bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of the Pericranial Periosteal Flap in Children for Treating Severe Lower Eyelid Retraction
Authors: Lim Christina S. , Malhotra Raman 
Published: July 2023

Purpose:
To describe a surgical technique that can achieve significant lower eyelid elevation in severe retraction in children using a pericranial periosteal flap with skin graft.

Methods:
A retrospective, single-center, case series of 3 consecutive pediatric cases are performed where a pericranial periosteal flap was used with a skin graft to manage severe lower eyelid retraction. Outcome measures include the extent of lower eyelid elevation (mm) and complications in the follow-up visits.

Results:
Three children with severe lower eyelid retraction underwent the surgery. There were 2 boys and 1 girl with the mean age of 6.7 years (range, 5–8 years). The improvement of lower eyelid retraction was 3, 3, and 7 mm at 28, 24, and 6 months, respectively. No perioperative or postoperative complications occurred.

Conclusions:
Children with severe lower eyelid retraction often have a complex craniofacial and surgical history, and its surgical correction can be challenging. This case series present the successful use of pericranial flaps in treating severe lower eyelid retraction in children. The authors recommend this flap in children where traditional options have either failed or are not applicable.
Early pigment dispersion and raised intraocular pressure after uneventful central-hole implantable collamer lens surgery
Authors: Chaudhary Sanjay , Mehra Hema , Mittal Shanu Kumar , Pandey Alka 
Published: July 2023

Introduction:
With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge.

Patient and Clinical Findings:
2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments.

Diagnosis, Intervention, and Outcomes:
All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases.

Conclusions:
The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.
Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage
Authors: Lindquist Nathan R. , Dietrich Mary S. , Patro Ankita , Henry Melissa R. , DeFreese Andrea J. , Freeman Michael H. , Perkins Elizabeth L. , Gifford René H. , Haynes David S. , Holder Jourdan T. 
Published: July 2023

ObjectiveTo quantify the effect of datalogging on speech recognition scores and time to achievement for a “benchmark” level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes.Study DesignRetrospective cohort.SettingTertiary referral center.PatientsThree hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020.Main Outcome MeasuresProcessor datalogging, speech recognition scores, achievement of “benchmark speech recognition performance” defined as 80% of the median score for speech recognition outcomes at our institution.ResultsThe 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant–nucleus–consonant and AzBio scores within the first year (odds ratio = 1.21,p< 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day.ConclusionsEarly CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
Bed Rest After Acute Myocardial Infarction: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Dinu Eleonora-Antoaneta , Rogozea Liliana M. 
Published: July 2023

Background:
Complete bed rest has been a component of the management of acute myocardial infarction, which was first diagnosed in the United States in 1912. The prescribed duration of bed rest has been progressively shortened in the past century.

Study Question:
What are the milestones of the changes in the expert approach to the duration of bed rest for patients with acute myocardial infarction?

Study Design:
To determine the changes in the experts' approach to the duration of bed rest after a diagnosis of acute myocardial infarction, as presented in a widely used textbook in the United States.

Data Sources:
The chapters presenting the management of myocardial infarction in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:
Complete rest for 2–6 weeks was recommended by the Cecil's experts from 1927 through 1967. The practice was questioned since the early 1950s, but the recommended duration of bed rest was decreased to 3–4 days only in 1971, after most US hospitals opened coronary care units. The required time in bed was further decreased to 1 day in 1992 and to 12 hours in 2004. By 2007, the literature contained data from 15 trials with a total of 1471 patients kept in bed “longer” and 1487 patients who had been prescribed bed rest for “shorter” periods after an acute uncomplicate myocardial infarction and there was no difference between the groups regarding reinfarction, cardiac mortality, or all-cause mortality.

Conclusions:
The duration of bed rest after acute myocardial infarction recommended by experts in the United States has had a downward trend with an inflection point in the early 1970s. The change reflected experts' opinion, rather than evidence produced by randomized controlled trials.
High-deductible Health Plans and Nonfatal Opioid Overdose
Authors: Eddelbuettel Julia C.P. , Barry Colleen L. , Kennedy-Hendricks Alene , Busch Alisa B. , Hollander Mara A.G. , Huskamp Haiden A. , Meiselbach Mark K. , Schilling Cameron , Stuart Elizabeth A. , Eisenberg Matthew D. 
Published: July 2023

Objectives:
Opioid-related overdose is a public health emergency in the United States. Meanwhile, high-deductible health plans (HDHPs) have become more prevalent in the United States over the last 2 decades, raising concern about their potential for discouraging high-need populations, like those with opioid use disorder (OUD), from engaging in care that may mitigate the probability of overdose. This study assesses the impact of an employer offering an HDHP on nonfatal opioid overdose among commercially insured individuals with OUD in the United States.

Research Design:
We used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. We used an intent-to-treat, difference-in-differences regression framework to estimate the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. We also used an event-study model to account for dynamic time-varying treatment effects.

Results:
Across both comparison and treatment groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. Our primary model and robustness checks revealed no impact of HDHP offer on the probability of a nonfatal overdose.

Conclusions:
Our study suggests that HDHP offer was not associated with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD. However, given the strong evidence that medications for OUD (MOUD) can reduce the risk of overdose, research should explore which facets of insurance design may impact MOUD use.
The potential role of 68Ga-FAPI-04 PET/CT for screening malignancy in suspected colonic lesions
Authors: Erol Fenercioğlu Özge , Beyhan Ediz , Şahin Rahime , Baloğlu Mehmet Can , Arslan Esra , Çermik Tevfik Fikret , Ergül Nurhan 
Published: July 2023

Aim
Benign colonic lesions like tubular adenoma may show intense uptake on F-18-FDG PET/CT and can be mistaken for malignancy. In this study, we evaluated the role of 68Ga-FAPI-04 PET/CT for discriminating the benign and malignant colonic lesions.

Methods
Forty patients with diagnosis of colorectal cancer who had undergone 18F-FDG-PET/CT and 68Ga-FAPI-04 PET/CT for initial staging were retrospectively analyzed. The unexpected foci of uptake in colon on 18F-FDG PET/CT were compared with 68Ga-FAPI-04 PET/CT with lesion and background SUVmax.

Results
The primary colorectal lesion SUVmax on both PET/CTs was similar. A total of 9 incidental colon lesions in 7 patients were detected showing intense 18F-FDG uptake and no 68Ga-FAPI-04 uptake. All of the lesions were consistent with tubular adenoma histopathologically.

Conclusion
68Ga-FAPI PET/CT may have a crucial role for discrimination of benign and malignant colonic lesions and avoid the unnecessary interventions and extended surgeries in patients with colorectal cancer.
Studying the Feasibility and Acceptability of an Interactive Web-based Lethal Means Safety Decision Aid for Hospitalized Adults With Suicide Risk (Lock to Live)
Authors: Singh Mandeep , Levins Brian , McCall William V. , Anderson Michael , Olsen Erik , Yee Victoria , Cushing Michaela , Spearman-McCarthy E. VANESSA 
Published: July 2023

Objective:

Lock to Live is an interactive web-based lethal means safety decision aid that promotes temporary storage of firearms and medications. It has primarily been provided to suicidal patients in emergency department settings. The goal of this study was to evaluate the feasibility and acceptability of the Lock to Live decision aid with hospitalized adults at increased risk of suicide.

Methods:
Subjects provided demographic information and completed the Columbia-Suicide Severity Rating Scale after which they completed the Lock to Live program followed by a survey.

Results:
Twenty participants were recruited for this study, 5 of whom had access to firearms and 19 of whom had access to medications. Lock to Live was feasible to use as the mean length of time to complete the program was 10.0±5.3 minutes. It was acceptable to most participants as 75% of participants found it to be easy to use, and 65% of participants agreed that Lock to Live was helpful in making a decision about changing access to firearms/medications.

Conclusion:

Lock 2 Live decision aid appears to be a feasible and acceptable tool for hospitalized patients at risk for suicide.
Reduction in Cognitive Symptoms Following Intranasal Esketamine Administration in Patients With Chronic Treatment-resistant Depression: A 12-Week Case Series
Authors: Pepe Maria , Bartolucci Giovanni , Marcelli Ilaria , Simonetti Alessio , Camardese Giovanni , Di Nicola Marco , Sani Gabriele 
Published: July 2023

Background:
Cognitive symptoms are a core feature of depressive disorders, interfere with full functional recovery and are prominent in patients with treatment-resistant depression (TRD), particularly in severe chronic cases. Intranasal (IN) esketamine was recently approved for the treatment of TRD; however, its effects on cognitive symptoms are unclear. In this article, we describe cognitive changes in 8 patients with chronic TRD who were treated with IN administration of esketamine.

Methods:
Eight outpatients with chronic TRD received IN esketamine over 3 months and were assessed at baseline and after 4, 8, and 12 weeks of treatment using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Digit Symbol Substitution Test (DSST), the Trail Making Test-B (TMT-B), the Patient Deficits Questionnaire for Depression 5-item (PDQ-D5), the Hamilton Anxiety Rating Scale (HARS), and the Clinical Global Impressions Scale (CGI).

Findings:
We observed reductions in cognitive symptoms according to DSST, TMT-B, and PDQ-D5 scores within the first 2 months of treatment with IN esketamine. These improvements were observed before patients achieved clinical response (≥50% decrease in baseline MADRS scores), and they also occurred earlier than reductions in HARS scores.

Conclusions:
A clinical response to IN esketamine was detected in severely ill patients with chronic TRD after 3 months of treatment. Interestingly, improvements on measures of cognitive symptoms were observed before patients achieved antidepressant response. These preliminary observations suggest an additional value to the antidepressant properties of IN esketamine. Clinical studies specifically investigating cognition as a primary outcome measure of IN esketamine in TRD are warranted.
“Psychotherapy in the Pressure Cooker”: A Systematic Review of Single Session Psychosocial Interventions in Emergency Departments for Suicide-related Thoughts or Behaviors
Authors: Bossé Chartier Gabrielle , Lam Frederick , Bergmans Yvonne , Lofchy Jodi , Bolton James M. , Klonsky E. David , Zaheer Juveria , Kealy David 
Published: July 2023

Objectives:
Up to 20% of individuals who die by suicide have visited an emergency department (ED) within 4 weeks of their death. Limited guidance is available regarding the modification of clinical outcomes following a psychosocial intervention in the ED for pediatric and adult populations.

Methods:
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies focused on single-session psychosocial interventions for pediatric and adult patients experiencing suicide-related thoughts or behaviors (SRTB) in the ED. Two reviewers independently screened articles identified using the key terms suicide/self-harm, emergency department, and interview. Medline, PubMed, Embase, PsycINFO, CINAHL, and CENTRAL were searched from inception to August 2018.

Results:
After screening 3234 abstracts, 29 articles were selected for full-text review and 14 articles, representing 8 distinct studies (N=782), were included. A high level of heterogeneity was present in the included articles, with 7 randomized-controlled trials, 2 nonrandomized-controlled trials, 2 cohort studies, 2 observational studies, and 1 feasibility study. Most of the included studies focused on adolescents (6 articles) or military veterans (7 articles). Strong statistical evidence of ED interventions improving outpatient service linkage was supported (χ2: 81.80, P<0.0001, 7 studies).

Conclusions:
The findings of this study suggested promising outcomes for patients presenting to the ED with SRTB who receive a single-session psychosocial intervention. All of the studies that measured such outcomes found significantly increased follow-up care in the intervention arm. Further research is needed to strengthen the evidence base, provide better patient representation, and improve our understanding of the mechanisms by which the psychosocial intervention for SRTB in the ED ameliorates patient outcomes (CRD42020156496).
Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol
Authors: Araya Sthefano , Webster Theresa K. , Egleston Brian , Amadio Grace M. , Panichella Juliet C. , Elmer Nicholas A. , Patel Sameer A. 
Published: July 2023

Background
Enhanced Recovery After Surgery (ERAS) implementation achieves earlier recovery, reduced hospital length of stay (LOS) and improved outcomes in patients undergoing deep inferior epigastric perforator (DIEP) free flaps. We sought to review our ERAS protocols and their impact on our patients' LOS compared with the literature.

Methods
This was a retrospective review of a single surgeon's experience from 2017 to 2021 of patients undergoing DIEP free-flap breast reconstruction with LOS as the primary outcome. Complication rates and patient demographics are described as secondary outcomes.

Results
One hundred twenty-one patients underwent DIEP free-flap breast reconstruction. After adapting ERAS protocols, there has been a 0.98 [SD, 0.17; confidence interval [CI], −1.3 to −0.64; P < 0.001) day decrease in length of stay comparing pre-ERAS to post-ERAS implementation. Length of stay has routinely decreased from an average discharge on day 4.17 (SD, 1.1; range, 3–8 days) in 2017 to discharge on day 2.91 (SD, 1.1; range, 1–5 days) in 2021. Seventy-five percent of patients in 2021 were hospitalized for 3 or fewer days compared with 75% of patients in 2017 hospitalized for 4 or more days. One patient experienced a flap failure. Our study supports successful discharge on postoperative days 2–3 compared with postoperative days 3–4 in the current literature.

Conclusions
The implementation of our ERAS protocol for DIEP free-flap breast reconstruction has resulted in a shorter LOS compared with contemporary literature. The ERAS protocols can be efficiently adopted in microsurgical DIEP breast reconstruction to achieve a shorter LOS without jeopardizing patient outcomes.
Adipose-Derived Stem Cells Enhance Graft Incorporation and Mineralization in a Murine Model of Irradiated Mandibular Nonvascularized Bone Grafting
Authors: Lynn Jeremy V. , Lalchandani Keshav B. , Daniel Melissa , Urlaub Kevin M. , Ettinger Russell E. , Nelson Noah S. , Donneys Alexis , Buchman Steven R. 
Published: July 2023

Background
Nonvascularized bone grafting represents a practical method of mandibular reconstruction. However, the destructive effects of radiotherapy on native bone preclude the use of nonvascularized bone grafts in head and neck cancer patients. Adipose-derived stem cells have been shown to enhance bone healing and regeneration in numerous experimental models. The purpose of this study was to determine the impact of adipose-derived stem cells on nonvascularized bone graft incorporation in a murine model of irradiated mandibular reconstruction.

Methods
Thirty isogenic rats were randomly divided into 3 groups: nonvascularized bone graft (control), radiation with nonvascularized bone graft (XRT), and radiation with nonvascularized bone graft and adipose-derived stem cells (ASC). Excluding the control group, all rats received a human-equivalent dose of radiation. All groups underwent mandibular reconstruction of a critical-sized defect with a nonvascularized bone graft from the contralateral hemimandible. After a 60-day recovery period, graft incorporation and bone mineralization were compared between groups.

Results
Compared with the control group, the XRT group demonstrated significantly decreased graft incorporation (P = 0.011), bone mineral density (P = 0.005), and bone volume fraction (P = 0.001). Compared with the XRT group, the ASC group achieved a significantly increased graft incorporation (P = 0.006), bone mineral density (P = 0.005), and bone volume fraction (P = 0.013). No significant differences were identified between the control and ASC groups.

Conclusions
Adipose-derived stem cells enhance nonvascularized bone graft incorporation in the setting of human-equivalent radiation.
The Utility of Flap Coverage for Limb Salvage in Patients With Severe Prosthetic Joint Infections of the Knee Requiring Implant Exchange
Authors: Kahramangil Bora , Pires Giovanna , Montorfano Lisandro , Riesgo Aldo M. , Ghaznavi Amir M. 
Published: July 2023

Background
Prosthetic joint infection (PJI) is a challenging complication of knee arthroplasty, which can require amputation in severe cases. This study analyzes the utility of flap reconstruction in PJIs requiring hardware removal and extensive soft tissue debridement.

Methods
This was a retrospective analysis of patients who were treated according to a multistage extremity salvage protocol between 2018 and 2022. The protocol involved at least 3 planned surgeries including (1) hardware removal with antibiotic spacer placement and soft tissue debridement, (2) spacer exchange with flap coverage, and (3) hardware reimplantation with simultaneous or delayed extensor mechanism reconstruction. All patients had large periprosthetic tissue defects that would necessitate an amputation if not reconstructed. Primary outcomes were extremity salvage and successful defect coverage.

Results
Fifty-two patients (25 female) underwent 62 reconstructions (52 primary, 10 salvage). Flap techniques included pedicled muscular (n = 32), fasciocutaneous (n = 4), combined muscular and fasciocutaneous (n = 2), and free flaps (n = 24). Overall rate of successful defect coverage was 95% (98% in primary and 80% in salvage reconstructions). At a median follow-up of 11 months, 41 patients completed the treatment protocol with a 68% (n = 28) extremity salvage rate (reimplantation arthroplasty, n = 15; permanent knee fusion, n = 13). On the multivariate model including demographic factors, defect size, and flap type, no single factor independently predicted limb salvage.

Conclusions
Alongside intensive orthopedic surgical treatment, flap coverage may aid in extremity salvage in severe knee PJIs by reestablishing healthy soft tissue coverage and allowing reimplantation arthroplasty. We recommend a multispecialty approach including plastic surgeons for this challenging condition.