bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Patient Characteristics and Surgical Variables That Influence Postoperative Complications following Bilateral Reduction Mammoplasty
Authors: Dow Todd , Crawley Emma , Selman Tamara , Al Youha Sarah , Bendor-Samuel Richard , Brennan Michael , Williams Jason 
Published: August 2023

Background:
Breast hypertrophy is known to be a source of both physical and psychosocial health deficits. Therefore, the ability to relieve these symptoms with surgical treatment is an important consideration for patients. The primary objective of this study was to assess the impact of patient body mass index (BMI) on postoperation complications. The secondary objective of this study was to assess patient demographics, surgical techniques, and patient comorbidities for their impact on specific postoperative complications.

Methods:
A retrospective chart review of all patients who received bilateral breast reduction surgery in Nova Scotia over the past 10 years was performed. A total of 1022 patients met the inclusion criteria of the study. Logistic regression modeling was performed to identify demographic factors, surgical techniques, and patient comorbidities that impact the risk of developing specific postoperative complications.

Results:
Our study population had a total complication incidence of 37.7%. BMI was not significantly different between patients who developed complications and those who did not. Logistic regression modeling showed a significant relationship that with each unit increase in BMI above the mean (25.9 kg/m2) the relative risk of patient-reported postoperative asymmetry increased by 6%.

Conclusions:
The findings of this study suggest that BMI has several nonsignificant relationships to postoperative complications following bilateral breast reduction. These trends do not translate to significantly increased complaints of asymmetry, scarring‚ or revision surgeries. This study also provides valuable information on the timeline of postoperative complications and when they can commonly be identified.
Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap
Authors: Triolo Julie C. , Buchs Nicolas C. , Tessitore Enrico , Hannouche Didier , Dominguez Dennis E. , Kalbermatten Daniel F. , Oranges Carlo M. 
Published: August 2023

Summary:
Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.
NAC Plaster Lifting Technique for the Management of Skin Redundancy in Severe Gynecomastia
Authors: Ramasamy Karthik , Jagadish Kiran Appaka C.V. , Jesudass Joyce , Raj Sunitha 
Published: August 2023

Background:
Gynecomastia is found to be a common cosmetic problem. Many techniques are currently available for the surgical treatment of gynecomastia, reported to be effective, with limited scar formation. The main objective of our unique reproducible nipple-areola complex (NAC) lifting technique is the management of skin redundancy in severe gynecomastia and positioning the NAC at an aesthetically pleasing site on the chest, for men.

Methods:
A retrospective study was conducted in 30 gynecomastia surgeries of grade III and IV done from January 2019 to December 2020. All these patients were treated by using the NAC lifting technique in our centre, and the results were assessed with patient and surgeon satisfaction scores. This lifting plaster technique is used after the skin closure of the Webster incision. The U slit in the lifting plaster prevents the wrinkling of the NAC and also avoids the second stage surgery for most of the cases of severe gynecomastia.

Results:
A retrospective analysis showed that all patients were satisfied with the technique and none of the patients returned for the second stage surgery. Minimal residual skin redundancy was observed, but it was not severe to necessitate a secondary procedure. All patients were satisfied and comfortable with the final outcome.There was no incidence of contour deformity after the procedure.

Conclusion:
This technique takes advantage of the elastic recoiling property of the skin and helps in re-draping the redundant skin on the chest wall and in positionining the NAC at an aesthetically pleasing position on the chest.
Combined Treatment with Lymphaticovenular Anastomosis and Ethanol Sclerotherapy for Cystic Lymphangioma in a Limb
Authors: Yoshida Shuhei , Imai Hirofumi , Roh Solji , Mese Toshiro , Koshima Isao 
Published: August 2023

Summary:
Several treatment options, including sclerotherapy and surgical excision, are available for the management of cystic lymphangioma. Lymphaticovenular anastomosis (LVA) has recently garnered attention in the field of microsurgery as a minimally invasive surgical reconstruction strategy. Combined treatment using surgical excision and LVA for large or persistent cystic lymphatic malformations has been reported but can be very invasive. This case report describes use of a combination of LVA and sclerotherapy to treat cystic lymphatic malformations with satisfactory results. This combination could be a complementary minimally invasive treatment for extensive cystic lymphatic malformations. The patient was an 18-year-old woman with a cystic lymphangioma from the axilla to the subclavicular area beneath pectoralis major and pectoralis minor. The size was a diameter of 12 cm and a maximum depth of 8 cm. The cystic lymphangioma was managed by combined treatment of LVA and ethanol sclerotherapy. The patient had subsequent resolution of the lymphangioma without any symptoms of lymphedema or recurrence. LVA is thought to be a less invasive treatment option when the lymphatics flowing into a cyst are detectable or can be targeted. However, this is not always the case, especially if the cyst is large, persistent, or infected. Combination of LVA with sclerotherapy is a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbation or occurrence of lymphedema. Therefore, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or persistent lymphocele.
Bilateral Transposition Flap for Postoperative Anal Stenosis after Reconstruction for Paget Disease
Authors: Nakatsuka Kengo , Karakawa Ryo , Fuse Yuma , Yoshimatsu Hidehiko , Yano Tomoyuki 
Published: August 2023

Summary:
One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction. A 57-year-old man presented to the clinic with diverticulitis secondary to severe anal stenosis, and reported difficulty with defecation after perianal skin resection around the anus and surgery to create a V-Y advancement flap for perianal primary Paget disease 9 months previously. After improvement of the diverticulitis using antibiotics, bilateral transposition flaps were transferred to release the anal stenosis. The surgical treatment for severe anal stenosis has been known to entail several complications, including infection, incontinence, anal mucosal ectropion, pruritus, wound dehiscence, and restenosis. In this severe case, because the scars were situated at the 6 o’clock and 12 o’clock positions on the anus due to the previous V-Y advancement flap, bilateral rotation flaps were transferred from the 3 o’clock and 9 o’clock positions of the anus to prevent wound dehiscence and partial flap necrosis. Three months later, the size of the anus was unchanged, but additional surgery was performed at the patient’s request. A bilateral transposition flap procedure was used, with flaps designed and elevated from the 6 o’clock and 12 o’clock positions. The postoperative course was uneventful, and the anal stenosis was improved.
Pulmonary Rehabilitation for Post-COVID-19
Authors: Aljazeeri Jafar , Almusally Rayyan , Wert Yijin , Abdelhalim Mostafa , Klinger Cathleen , Ramesh Navitha , Rahman Taj 
Published: August 2023

Purpose:
Patients with COVID-19 often report persistent respiratory symptoms. Limited data exist on how to mitigate long-term sequelae of exercise intolerance and dyspnea. We aimed to study the role of pulmonary rehabilitation (PR) in patients with post-COVID-19.

Methods:
This was an observational study. Consecutive patients with post-COVID-19, admitted to three separate outpatient PR programs, were enrolled. The program consisted of 8-12 wk of PR sessions (3 times/wk). Data were gathered at the initial visit and discharge. The primary outcome was the change in the 6-min walk test (6MWT) distance. Secondary outcomes included the Shortness of Breath Questionnaire (SOBQ), modified Borg dyspnea scale, Patient Health Questionnaire-9 (PHQ-9), and Lung Information Needs Questionnaire (LINQ).

Results:
A total of 56 patients completed the PR program (age 62.8 ± 14.7 yr, 57% were men). At baseline, the mean 6MWT was 313.3 ± 193.8 m. On average, the 6MWT improved by 84.3 m after PR (P < .0001). Apart from the modified Borg dyspnea scale, there was improvement across secondary outcomes: SOBQ (−16.9 points), PHQ-9 (−2.6 points), and LINQ (−4.2 points); all P < .05.

Conclusion:
Pulmonary rehabilitation showed a promising positive effect on patients with with post-COVID-19. It improved exercise capacity, perception of dyspnea, depressive symptoms, and patient knowledge needed to manage their lung disease. Pulmonary rehabilitation should be considered for post-COVID-19 patients.
Neurotrophic Keratopathy After Slow Coagulation Transscleral Cyclophotocoagulation
Authors: Sayed Mohamed S. , Khodeiry Mohamed M. , Elhusseiny Abdelrahman M. , Sabater Alfonso L. , Lee Richard K. 
Published: August 2023

Purpose:
Decreased corneal sensation and subsequent neurotrophic keratopathy (NK) is an uncommon complication after transscleral cyclophotocoagulation (TSCPC). Post-TSCPC NK has been rarely reported in the literature, predominantly after traditional, “pop technique” continuous-wave TSCPC or micropulse CPC. The authors report the first case series of NK after slow-coagulation TSCPC (SC-TSCPC).

Methods:
This was a respective chart review of patients who developed NK after SC-TSCPC. The collected data included demographic data, type of glaucoma, risk factors for corneal anesthesia in addition to the number of laser spots, and the extent of the treated area.

Results:
Four eyes experienced NK after SC-TSCPC. The median time for the development of NK was 4 weeks. At the final visit, 2 patients had a resolution of NK, 1 had a persistent corneal ulcer, and 1 had worsening NK and corneal perforation.

Conclusions:
NK is a rare but a vision-threatening complication that can develop after SC-TSCPC in patients with risk factors for decreased corneal sensation. Early diagnosis and proper management are crucial to reducing the risk of vision loss and improving the prognosis of these cases.
The safety and efficacy between remimazolam and propofol in intravenous anaesthesia of endoscopy operation: a systematic review and meta-analysis
Authors: Zhao Mei-ji , Hu Hai-feng , Li Xin-lei , Li Xiao-ming , Wang Da-chuan , Kuang Ming-jie 
Published: August 2023

Background:
Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol.

Aim:
This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery.

Method:
MEDLINE, EMBASE, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile.

Results:
Compared to propofol, the use of remimazolam reduced postoperative injection pain [Relative Risk (RR)=0.06, 95% confidence interval (CI): 0.03–0.12, P<0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28–0.73, P=0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08–0.47, P=0.0002); however, it also slightly reduced the success rate of the operation [Risk Difference (RD)=−0.02, 95% CI: −0.04–−0.01, P=0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD=−0.01, 95% CI: −0.03–0.01, P=0.35), recovery time after the operation [STD Mean Difference (SMD)=0.68, 95% CI: −0.43–1.80, P=0.23] or discharge time (SMD=0.17, 95% CI: −0.58–0.23, P=0.41). We also performed a subgroup analysis of each corresponding outcome.

Conclusion:
Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility.
Effect of body weight support training on lower extremity motor function in patients with spinal cord injury: a systematic review and meta-analysis
Authors: Huang Lei , Huang Hai liang , Dang Xiao wen , Wang Ya jie 
Published: August 2023

Abstract

Objective
To systematically evaluate the effect of body weight support training (BWST) on lower extremity motor functions in patients with spinal cord injury (SCI) and to compare the effect differences among three BWST methods.

Design
PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, CBM, VIP, and Wan Fang databases were searched until December 31, 2022. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and ADDIS 1.16.8.

Results
Nineteen RCTs involving 864 patients were included. The meta-analysis showed that BWST could improve lower extremity motor scores (LEMSs) according to the ISCNCSCI standard (mean difference [MD] = 6.38, 95% confidence interval [CI] = 3.96, 8.80; P < 0.05), walking speed (SMD = 0.77, 95% CI = 0.52, 1.02; P < 0.05), and modified Barthel index (MBI) scores (MD = 9.85, 95% CI = 8.39, 11.30; P < 0.05). The network meta-analysis showed no significant difference among the three BWST methods for improving LEMSs in patients with SCI. The best probability ranking of the BWST methods for improving LEMSs in patients with SCI was robot-assisted gait training (RAGT) (P = 0.60), followed by aquatic exercise (P = 0.21) and BWST (P = 0.19).

Conclusions
BWST can improve lower extremity motor function in patients with SCI. No significant difference was observed among the three BWST methods, but RAGT may produce the best effect.
Wide-Awake Carpal Tunnel Release in the United States: Trends in Volume and Reimbursement by Operative Setting
Authors: Kammien Alexander J. , Kim Samuel , Mookerjee Vikram G. , Williams Mica C. G. , Prsic Adnan , Grauer Jonathan N. , Colen David L. 
Published: August 2023

Background:
Office-based surgery can increase logistical and financial efficiency for patients and surgeons. The current study compares wide-awake, office-based carpal tunnel release to wide-awake operations performed in the operating room in terms of volume, financial burden, narcotic prescriptions, and adverse events.

Methods:
Operations performed under local-only anesthesia from 2010 to 2020 were identified in a national administrative database (PearlDiver). Patients were grouped by surgical setting and matched based on age, sex, comorbidity burden, and geographic region. Primary endpoints included total disbursement and physician reimbursement, and 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSIs).

Results:
Before matching, there were 303,741 operating room operations and 5463 office operations. From 2010 to 2020, the percentage of operations in the office increased from 1.2% to 3.4%. Matched cohorts included 21,835 operating room operations and 5459 office operations. Office surgery was associated with lower total disbursement and physician reimbursement for patients with commercial insurance, Medicaid, and Medicare. Linear regression modeling indicated that office-based surgery was significantly associated with lower total disbursement and physician reimbursement. Fewer office patients filled narcotic prescriptions and visited the ED, and there was no difference in SSIs.

Conclusions:
Compared with operating room surgery, office surgery was associated with lower financial burden, fewer narcotics prescriptions and ED visits, and a similar incidence of SSIs. These findings, together with literature showing greater efficiency in the office, suggest that office-based operations are safe and cost-effective and should continue to grow.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Predicting polycystic ovary syndrome (PCOS) with machine learning algorithms from electronic health records
Authors: Zad Zahra , Jiang Victoria S. , Wolf Amber T. , Wang Taiyao , Cheng J. Jojo , Paschalidis Ioannis Ch. , Mahalingaiah Shruthi 
Published: August 2023

AbstractIntroductionPredictive models have been used to aid early diagnosis of PCOS, though existing models are based on small sample sizes and limited to fertility clinic populations. We built a predictive model using machine learning algorithms based on an outpatient population at risk for PCOS to predict risk and facilitate earlier diagnosis, particularly among those who meet diagnostic criteria but have not received a diagnosis.MethodsThis is a retrospective cohort study from a SafetyNet hospital’s electronic health records (EHR) from 2003-2016. The study population included 30,601 women aged 18-45 years without concurrent endocrinopathy who had any visit to Boston Medical Center for primary care, obstetrics and gynecology, endocrinology, family medicine, or general internal medicine. Four prediction outcomes were assessed for PCOS. The first outcome was PCOS ICD-9 diagnosis with additional model outcomes of algorithm-defined PCOS. The latter was based on Rotterdam criteria and merging laboratory values, radiographic imaging, and ICD data from the EHR to define irregular menstruation, hyperandrogenism, and polycystic ovarian morphology on ultrasound.ResultsWe developed predictive models using four machine learning methods: logistic regression, supported vector machine, gradient boosted trees, and random forests. Hormone values (follicle-stimulating hormone, luteinizing hormone, estradiol, and sex hormone binding globulin) were combined to create a multilayer perceptron score using a neural network classifier. Prediction of PCOS prior to clinical diagnosis in an out-of-sample test set of patients achieved AUC of 85%, 81%, 80%, and 82%, respectively in Models I, II, III and IV. Significant positive predictors of PCOS diagnosis across models included hormone levels and obesity; negative predictors included gravidity and positive bHCG.ConclusionsMachine learning algorithms were used to predict PCOS based on a large at-risk population. This approach may guide early detection of PCOS within EHR-interfaced populations to facilitate counseling and interventions that may reduce long-term health consequences. Our model illustrates the potential benefits of an artificial intelligence-enabled provider assistance tool that can be integrated into the EHR to reduce delays in diagnosis. However, model validation in other hospital-based populations is necessary.
Immunoregulatory macrophages modify local pulmonary immunity and ameliorate hypoxic-pulmonary hypertension
Authors: Fernandez-Gonzalez Angeles , Mukhia Amit , Nadkarni Janhavi , Willis Gareth R. , Reis Monica , Zhumka Kristjan , Vitali Sally , Liu Xianlan , Galls Alexandra , Mitsialis S. Alex , Kourembanas Stella 
Published: August 2023

ABSTRACTRationaleMacrophages play a central role in the onset and progression of vascular disease in pulmonary hypertension (PH) and cell-based immunotherapies aimed at treating vascular remodeling are lacking.ObjectiveTo evaluate the effect of pulmonary administration of macrophages modified to have an anti-inflammatory/pro-resolving phenotype in attenuating early pulmonary inflammation and progression of experimentally induced PH.MethodsMouse bone marrow derived macrophages (BMDMs) were polarizedin vitroto a regulatory (M2reg) phenotype. M2regprofile and anti-inflammatory capacity were assessedin vitroupon lipopolysaccharide (LPS)/interferon-γ (IFNγ) restimulation, before their administration to 8- to 12-week-old mice. M2regprotective effect was tested at early (2 to 4 days) and late (4 weeks) time points during hypoxia (8.5% O2) exposure. Levels of inflammatory markers were quantified in alveolar macrophages and whole lung, while PH development was ascertained by right ventricular systolic pressure (RSVP) and right ventricular hypertrophy (RVH) measurements. Bronchoalveolar lavage (BAL) from M2reg-transplanted hypoxic mice was collected, and its inflammatory potential tested on naïve BMDMs.ResultsM2regmacrophages demonstrated a stable anti-inflammatory phenotype upon a subsequent pro-inflammatory stimulus by maintaining the expression of specific anti-inflammatory markers (Tgfß, Il10 and Cd206) and downregulating the induction of proinflammatory cytokines and surface molecules (Cd86, Il6 and Tnfα). A single dose of M2regsattenuated the hypoxic monocytic recruitment and perivascular inflammation. Early hypoxic lung and alveolar macrophage inflammation leading to PH development was significantly reduced and, importantly, M2regsattenuated RVH, RVSP and vascular remodeling at 4 weeks post treatment.ConclusionsAdoptive transfer of M2regshalts the recruitment of monocytes and modifies the hypoxic lung microenvironment, potentially changing the immunoreactivity of recruited macrophages and restoring normal immune functionality of the lung. These findings provide new mechanistic insights on the diverse role of macrophage phenotype on lung vascular homeostasis that can be explored as novel therapeutic targets.