMENT OF BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION WITH HIGH-DOSE INTRAVENOUS IMMUNOGLOBULIN THERAPY
Authors: Saba Nicholas J. , Hong Timothy J. , Walter Scott D. 
Published: August 2023

Purpose:
The management of bilateral diffuse uveal melanocytic proliferation is controversial, with most earlier reports advocating for plasmapheresis. Here, we report a case of bilateral diffuse uveal melanocytic proliferation secondary to gastric adenocarcinoma that was successfully treated with adjunctive intravenous immunoglobulin, using a loading dose followed by a treat-and-extend strategy.

Methods:
Clinical case report with 3 years of follow-up including serial ophthalmologic examinations. Functional assessments included visual acuity and subjective visual complaints. Periodic anatomic assessments were performed including serial optical coherence tomography, ultra-widefield fundus imaging, multimodal angiography, and ophthalmic ultrasound.

Results:
A 75-year-old man presented with a 6-month history of blurry vision and difficulty with dark and light adaptation in both eyes. A diagnosis of bilateral diffuse uveal melanocytic proliferation was established based on clinical findings and subsequent discovery of an underlying gastric malignancy; the diagnosis of a paraneoplastic syndrome was further substantiated by documentation of cancer-associated antiretinal antibodies and serum reactivity against human retina by immunohistochemistry. Treatment with high-dose (2 g/kg) intravenous immunoglobulin was initiated with biweekly, followed by monthly, then q2-3 monthly dosing intervals. Meanwhile, the patient received surgical resection and systemic chemotherapy resulting in complete radiographic remission of the primary cancer. Over the course of 3 years, the patient has demonstrated clinically significant improvements in visual acuity and subjective visual function. Rapid and sustained anatomic improvements were observed in serous retinopathy and choroidal thickness.

Conclusion:
Intravenous immunoglobulin may be a viable adjunctive treatment option for some patients with bilateral diffuse uveal melanocytic proliferation.
CHRONIC HYPOTONY AND UVEITIS MANAGED WITH PARS PLANA VITRECTOMY, SILICONE OIL TAMPONADE, AND PERMANENT KERATOPROSTHESIS
Authors: Hou Kirk K. , Aldave Anthony J. , Kreiger Allan E. 
Published: August 2023

Purpose:
We report a case of silicone oil placement after Boston type 1 keratoprosthesis implantation for improvement and maintenance of intraocular pressure in a patient with chronic hypotony secondary to chronic uveitis.

Methods:
Observational case report.

Results:
A 54-year-old woman with a history of bilateral chronic panuveitis and subsequent hypotony presented with progressive corneal decompensation and band keratopathy in her better-seeing left eye. Corrected distance visual acuity in her left eye declined from count fingers at 3′ to hand motion. In an effort to clear the visual axis and stabilize intraocular pressure, implantation of a Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil injection was performed. Postoperatively, the intraocular pressure improved to the midteens and vision improved to count fingers at 4′with a follow-up of 2 years.

Conclusion:
Pars plana vitrectomy and injection of silicone oil after placement of a Boston type 1 keratoprosthesis can successfully improve and maintain intraocular pressure in eyes affected by chronic uveitis with ciliary body atrophy and chronic hypotony. This strategy effectively reverses such problems as hypotony maculopathy, disk swelling, scleral infolding, and corneal failure.