bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why Does an “Avatar Nose” Appear After Dermal Filler Injection? Insights From a Cadaveric Study on the Nasofrontal Ligament
Authors: Wan Jovian , Hong Gi-Woong , Wu Raymond , Alvin Lee Kar Wai , Wah Chan Lisa Kwin , Chua Deborah , Cartier Hugues , Kim Soo-Bin , Yi Kyu-Ho 
Published: January 2025

BACKGROUND
Nonsurgical rhinoplasty (NSR) with dermal fillers has gained popularity because of its immediate and visible results, minimal downtime, and long-lasting effects. However, complications such as filler migration can lead to the development of the “Avatar nose,” a condition where the nose appears unnaturally wide and bulbous in the nasion area, disrupting facial harmony. This phenomenon is often exacerbated by the presence of a taut nasofrontal ligament, which tethers the periosteum to the dermal layer and influences nasal contour.

OBJECTIVE
This study aims to introduce and define the nasofrontal ligament, a previously unrecognized anatomical structure identified during cadaveric dissection, and to measure the penetration force required to traverse this ligament in the context of NSR. By exploring these aspects, the study seeks to enhance the understanding of nasal anatomy and improve the precision and outcomes of filler-based NSR.

METHODS
The study involved the dissection of 2 fresh-frozen human cadaveric specimens, during which the nasofrontal ligament was identified. Penetration force was measured using a motorized force tester, with a standardized cannula depth of 5 mm. The force required to traverse the nasofrontal ligament was compared with a control point devoid of ligaments and muscles.

RESULTS
The nasofrontal ligament required a significantly higher penetration force compared with the control point, highlighting its structural integrity and potential impact on filler migration. These findings suggest that subcision of the ligament could prevent the development of the “Avatar nose” and improve the outcomes of NSR.

CONCLUSION
This study introduces the nasofrontal ligament as a key anatomical structure in NSR and demonstrates its influence on filler migration. Subcision of this ligament may enhance filler stability and aesthetic outcomes. However, the study's limitations, including a small sample size and the exclusive use of Korean cadavers, suggest the need for further research across diverse populations to validate these findings and refine NSR techniques.
Two Cases of Ischemic Complications in Abdominoplasty After Use of a New Biologic Migraine Medication
Authors: Tuominen Reetta , Koljonen Virve 
Published: January 2025

Summary:
Abdominoplasty is a common aesthetic procedure, and ischemic complications are rare, particularly in nonsmokers. We present 2 cases of ischemic complications in nonsmoking patients treated with fremanezumab, a biologic medication for severe migraines. A 55-year-old woman underwent lipoabdominoplasty on December 18, 2023. At the 16-day postoperative follow-up, demarcated necrosis was observed beneath the wound tape, and secondary direct closure was performed 6 weeks later. She had been using fremanezumab for 4 years. A 47-year-old woman underwent abdominoplasty on April 23, 2024, with moderate dissection and liposuction to the flanks. Signs of abdominal flap ischemia were evident in the operating room, and treatment for the Raynaud phenomenon was initiated immediately. The ischemia demarcated over 2 weeks, and secondary direct closure was performed 3 weeks postoperatively. She had been using fremanezumab for two months. Calcitonin gene-related peptide antagonists are potent medications for severe migraine with few contraindications. Fremanezumab may affect peripheral circulation, potentially increasing the risk of surgical complications.
Facial Fat Grafting Cannula: A Tool to Facilitate Closed Irrigation in Flexor Tenosynovitis
Authors: Kreutz-Rodrigues Lucas , Tunaboylu Mehmet Furkan , Moran Steven L. 
Published: January 2025

Summary:
Pyogenic flexor tenosynovitis (PFT), also known as septic or suppurative flexor tenosynovitis, is a closed-space infection of the hand’s flexor tendon sheath that necessitates timely diagnosis and treatment. The treatment consists of antibiotic therapy often combined with prompt surgical treatment. The most common surgical approach is the closed irrigation technique, which involves inserting a 16-gauge angiocatheter in the proximal aspect of the flexor tendon sheath, leaving the distal end of the Brunner incision open during the irrigation process. However, this method has its own challenges, such as catheter bending and kinking, thereby obstructing the fluid irrigation process and prolonging the operative duration. Instead, we propose the use of a rigid plastic facial fat grafting cannula, which is coupled to a 50-mL syringe with 0.9% saline solution. The cannula is placed at the level of the A1 pulley, and irrigation is easily performed. This simplifies this process by maintaining adequate fluid outflow through the flexor tendon sheath.
Downstaging of hepatocellular carcinoma before liver transplantation: Results from a national multicenter prospective cohort study
Authors: Xu Edison , Tabrizian Parissa , Gutierrez Julio , Hoteit Maarouf , Ghaziani Tara , Zhou Kali , Parikh Neehar , Ajmera Veeral , Aby Elizabeth , Shui Amy , Marino Rebecca , Martin Allison , Wong Christopher , Kao Karissa , Dave Shravan , Florman Sander , Yao Francis , Mehta Neil 
Published: January 2025

Background and Aims:
Patients with HCC meeting United Network for Organ Sharing (UNOS)-downstaging (DS) criteria have excellent post-liver transplantation (LT) outcomes. Studies on HCC beyond UNOS-DS criteria (“All-Comers” [AC]) have been limited by small sample size and short follow-up time, prompting this analysis.

Approach and Results:
Three hundred twenty-six patients meeting UNOS-DS and 190 meeting AC criteria from 9 LT centers across 5 UNOS regions were enrolled from 2015 to 2023 and prospectively followed. Competing risk analysis and Kaplan-Meier method were used to evaluate DS and LT outcomes, and Fine-and-Gray and Cox models were used to identify predictors of outcomes. AC and UNOS-DS had similar median alpha-fetoprotein (15 vs. 12 ng/mL; p=0.08), MELD (9 vs. 9; p=0.52), and Child-Pugh (A vs. A; p=0.30). Two years after the first local regional therapy, 82% of UNOS-DS and 66% of AC were successfully downstaged (p<0.001). In AC, DS rates were 72% for tumor number plus diameter of largest lesion <10, 51% for sum 10–12, and 39% for sum >12 (p=0.01). Yttrium-90 achieved higher DS success than transarterial chemoembolization in AC (74% vs. 65%; p<0.001). 48% of UNOS-DS and 40% of AC underwent LT (p=0.10). Five-year post-LT survival was similar between UNOS-DS and AC (74% vs. 72%; p=0.77), although 5-year post-LT recurrence was higher in AC (30% vs. 14%; p=0.02).

Conclusions:
Despite higher HCC recurrence and lower intention-to-treat survival in AC, post-LT survival was comparable between UNOS-DS and AC. Yttrium-90 attained higher DS success than transarterial chemoembolization in AC. LT after DS is feasible in AC, though defining an upper limit in tumor burden may be necessary.
Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury
Authors: Luszawski Caroline A. , Minich Nori M. , Bigler Erin D. , Taylor H. Gerry , Bacevice Ann , Cohen Daniel M. , Bangert Barbara A. , Zumberge Nicholas A. , Tomfohr-Madsen Lianne M. , Brooks Brian L. , Yeates Keith Owen 
Published: January 2025

Objective: Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI). Setting: Emergency departments (EDs) at 2 children’s hospitals in the Midwestern United States. Participants: Children and adolescents aged 8 to 16 years old diagnosed with either a mTBI (n = 143) or OI (n = 74) and recruited within 24 hours postinjury. Design: Observational, prospective, concurrent cohort study with longitudinal follow-up. Main measures: Parents rated children’s preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6 months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children’s preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6 months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely. Results: Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group (P = .060, d = 0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6 months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type. Conclusions: The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.
Optical Coherence Tomography Angiography in Patients With the Boston Keratoprosthesis Type 1
Authors: Sun Jessica A. , Johnson Grace , Saini Chhavi , Chang Aimee C. , Devlin Julia , Wang Haobing , Chung In Young , Dohlman Thomas H. , Paschalis Eleftherios I. , Chodosh James , Shen Lucy Q. 
Published: January 2025

Purpose:
To report on optical coherence tomography angiography (OCTA) in patients with a type 1 Boston keratoprosthesis (KPro) and determine its feasibility through assessment of imaging artifacts.

Methods:
KPro and non-KPro subjects were matched for age, gender, and glaucoma diagnosis. OCTA images of the peripapillary optic nerve were obtained, reviewed by 2 readers masked to the diagnosis for artifacts and usability, and used for microvascular measurements.

Results:
KPro subjects (n = 18) had worse visual acuity than non-KPro (n = 36) subjects (LogMAR mean ± standard deviation 0.36 ± 0.30 vs. 0.07 ± 0.11, P < 0.001) and a greater proportion were monocular (56% vs. 3%, P < 0.001). OCTA from KPro eyes had more artifacts per scan than images from non-KPro eyes (4 ± 2 vs. 2 ± 2, P < 0.001). About 33% of KPro images were useable based on having image quality score above 40 and artifact in less than 10% of the peripapillary region. Worse visual acuity (odds ratio [OR] 0.01, 95% confidence interval [CI] 2 x 10−4-0.30, P = 0.02) and KPro (OR 0.19, 95% CI 0.05–0.63, P = 0.008) were associated with lowered likelihood of usability. Useable OCTA from 3 KPro eyes with glaucoma demonstrated microvascular defects in the inferior peripapillary region and lower vessel density and flow compared with 3 KPro eyes without glaucoma.

Conclusions:
This is the first study assessing OCTA in KPro patients and identified a higher incidence of artifacts that may be associated with the KPro optic. About 33% of KPro images were useable for microvascular measurements, supporting further OCTA research in this population to assess vascular pathology of glaucoma.
Metabolic consequences and tubular function after augmentation cystoplasty in children with neurogenic bladder
Authors: Chang Jei-Wen , Yang Hui-Hsin , Lin Tzu-Ching , Kuo Fang-Cheng , Fan Yu-Hua , Chen Hsin-Hung , Yang Ling-Yu , Liu Chin-Su , Tsai Hsin-Lin 
Published: January 2025

Background:
While many studies have reported the renal outcomes and metabolic consequences of augmentation cystoplasty (AC), few have focused on changes in renal tubular function. This study investigated the prevalence of metabolic disturbances, renal tubular function, and 24-hour urine chemistry, aiming to evaluate the association between metabolic alterations and urolithiasis after AC.

Methods:
We investigated serum biochemistry, blood gas, and 24-hour urinary metabolic profile of children who underwent AC between January 2000 and December 2020. The assessed outcomes included metabolic complications, tubular function, and magnesium status. Associations between 24-hour urinary metabolic parameters and urolithiasis formation were also examined.

Results:
A total of 25 patients with a mean follow-up period of 13.8 ± 5.7 years were enrolled. The mean age at AC was 7.5 ± 4.4 years, and 22 and 3 patients underwent AC using the ileum and colon, respectively. There were no abnormalities in serum levels of sodium, potassium, chloride, and calcium. Hypomagnesemia (magnesium <1.7 mg/dL) due to renal loss was observed in one patient (4.0%). Six (24.0%) patients had increased urinary β2-microglobulin levels and normal serum levels. The ratio of the maximum rate of tubular phosphate reabsorption to the glomerular filtration rate was low in three (12.0%) patients. Four (16.0%) patients had normal serum magnesium levels but urinary magnesium excretion <40 mg/d. Urolithiasis occurred in 11 patients (44.0%). The most common 24-hour urine metabolic abnormality was hypomagnesiuria (72.0%). No urinary metabolic parameters or daily protein intake were associated with urolithiasis.

Conclusion:
AC for children is safe and does not significantly impact the metabolic profile. Excretions of 24-hour urinary calcium, uric acid, magnesium, and the sodium-to-potassium ratio were not associated with urolithiasis. However, a high prevalence of 24-hour urine magnesium excretion <88 mg/1.73 m2 was noted. Further prospective studies are needed to investigate longitudinal changes in renal tubular function and 24-hour urine metabolic profiles, particularly magnesium status.
Intraoperative methods for detecting bile leakage for liver resection: Current situation
Authors: Mo Shu-Tian , Peng Tao 
Published: January 2025

Abstract
Bile leakage is one of the common complications after hepatectomy. Recalcitrant bile leakage not only seriously affects the quality of life of patients, but also prolongs the hospitalization time, increases hospitalization costs, and puts psychological, mental, and financial pressure on patients. The most commonly used methods for the surgical detection of bile leakage include the White test, developer injection through the gallbladder tube/gallbladder, and photodynamic imaging. A new method, Peng’s leakage test, was developed by the authors to detect bile duct leakage and was shown to be the best method available to prevent postoperative bile leakage in patients.
Physical Restraint in a Pediatric Intensive Care Unit: A Cross-Sectional, Observational Study in China
Authors: WANG Ling-Ying , HU Zi-Yi , TANG Meng-Lin , HU Xiu-Ying 
Published: January 2025

ABSTRACT

Background
Research data on the extent of and protocols related to physical restraint (PR) in pediatric intensive care units (PICUs) are scarce. Most previous studies in China on this topic have focused on the prevalence, reasons, and background of PR use among adult patients.

Purpose
This study was designed to delineate the application of PR and the factors associated with PR use in PICUs in China.

Methods
A cross-sectional study was conducted in one PICU at West China Hospital, Sichuan University, from January 2020 to December 2020. A total of 1,086 pediatric patients in the PICU were included in this study. Data collection was performed over 11 months, utilizing PR observation forms and patient records. Descriptive statistical analysis was used to obtain the data, and logistic regression models were used to analyze the independent risk factors for PR.

Results
Of the 1,086 participants, 750 (69.1%) experienced being restrained, and 83.5% of the restrained participants who were pediatric patients were restrained for more than 50% of their time during their PICU stay. The results of logistic regression analysis identified age (1–6 years: OR = 2.090, 95% CI [1.508, 2.897], p < .001; 7–17 years: OR = 0.523, 95% CI [0.358, 0.765], p = .001), use of mechanical ventilation (OR = 2.126, 95% CI [1.480, 3.055], p < .001), use of drainage tubes (OR = 1.916, 95% CI [1.445, 2.541], p < .001), and sedation (OR = 1.494, 95% CI [1.101, 2.026], p = .010) as significantly correlated with the use of PR in the PICU. For the 750 patients who experienced being restrained, PR initiation was documented with a written medical order, and in 604 cases (80.5%), the restraints were removed without similar documentation.

Conclusions
The use of PR is common in PICUs in China, with more than half of pediatric patients being restrained during their stay. Age, mechanical ventilation, use of drainage tubes, and use of sedative drugs were identified as significantly associated with PR use. Developing standardized procedures/guidelines for PR use in Chinese PICUs and enhancing medical staff education on PR practices are imperative.
Comparative effectiveness of acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: a network meta-analysis of randomized trials
Authors: Zhou Ting , Hou Huaijin , Cairen Zhuoma , Wang Yun , Wang Peng , Ge Long , Wa Macuo , Xu Ziqing , Tang Feng , Wang Caihong , Liu Rongxin , Li Deyan , Xue Jianjun , Zhang Senbing 
Published: January 2025

Objective:
The objective was to systematically evaluate the effectiveness of different acupoint stimulation techniques in preventing postoperative nausea and vomiting (PONV) after general anesthesia.

Methods:
The authors searched PubMed, Cochrane Library, Web of Science, and Embase for relevant papers, about the effect of acupoint stimulation for preventing PONV from their inception to 31 July 2023. Two reviewers performed study screening, data extraction, and risk of bias assessment. The authors focused on patient important outcomes, including the incidence of PONV, postoperative nausea (PON), or postoperative vomiting (POV), and the number of patients requiring antiemetic rescue. The authors conducted network meta-analyses to estimate the relative effectiveness between different acupoint stimulation using Stata 17.0 and Revman 5.3 software.

Results:
The authors included 50 randomized trials involving 7372 participants (median age: 43.5 years, female: 73.3%). The network meta-analysis revealed that compared with the control (sham acupoint stimulation or blank control), antiemetic alone could significantly reduce the incidence of POV (RR 0.49, 95% CI: 0.36–0.69), but could not significantly reduce the incidence of PONV and PON (RR 0.49, 95% CI: 0.36–0.69; RR 0.81, 95% CI: 0.59–1.10; respectively); both TEAS and electroacupuncture alone significantly reduced the incidence of PONV, PON, and POV, and combined with antiemetic was usually more effective than single acupoint stimulation.

Conclusions:
Both TEAS and electroacupuncture, with or without antiemetic, could significantly reduce the incidences of postoperative nausea and vomiting after general anesthesia.
Human or Machine? A Comparative Analysis of Artificial Intelligence–Generated Writing Detection in Personal Statements
Authors: Goodman Margaret A. , Lee Anthony M. , Schreck Zachary , Hollman John H. 
Published: January 2025

Introduction.
This study examines the ability of human readers, recurrence quantification analysis (RQA), and an online artificial intelligence (AI) detection tool (GPTZero) to distinguish between AI-generated and human-written personal statements in physical therapist education program applications.

Review of Literature.
The emergence of large language models such as ChatGPT and Google Gemini has raised concerns about the authenticity of personal statements. Previous studies have reported varying degrees of success in detecting AI-generated text.

Subjects.
Data were collected from 50 randomly selected nonmatriculated individuals who applied to the Mayo Clinic School of Health Sciences Doctor of Physical Therapy Program during the 2021–2022 application cycle.

Methods.
Fifty personal statements from applicants were pooled with 50 Google Gemini–generated statements, then analyzed by 2 individuals, RQA, and GPTZero. RQA provided quantitative measures of lexical sophistication, whereas GPTZero used advanced machine learning algorithms to quantify AI-specific text characteristics.

Results.
Human raters demonstrated high agreement (κ = 0.92) and accuracy (97% and 99%). RQA parameters, particularly recurrence and max line, differentiated human- from AI-generated statements (areas under receiver operating characteristic [ROC] curve = 0.768 and 0.859, respectively). GPTZero parameters including simplicity, perplexity, and readability also differentiated human- from AI-generated statements (areas under ROC curve > 0.875).

Discussion and Conclusion.
The study reveals that human raters, RQA, and GPTZero offer varying levels of accuracy in differentiating human-written from AI-generated personal statements. The findings could have important implications in academic admissions processes, where distinguishing between human- and AI-generated submissions is becoming increasingly important. Future research should explore integrating these methods to enhance the robustness and reliability of personal statement content evaluation across various domains. Three strategies for managing AI's role in applications—for applicants, governing organizations, and academic institutions—are provided to promote integrity and accountability in admission processes.
Timely delivery of care in neurological emergencies: can standardized management protocols help?
Authors: Ouyang Menglu , Allende Ma. Ignacia , Anderson Craig S. 
Published: January 2025

Purpose of review
To review the evidence that supports the implementation of goal-directed care bundle protocols to improve outcomes from neurocritical conditions, and of the possible advantage of specific over generalized protocols.

Recent findings
Articles from January 1, 2023 to July 31, 2024 were searched to evaluate the effectiveness of standardized management in neurological emergencies. The use of care bundles and standardized protocols with time- and target-related metrics has shown benefit in patients with acute stroke and traumatic brain injury.

Summary
A goal-directed care protocol to guide standard management implemented by a multidisciplinary team can improve outcomes from neurological emergencies. However, implementation challenges need to be addressed before wide adoption of protocolized care for maximum benefit to populations.
Timing of neuroprognostication in the ICU
Authors: Faiver Laura , Steinberg Alexis 
Published: January 2025

Purpose of review
Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis.

Recent findings
The goal of neuroprognostication is to provide a timely and accurate prediction of a patient's neurologic outcome so treatment can proceed in accordance with a patient's values and preferences. Neuroprognostication should be delayed until at least 72 h after injury and/or only when the necessary prognostic data is available to avoid early withdraw life-sustaining treatment on patients who may otherwise survive with a good outcome. Clinicians should be aware of the limitations of available predictors and prognostic models, the role of flawed heuristics and the self-fulfilling prophecy, and the influence of surrogate decision-maker bias on end-of-life decisions.

Summary
The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.