bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local excision as a viable alternative to hysterectomy for early-stage cervical cancer in women of reproductive age: a population-based cohort study
Authors: Chen Ying , Zheng Yongqiang , Wu Yaling , Dai Jun , Zhu Xiaoran , Wu Tong , Tang Weicheng , Yang Shuhao , Zhang Jinjin , Zhou Su , Wu Meng , Zhang Chun , Wang Shixuan 
Published: April 2023

Background:
Local excision as the main alternative for fertility-sparing surgery (FSS) has been widely used in patients with early-stage cervical cancer to achieve fertility preservation, but its safety and practicability are still questioned. Therefore, The authors evaluated the current application of local excision in early-stage cervical cancer with this population-based study and compared its efficacy with hysterectomy.

Materials and methods:
Women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I cervical cancer at childbearing age (18–49 years) recorded in the Surveillance, Epidemiology and End Results (SEER) database from 2000 to 2017 were included. Overall survival (OS) and disease-specific survival (DSS) rates were compared between local excision and hysterectomy.

Results:
A total of 18 519 patients of reproductive age with cervical cancer were included, and 2268 deaths were observed. 17.0% of patients underwent FSS via local excision, and 70.1% underwent hysterectomy. Among patients younger than 39 years, OS and DSS of local excision were comparable to those of hysterectomy, whereas, in patients older than 40 years, OS and DSS of local excision were significantly worse than those of hysterectomy. In addition, OS and DSS of local excision were similar to hysterectomy in patients with stage IA cervical cancer, but OS and DSS were inferior to hysterectomy in patients with stage IB cervical cancer who underwent local excision.

Conclusion:
For patients without fertility requirements, hysterectomy remains the best therapeutic option. However, for patients under 40 years of age diagnosed with stage IA cervical cancer, FSS via local excision is a viable option that can achieve a well-balanced outcome between tumour control and fertility preservation.
How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners
Authors: van Dusseldorp Loes , Groot Marieke , van Vught Anneke , Goossens Peter , Hulshof Hugo , Peters Jeroen 
Published: April 2023

ABSTRACT

Background:
Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP).

Purpose:
To explore what meaning people with SMI associate with the care provided by a PMHNP.

Methodology:
A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP).

Results:
Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia.

Conclusions:
The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance.

Implications:
For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.
Alar Crease Creation Suture in Nasal Reconstruction
Authors: Yen Cheng-I , Huang Chih-Jung , Chang Chun-Shin , Chen Hung-Chang , Yang Shih-Yi , Chang Shu-Yin , Yang Jui-Yung , Chuang Shiow-Shuh , Hsiao Yen-Chang 
Published: April 2023

Summary:
The crescentic alar groove serves as a topographic landmark that frames the ala and separates this convex structure from the surrounding cosmetic subunits. This aesthetic landmark can be attenuated or even obliterated during wound repair in this area. Flaps spanning the alar crease are often noticeably bulky with a pin-cushioned appearance in nasal reconstruction, and it is challenging to reproduce a natural-appearing alar groove. The authors proposed a novel technique with a modified, interrupted inverted horizontal mattress suture to create an alar groove. From March of 2016 to May of 2021, 22 consecutive patients with alar defects who underwent nasal reconstruction with the paramedian forehead flap were identified. All patients underwent the authors’ novel technique for the creation of the alar groove. The mean follow-up time was 3 years 7 months (range, 14 months to 5 years). A total of 32 alar crease creation suture operations were performed. All uneven wounds healed uneventfully within 2 weeks. Two cases of postoperative fading alar grooves required alar crease creation sutures to be redone. The authors’ novel alar crease creation suture is a safe, straightforward, and reliable technique to create an aesthetic alar groove in forehead flap nasal reconstruction. It can create a medially shallow and laterally deep alar crease without apparent complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship–Trained Women
Authors: Abdou Salma A. , Sharif-Askary Banafsheh , Sayyed Adaah A. , Charipova Karina , Song David H. , Fan Kenneth L. , Evans Karen K. 
Published: April 2023

Background:
The “leaky pipeline” phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression.

Methods:
An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program.

Results:
Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors.

Conclusions:
Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.
Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction
Authors: Andersen Emily S. , Chishom Taylor Ann , Rankin Jackson , Juan Hui Yu , Coots Lesley , Mountziaris Paschalia M. 
Published: April 2023

Background
Infection following implant-based breast reconstruction can lead to devastating complications. Risk factors for infection include smoking, diabetes, and obesity. Intraoperative hypothermia may represent another modifiable risk factor. This study analyzed the effect of hypothermia in post-mastectomy immediate implant-based reconstruction on postoperative surgical site infection.

Methods:
This was a retrospective review of 122 patients with intraoperative hypothermia, defined as <C;35.5 °C, and 106 normothermic patients who underwent post-mastectomy implant-based reconstruction between 2015-2021. Demographics, comorbidities, smoking status, hypothermia (and its duration), and length of surgery were collected. The primary outcome was surgical site infection. Secondary outcomes included reoperation and delayed wound healing.

Results:
81% (185) of patients underwent staged reconstruction with tissue expander placement and 18.9% (43) had a direct to implant procedure. Over half (53%) of the patients experienced intraoperative hypothermia. In the hypothermic group, a higher proportion of patients had surgical site infections (34.4% versus 17% of normothermic patients, p < 0.05) and wound healing complications (27.9% versus 16%, p < 0.05). Intraoperative hypothermia predicted surgical site infection (OR 2.567, 95% CI: 1.367-4.818, p < 0.05) and delayed wound healing (OR 2.023, 95% CI: 1.053-3.884, p<0.05). Longer duration of hypothermia significantly correlated with surgical site infection, with an average 103 minutes versus 77 minutes (p < 0.05).

Conclusion:
This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative infection in post-mastectomy implant-based breast reconstruction. Maintaining strict normothermia during implant-based breast reconstruction procedures may improve patient outcomes by reducing the risk of postoperative infection and delayed wound healing.
Comparative Impact Analysis of Low-Deductible Insurance Versus In-house Hospital Assumption of Risk and Management on Medical Malpractice Claims
Authors: Vetrugno Giuseppe , Grassi Simone , Foti Federica , Siodambro Chiara , Grassi Vincenzo M. , Conte Celeste , Ghisellini Renato , De-Giorgio Fabio , Ausania Francesco , Cittadini Francesca , Rossi Riccardo , Morte Gabriele Della , Caputo Matteo , Pascali Vincenzo L. , Ozonoff Al , Oliva Antonio 
Published: April 2023

Objectives
Claims management is critical to ensure the safe and high-quality medical care for which liability insurers and/or hospitals are responsible. The aim of this research is to determine whether increasing hospital malpractice risk exposure, with increasing deductibles, has an impact on malpractice claims and payouts.

Methods
The study was conducted at a single tertiary hospital, the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Payouts on closed reported and registered claims were analyzed during 4-study periods, which ranged from 1.5 million euro annual aggregate deductibles entirely managed by the insurance company to 5 million euro annual aggregate deductibles entirely managed by the hospital. We retrospectively analyzed 2034 medical malpractice claims submitted between January 1, 2007, and August 31, 2021. Four periods were examined depending on the claims management model adopted, ranging from total outsourcing to the insurer (period A) to an almost total hospital assumption of risk method (period D).

Results
We found that progressive hospital assumption of risk is associated with a decrease in the incidence of medical malpractice claims (average variation per year: −3.7%; P = 0.0029 if the 2 initial periods and the 2 last periods—characterized by the highest risk retention—are respectively aggregated and compared), an initial decrease in the mean claims cost followed by an increase that is still lower than the national increase (−5.4% on average), and an increase in the total claims cost (when compared with the period where the insurer solely managed claims). We also found that the rate of increase in payouts was less than the national average.

Conclusions
The assumption of more malpractice risk by the hospital was associated with the adoption of numerous patient safety and risk management initiatives. The decrease in claims incidence could be due to the implementation of patient safety policies, while the cost increase could be attributed to inflation and rising costs of healthcare services and claims. Notably, only the hospital assumption of risk model with a high-deductible insurance coverage is sustainable for the studied hospital, while also being profitable for the insurer. In conclusion, as hospitals progressively assumed more risk and management responsibility of malpractice claims, there was a progressive decrease in the total number of claims, and a less rapid rise in claim payouts as compared with the national average. Even a small assumption of risk appeared to elicit meaningful changes in claim filings and payouts.
Evaluation of the Diagnostic Efficacy of EC-Test for Latent Tuberculosis Infection in Ambulatory People Living with HIV
Authors: Chongxing Zhou , Yuanchun Li , Yan Huang , Dabin Liang , Zhezhe Cui , Liwen Huang , Huifang Qin , Jing Ye , Fengxue Long , Xiaoyan Liang , Lifan Zhang , Xiaoqing Liu , Yanlin Zhao , Mei Lin 
Published: April 2023

Background:
Latent tuberculosis infection (LTBI) co-infected with human immunodeficiency virus (HIV) is more likely to develop into active tuberculosis (ATB), recombinant Mycobacterium tuberculosis fusion protein (ESAT6/CFP10, EC) Test is a latest developed method for LTBI. Compared with the interferon γ release test assays (IGRAs), the diagnostic performance of EC-Test to LTBI screening in HIV needs to be evaluated.

Methods:
A population-based multicenter prospective study was conducted in Guangxi Province, China. The baseline data was collected and LTBI were measured by QuantiFERON-TB Gold In-Tube (QFT-GIT), EC-Test and T-cell spot of the TB assay (T-SPOT.TB).

Results:
A total of 1478 patients were enrolled. when taking T-SPOT.TB as reference, the value of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency that EC-Test to diagnosis LTBI in HIV is 40.42%, 97.98%, 85.26%, 85.04% and 85.06% respectively; when taking QFT-GIT as reference, the value is 36.00%, 92.57%, 55.10%, 85.09% and 81.13%, respectively. When the CD4+ <200 /μl, the accuracy of EC-Test to T-SPOT.TB and QFT-GIT were 87.12% and 88.89%, respectively; when the 200 ≤ CD4+ ≤ 500 /μl, the accuracy of EC-Test were 86.20% and 83.18%, respectively; when the CD4+ >500/μl, the accuracy of EC-Test were 84.29% and 77.94%, respectively. The incidence of adverse reactions in EC-Test is 34.23% and the serious adverse reactions is 1.15%.

Conclusion:
EC-Test has good consistency compared with IGRAs in detecting LTBI in HIV no matter in different immunosuppression status or different regions, and the safety of EC-Test is also well, suitable for LTBI screening in HIV in high prevalence settings.
FAPI PET Positivity in Fibrolamellar Hepatocellular Carcinoma
Authors: Suthar Ritesh Ramesh , Purandare Nilendu , Shah Sneha , Agrawal Archi , Puranik Ameya , Rangarajan Venkatesh 
Published: April 2023

Abstract
Fibrolamellar hepatocellular carcinoma (HCC) is a variant of HCC. It is a malignant tumor, but its imaging features often overlap focal nodular hyperplasia, which is a benign entity. FDG PET/CT is also not much help in these cases because both lesions do not concentrate FDG. We present one such case of fibrolamellar HCC with FAPI PET/CT positivity.
Characterizing Early-Onset Alzheimer Disease Using Multiprobe PET/MRI
Authors: Xu Xiaojun , Ruan Weiwei , Liu Fang , Liu Qingyao , Gai Yongkang , Su Ying , Liang Zhihou , Sun Xun , Lan Xiaoli 
Published: April 2023

Purpose
Early-onset Alzheimer disease (EOAD) is rare, highly heterogeneous, and associated with poor prognosis. This AT(N) Framework–based study aimed to compare multiprobe PET/MRI findings between EOAD and late-onset Alzheimer disease (LOAD) patients and explore potential imaging biomarkers for characterizing EOAD.

Methods
Patients with AD who underwent PET/MRI in our PET center were retrospectively reviewed and grouped according to the age at disease onset: EOAD, younger than 60 years; and LOAD, 60 years or older. Clinical characteristics were recorded. All study patients had positive β-amyloid PET imaging; some patients also underwent 18F-FDG and 18F-florzolotau PET. Imaging of the EOAD and LOAD groups was compared using region-of-interest and voxel-based analysis. Correlation of onset age and regional SUV ratios were also evaluated.

Results
One hundred thirty-three patients were analyzed (75 EOAD and 58 LOAD patients). Sex (P = 0.515) and education (P = 0.412) did not significantly differ between groups. Mini-Mental State Examination score was significantly lower in the EOAD group (14.32 ± 6.74 vs 18.67 ± 7.20, P = 0.004). β-Amyloid deposition did not significantly differ between groups. Glucose metabolism in the frontal, parietal, precuneus, temporal, occipital lobe, and supramarginal and angular gyri was significantly lower in the EOAD group (n = 49) than in the LOAD group (n = 44). In voxel-based morphometry analysis, right posterior cingulate/precuneus atrophy was more obvious in the EOAD (P < 0.001), although no voxel survived family-wise error correction. Tau deposition in the precuneus, parietal lobe, and angular, supramarginal, and right middle frontal gyri was significantly higher in the EOAD group (n = 18) than in the LOAD group (n = 13).

Conclusions
Multiprobe PET/MRI showed that tau burden and neuronal damage are more severe in EOAD than in LOAD. Multiprobe PET/MRI may be useful to assess the pathologic characteristics of EOAD.
SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer
Authors: Dilege Ece , Celik Burak , Falay Okan , Boge Medine , Sucu Serkan , Toprak Safa , Agcaoglu Orhan , Kapucuoglu Nilgun , Demirkol Onur 
Published: April 2023

Purpose
The aim of this study was to evaluate the impact of SPECT/CT lymphoscintigraphy on targeted axillary dissection (TAD) in node-positive breast cancer (BC) patients who had undergone neoadjuvant chemotherapy (NAC).

Methods
Sixty-two female BC patients with biopsy-confirmed axillary nodal metastases underwent NAC, followed by breast surgery with TAD. A metallic clip was placed in the sampled LN before NAC. On the day of surgery, a periareolar intradermal 99mTc-nanocolloid injection was administered, followed by SPECT/CT lymphoscintigraphy. The clipped nodes were localized on CT images, assessed for 99mTc uptake before surgery, and confirmed during the procedure.

Results
T1–4, N1–2 patients were enrolled in the study. All patients underwent sentinel lymph node (SLN) biopsy. The clipped node was the SLN in 54 (88.5%) patients. In 3 patients (4.9%), a clip was found in a nonsentinel lymph node. In 4 patients, the clips were not visible on SPECT/CT images, and lymph nodes were not found during the procedure. SPECT/CT correctly localized the clipped lymph node in all patients. The overall false-negative rate for TAD was 3.33%. The mean follow-up duration was 29 months, and there were no axillary recurrences.

Conclusions
SPECT/CT lymphoscintigraphy can accurately localize clipped nodes and SLNs after NAC in patients with node-positive BC.
Predicting Distant Recurrences in Invasive Breast Carcinoma Patients Using Clinicopathological Data: A cross-institutional and AI-based study
Authors: Sukhadia Shrey S. , Muller Kristen E. , Workman Adrienne A. , Nagaraj Shivashankar H. 
Published: April 2023

AbstractBreast cancer ranks second in the most common cancer in women worldwide with 30% of cases resulting into recurrence of the disease at distant organs post the treatment. While clinicians have utilized several clinicopathological measurements for prediction of distant recurrences in invasive breast carcinoma (IBC), none of those studies have showcased the potential of combining clinicopathological evaluations of IBC tumors pre and post therapies using machine learning (ML) or artificially intelligent (AI) models to predict the distant recurrence of the disease in respective patients. The goal of our study was to determine whether classification-based ML/AI techniques can predict distant recurrences in IBC patients using key clinicopathological measurements that includes pathological staging of tumor and surrounding lymph nodes deemed both pre- and post-neoadjuvant therapy, imaging-based therapy responses, and the status of adjuvant therapy administered to patients. We trained and tested clinicopathological ML/AI model using dataset from Duke University and validated it using external dataset from Dartmouth Hitchcock Medical Center (DHMC). Random Forest (RF) model performed best compared to C-Support Vector Classifier (SVC) and Multi-Layer Perceptron (MLP) yielding AUC ranging 0.75-1.0 (p<0.002) across both the institutions, thereby demonstrating the cross-institutional portability and validity of ML/AI models in the field of clinical research in cancer.
Does the syrinx, a peripheral structure, constrain effects of sex steroids on behavioral sex reversal in adult canaries?
Authors: dos Santos Ednei B. , Logue David M. , Ball Gregory F. , Cornil Charlotte A. , Balthazart Jacques 
Published: April 2023

AbstractWe previously confirmed that effects of testosterone (T) on singing activity and on the volume of brain song control nuclei are sexually differentiated in adult canaries: females are limited in their ability to respond to T as males do. Here we expand on these results by focusing on sex differences in the production and performance of trills, i.e., rapid repetitions of song elements. We analyzed more than 42,000 trills recorded over a period of 6 weeks from 3 groups of castrated males and 3 groups of photoregressed females that received Silastic™ implants filled with T, T plus estradiol or left empty as control. Effects of T on the number of trills, trill duration and percent of time spent trilling were all stronger in males than females. Irrespective of endocrine treatment, trill performance assessed by vocal deviations from the trill rate versus trill bandwidth trade-off was also higher in males than in females. Finally, inter-individual differences in syrinx mass were positively correlated with trill production in males but not in females. Given that T increases syrinx mass and syrinx fiber diameter in males but not in females, these data indicate that sex differences in trilling behavior are related to sex differences in syrinx mass and syrinx muscle fiber diameter that cannot be fully reversed by sex steroids in adulthood. Sexual differentiation of behavior thus reflects organization not only of the brain but also of peripheral structures.