bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Overwhelming Postsplenectomy Sepsis: Role of Plastic Surgeon
Authors: Starnoni Marta , Pappalardo Marco , Marra Caterina , Pinelli Massimo , De Santis Giorgio 
Published: July 2023

Summary:
The overwhelming post-splenectomy infection (OPSI) is a feared late complication of splenectomy, with high morbidity and a mortality rate of up to 50%. Although the management of this syndrome is the duty of clinical physicians, the interest of plastic surgeons in OPSI is related to the injury that can occur in tissues with an end circulation, such as the limb extremities, nasal tip, and lips. In the management of OPSI, surgical techniques are not highlighted. The role of the plastic surgeon can be fundamental for the prevention of further extension of the necrotic tissue, improving as much as possible the vascularization around it. Moreover, a critical role in the management of OPSI is avoiding superinfection of the necrotic areas by combining different techniques and methods, such as surgical debridements, negative pressure wound therapy, and conservative treatment. Last but not least, functional and aesthetic restoration of the injured parts is of paramount importance for the final outcome. In this article, we describe the management of two unvaccinated patients with necrosis of the extremities after OPSI.
Distal Bypass to the Deep Palmar Arch for Treatment of a Unique Presentation of Digital Ischemia
Authors: Lee Nayun , Gehring Michael B. , Washington Kia M. 
Published: July 2023

Summary:
Radial artery occlusion leading to hand ischemia is a serious problem that may require prompt surgical intervention. Due to the rarity of these events, consensus on the most effective surgical approach has not yet been reached. There is even scarce literature on appropriate management of symptomatic radial occlusion in patients with a congenital variation in hand vasculature. We report on a case of a 38-year-old woman with radial artery occlusion who underwent a successful distal radial artery bypass to the deep palmar arch due to a diminutive ulnar artery and the absence of a superficial palmar arch. Radial artery bypass to the deep palmar arch using a reversed vein graft is a viable treatment option for preventing further digital ischemia or necrosis in patients with a compromised vasculature of the hand.
Beyond Physical Well-being: Exploring Demographic Variances in Psychosocial Well-being before Breast Reconstruction
Authors: Kebede Sara N. , Martin Morgan S. , Baker Nusaiba F. , Saad Omar A. , Losken Albert 
Published: July 2023

Background:
A patient’s preoperative satisfaction with their breasts and baseline psychosocial, sexual, and physical well-being are important considerations when planning breast reconstruction. We sought to elucidate variances in preoperative responses among patients undergoing postmastectomy breast reconstruction.

Methods:
Preoperative BREAST-Q responses and demographic data, including race, generation, median household incomeinstitutional review board and body mass index (BMI) were collected from breast cancer patients scheduled for mastectomy. Associations between demographic group and survey response were analyzed by chi-square or independent t-tests.

Results:
In total, 646 of 826 patients identified had complete data and were included in the final analysis. Patients in BMI group 1 (16–24.9) were more likely to report feeling “very satisfied” with how they looked unclothed compared with patients in other BMI groups (P = 0.031). Conversely, patients in groups 3 and 4 (35+), reported lower satisfaction (P = 0.037) and felt less attractive without clothes (P = 0.034). Asian women were less likely to feel attractive (P = 0.007), and Black patients were less likely to feel of equal worth to other women (P < 0.001). Finally, patients were less likely to report confidence in social settings if they were Black (P < 0.001), Asian (P < 0.001), from the millennial generation (P = 0.017), or living in zip codes with median household income less than $55,000 (P = 0.042).

Conclusions:
Breast cancer patients’ feelings toward their natural breasts vary widely between demographic groups. Understanding baseline psychosocial factors in this population is key to informing preoperative discussions and interpreting postoperative satisfaction.
Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis
Authors: Roider Laura A. , Nguyen David C. , Pusapadi Ramkumar Shreya , Tyson Cody V. , Lund Herluf G. , Plikaitis Christina M. 
Published: July 2023

Background:
Despite the increasing prevalence of breast implant associated anaplastic large cell lymphoma, there remains a paucity of literature guiding management of asymptomatic patients with textured breast implants. This risk can be anxiety provoking in breast reconstruction patients given their history of cancer or increased future risk. The purpose of this study is to evaluate current practice trends when managing the concerned asymptomatic patient following textured implant-based breast reconstruction.

Methods:
An electronic survey was distributed to members of the American Society of Plastic Surgeons, regarding management of asymptomatic breast reconstruction patients with textured devices. Anonymous responses were collected, and statistical analysis was performed.

Results:
A total of 304 responses were received. Of respondents, 237 (92%) have managed asymptomatic patients with textured devices. Historically, the overwhelming majority (89%) used textured devices; however, only 25% report current use. Regarding management of asymptomatic breast reconstruction patients, 87% recommend conservative management, while 13% recommend surgical management. When surgery is performed, 16.3% of respondents elected for implant exchange, 33.8% recommended implant exchange with partial capsulectomy, and 49.8% elected for implant exchange with total capsulectomy. Evaluation of practice patterns based on demographics demonstrated statistically significant differences in current use of textured devices and management of acellular dermal matrix.

Conclusions:
Despite decreased current use, there is a significant population of asymptomatic breast reconstruction patients with a history of textured devices concerned for risk of breast implant associated anaplastic large cell lymphoma. This survey demonstrates ongoing variability in surgeon recommendations regarding conservative and surgical management of these patients and the need for continued development of evidence-based guidelines.
Rapid monophasic HBsAg decline during nucleic-acid polymer–based therapy predicts functional cure
Authors: Hershkovich Leeor , Shekhtman Louis , Bazinet Michel , Pântea Victor , Placinta Gheorge , Cotler Scott J. , Vaillant Andrew , Dahari Harel 
Published: July 2023

Background and Aims:
Analyzing the interplay among serum HBV DNA, HBsAg, anti-HBs, and alanine aminotransferase (ALT) during nucleic-acid polymer (NAP)-based therapy for chronic hepatitis B provides a unique opportunity to identify kinetic patterns associated with functional cure.

Methods:
All participants with HBeAg-negative chronic HBV infection in the REP 401 study (NCT02565719) first received 24 weeks of tenofovir-disoproxil-fumarate (TDF) monotherapy. The early triple therapy group (n = 20) next received 48 weeks of TDF+pegylated interferon-α2a (pegIFN)+NAPs. In contrast, the delayed triple therapy group (n = 20) next received 24 weeks of TDF+pegIFN before 48 weeks of triple therapy. Three participants discontinued treatment and were excluded. Functional cure (HBsAg and HBV DNA not detectable with normal ALT) was assessed at 48 weeks post-treatment. Different kinetic phases were defined by at least a 2-fold change in slope. A single-phase decline was categorized as monophasic, and 2-phase declines were categorized as biphasic.

Results:
Fourteen (35%) participants achieved a functional cure. HBV DNA remained below or near undetectable for all participants by the end of TDF monotherapy and during subsequent combination therapies. Three HBsAg kinetic patterns were found in both the early and delayed groups, nonresponders (n = 4 and n = 4), monophasic (n = 11 and n = 11), and biphasic (n = 4 and n = 3), respectively. All participants who achieved a functional cure had a monophasic HBsAg kinetic pattern during triple therapy. Among participants with a monophasic HBsAg decline, those who had a functional cure had a shorter median time to HBsAg loss of 21 (interquartile range=11) weeks compared with those who did not achieve functional cure [median: 27 (7) weeks] (p = 0.012).

Conclusions:
Functional cure was associated with a rapid monophasic HBsAg decline during NAP-based therapy. A nonmonophasic HBsAg kinetic pattern had a 100% negative predictive value (NPV) for a functional cure.
Baseline Characteristics of 1976 Patients With Ectatic Corneal Disorders at a Single Center From 2010 to 2021: A Cross-Sectional Study of the Homburg Keratoconus Center
Authors: Sideroudi Haris , Flockerzi Elias , Daas Loay , Jullien Theresia , Xanthopoulou Kassandra , Hamon Loïc , Seitz Berthold 
Published: July 2023

Objectives:
The study objective was to analyze the baseline characteristics of keratoconus (KC) patients at the Homburg Keratoconus Center from 2010 to 2021.

Methods:
This cross-sectional study included 3,674 eyes, with analysis of demographics, clinical findings, visual function, endothelial measurements, and topographic, tomographic, and corneal biomechanical data from the first visit.

Results:
Mean patient age was 36.3±13.8 years. The mean uncorrected distance visual acuity in log of minimal angle of resolution was 0.60 (20/80, Snellen equivalent), and the corrected mean was 0.3 (20/40). Of 1976 patients, 48.9% reported eye rubbing. Mean values (ranges) were 49.4±6.3 (36.3–78.0) D for steep keratometry, 462.4±66.0 (48.0–659.0) μm for thinnest corneal thickness, 9.7±8.7 (−0.5 to 88.8) for Belin/Ambrósio enhanced ectasia total deviation, 0.8±0.4 (0.0–1.0) for the Corvis biomechanical index, 0.9±0.2 (0.0–1.0) for the tomographic biomechanical index, 0.1±0.5 (−0.9 to 2.0) for the KC match index, 8.3±1.8 (2.2–17.7) mm Hg for corneal hysteresis, 7.1±2.2 (0.0–17.0) mm Hg for corneal resistance factor, and 2,562.9±326.3 (1,011–3,937) cells/mm2 for endothelial cell density. The average ABCDE KC stage was A2B3C1D1E2. Distance-corrected visual acuity correlated strongly with topometric, tomographic, and biomechanical data (P<0.001).

Conclusions:
This comprehensive description of baseline features of KC patients at a tertiary center provides a reference for further longitudinal and international multicentric studies.
High Tidal Volume, High Positive End Expiratory Pressure and Apneic Breath Hold Strategies (Lung Navigation Ventilation Protocol) With Cone Beam Computed Tomography Bronchoscopic Biopsy of Peripheral Lung Lesions
Authors: Bhadra Krish , Baleeiro Carlos , Patel Sumit , Condra William , Bader Brittany Amento , Setser Randolph M. , Youngblood Sloan 
Published: July 2023

Background:
A dedicated anesthesia protocol for bronchoscopic lung biopsy—lung navigation ventilation protocol (LNVP)—specifically designed to mitigate atelectasis and reduce unnecessary respiratory motion, has been recently described. LNVP demonstrated significantly reduced dependent ground glass, sublobar/lobar atelectasis, and atelectasis obscuring target lesions compared with conventional ventilation.

Methods:
In this retrospective, single-center study, we examine the impact of LNVP on 100 consecutive patients during peripheral lung lesion biopsy. We report the incidence of atelectasis using cone beam computed tomography imaging, observed ventilatory findings, anesthesia medications, and outcomes, including diagnostic yield, radiation exposure, and complications.

Results:
Atelectasis was observed in a minority of subjects: ground glass opacity atelectasis was seen in 30 patients by reader 1 (28%) and in 18 patients by reader 2 (17%), with good agreement between readers (κ = 0.78). Sublobar/lobar atelectasis was observed in 23 patients by reader 1 and 26 patients by reader 2, also demonstrating good agreement (κ = 0.67). Atelectasis obscured target lesions in very few cases: 0 patients (0%, reader 1) and 3 patients (3%, reader 2). Diagnostic yield was 85.9% based on the AQuIRE definition. Pathology demonstrated 57 of 106 lesions (54%) were malignant, 34 lesions (32%) were benign, and 15 lesions (14%) were nondiagnostic.

Conclusion:
Cone beam computed tomography images confirmed low rates of atelectasis, high tool-in-lesion confirmation rate, and high diagnostic yield. LNVP has a similar safety profile to conventional bronchoscopy. Most patients will require intravenous fluid and vasopressor support. Further study of LNVP and other ventilation protocols are necessary to understand the impact of ventilation protocols on bronchoscopic peripheral lung biopsy.
Best Practices for Promoting Safe Patient Care Delivery by Hospital-Based Traveling Clinical Staff
Authors: Krzyzewski Julia , Cook Michelle , Memken Amanda , Johnson Micayla , Francis Sarah E. , Romao Bailey , White Jessica , Bowers Jade , Watson Heather , Whalen Madeleine 
Published: July 2023

Background:
Hospitals use traveling clinical staff (TCS) to fill personnel shortages. Although this approach may help improve staffing ratios, it is not without risk.

Purpose:
The interdisciplinary team conducted an integrative literature review to determine best practices for promoting safe patient care delivery by TCS.

Methods:
Using the Johns Hopkins Evidence-Based Practice model, the authors performed an integrative literature review, including appraisal of quality, synthesis of themes, and best-evidence recommendations.

Results:
The final synthesis included 16 articles. Evidence demonstrated the importance of preemployment screening, standardized onboarding and orientation, and optimizing the integration of TCS into the work environment.

Conclusion:
Hospitals should use these recommendations when incorporating TCS into their teams.
Internet-Based Treatment of Body Dysmorphic Disorder
Authors: Schoenenberg Katrin , Bosbach Katharina , Baumeister Harald , Küchler Ann-Marie , Hartmann Andrea Sabrina , Harrer Mathias , Ebert David Daniel , Martin Alexandra 
Published: July 2023

Abstract
Initial findings indicate the effectiveness of internet-based interventions for body dysmorphic disorder (BDD). In order to substantiate these findings, a seven-module guided internet-based intervention was created and examined. We report the mixed data of participants with clinical and subclinical BDD of the treatment group (n = 18). We investigated the feasibility, the quality of the program content, the design and usability, and its effects on symptom severity and related psychopathology. Adherence to the intervention was low and dropout rate high (55.6%). The program content, perceived website usability, and visual aesthetic were rated high. Credibility and expectancy were on a medium level. Satisfaction with appearance improved significantly in the intention-to-treat analysis (d = 0.58). In sum, symptom-related outcomes and program evaluation showed a positive trend albeit the study conduction was difficult. Future programs should investigate the role of additional motivation strategies and more flexible support addressing the known treatment barriers.
The Course Patterns and Diagnostic Shifts of Patients With Schizoaffective Disorder
Authors: Yıldırım Yusuf Ezel , Çetinay Aydın Pınar , Gümüşay Uğur Merve 
Published: July 2023

Abstract
Since its introduction, schizoaffective disorder (SAD) has been one of the most controversial diagnoses in psychiatry, both clinically and nosologically. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), SAD diagnostic criteria were changed, and instead of a cross-sectional diagnosis, a longitudinal approach covering the life course of the illness was adopted. In this study, the meaning of this conceptual shift in the diagnosis of SAD in clinical practice is investigated throughout the course of the illness for patients with SAD. Sixty-two inpatients diagnosed with SAD according to DSM-5 diagnostic criteria are included in this study. The course of the illness from its onset to the present is investigated retrospectively. The disease duration is 18.3 ± 9.1 years. The most common diagnoses in the first hospitalization are bipolar disorder (manic episodes) and psychotic disorder, not otherwise specified. Furthermore, the time that elapsed between the first psychiatric application of the patients and the diagnosis of SAD is 9.5 ± 7.3 years. Further, when the course of the illness is grouped according to the predominance of affective and psychotic disorders, recurrent affective disorders are observed most frequently (29.3%), followed by mixed-episode disorders and a shift from affective disorders to psychotic disorders (22.4%). It is found that SAD has a heterogeneous course, and affective disorder diagnoses are more dominant during the course of the illness. The clinical relevance of the longitudinal emphasis on the total duration of the illness in the DSM-5 is also demonstrated. The affective and psychotic dichotomy, based on Kraepelin, has failed to elucidate the course of the disease in clinical practice. Therefore, clinicians should meticulously evaluate the entire course of the illness for SAD and avoid conclusive judgments over a single episode.
Cannabis and Pregnancy: A Review
Authors: Hayer Sarena , Mandelbaum Ava D. , Watch Lester , Ryan Kimberly S. , Hedges Madeline A. , Manuzak Jennifer A. , Easley Charles A. , Schust Danny J. , Lo Jamie O. 
Published: July 2023

ImportancePrenatal cannabis use is rising and is a major public health issue. Cannabis use in pregnancy and during lactation has been associated with increased maternal and offspring morbidity and mortality.ObjectiveThis review aims to summarize the existing literature and current recommendations for cannabis use during pregnancy or lactation.Evidence AcquisitionA PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: “cannabis,” “cannabinoid,” “delta-9-tetrahydrocannabinol,” “THC,” “cannabidiol,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” and “lactation.”ResultsAvailable studies on cannabis use in pregnancy and during lactation were reviewed and support an association with increased risk of preterm birth, neonatal intensive care unit admission, low birth weight, and small-for-gestational-age infants.Conclusion and RelevanceThere is a critical need for research on the effects of cannabis use in pregnancy and during lactation. This is a necessary first step before furthering patient education, developing interventions, and targeting antenatal surveillance to ameliorate the adverse impacts on maternal and fetal health.Target AudienceObstetricians and gynecologists, family physicians, pediatriciansLearning ObjectivesAfter participating in this activity, the learner should be better able to describe options for treatment of cannabis use disorder; explain common forms of cannabinoids available for use; and discuss screening options for cannabis use in pregnancy.
Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation
Authors: Lambert Katherine A. , Honart Anne West , Hughes Brenna L. , Kuller Jeffrey A. , Dotters-Katz Sarah K. 
Published: July 2023

ABSTRACT

Importance
Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care.

Objective
To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario.

Evidence Acquisition
Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed.

Results
These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens.

Conclusions
Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV.

Relevance
Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After reading this article, the provider should be better able to discuss diagnosis and management of endometritis; describe antibiotic regimens recommended in the setting of uterine exploration postpartum; and identify antibiotic regimens recommended in the setting of postpartum uterine instrumentation.
Concurrent Surgery for Locoregional Gynecologic Cancers and Pelvic Floor Disorders in a Population of Patients With Medicare Insurance
Authors: Corey Logan , Seaton Randell , Ruterbusch Julie J. , Bretschneider Carol Emi , Vezina Alex , Do Trieu , Hobson Deslyn , Winer Ira 
Published: July 2023

(Abstracted from Obstet Gynecol 2023;141:629–641)
Most women diagnosed with a gynecologic cancer report symptoms related to pelvic organ prolapse or urinary incontinence (POP-UI) before and during their cancer treatment. Often, these symptoms go untreated; however, several studies have suggested concurrent surgery for gynecologic cancer, and POP-UI symptoms is safe and may reduce total surgeries but lack long-term follow-up data.
Cell-Free DNA in Maternal Blood and Artificial Intelligence: Accurate Prenatal Detection of Fetal Congenital Heart Defects
Authors: Bahado-Singh Ray , Friedman Perry , Talbot Ciara , Aydas Buket , Southekal Siddesh , Mishra Nitish K. , Guda Chittibabu , Yilmaz Ali , Radhakrishna Uppala , Vishweswaraiah Sangeetha 
Published: July 2023

(Abstracted from Am J Obstet Gynecol 2023;228(1):76.e1–76.e10)
Congenital heart defects (CHDs) are one of the leading causes of child morbidity and mortality. Previous research has shown that prenatal detection of CHD can significantly reduce the risk of death for severe cases, yet the current techniques available for prenatal diagnosis detect approximately only half of cases.
Centering Group Treatment for Women With Interstitial Cystitis/Bladder Pain Syndrome: A Prospective, Parallel-Group Cohort Study
Authors: Meriwether Kate V. , Ravichandran Niharika , Darley Cassandra J. , Panter Virginia , Komesu Yuko M. 
Published: July 2023

(Abstracted from Urogynecology 2023;29:410–421)
Although difficult to diagnose and measure, interstitial cystitis/bladder pain syndrome (ICBPS) affects up to 1 in 10 women (with even higher rates amid pelvic pain populations). This condition causes shame and stigma for its victims, leading to isolation, loneliness, and compromised ability to voice personal needs.