bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Personalized Opioid Prescription Model for Predicting Postoperative Discharge Opioid Needs
Authors: Zhang Kevin K. , Blum Kevin M. , Chu Jacqueline J. , Zewdu Abeba , Janse Sarah , Skoracki Roman , Janis Jeffrey E. , Barker Jenny C. 
Published: January 2023

Background:
Opioid overprescribing after surgery is common. There is currently no universal predictive tool available to accurately anticipate postdischarge opioid need in a patient-specific manner. This study examined the efficacy of a patient-specific opioid prescribing framework for estimating postdischarge opioid consumption.

Methods:
A total of 149 patients were evaluated for a single-center retrospective cohort study of plastic and reconstructive surgery patients. Patients with length of stay of 2 to 8 days and quantifiable inpatient opioid consumption (n = 116) were included. Each patient’s daily postoperative inpatient opioid consumption was used to generate a personalized logarithmic regression model to estimate postdischarge opioid need. The validity of the personalized opioid prescription (POP) model was tested through comparison with actual postdischarge opioid consumption reported by patients 4 weeks after surgery. The accuracy of the POP model was compared with two other opioid prescribing models.

Results:
The POP model had the strongest association (R
2 = 0.899; P < 0.0001) between model output and postdischarge opioid consumption when compared to a procedure-based (R
2 = 0.226; P = 0.025) or a 24-hour (R
2 = 0.152; P = 0.007) model. Accuracy of the POP model was unaffected by age, gender identity, procedure type, or length of stay. Odds of persistent use at 4 weeks increased, with a postdischarge estimated opioid need at a rate of 1.16 per 37.5 oral morphine equivalents (P = 0.010; 95% CI, 1.04 to 1.30).

Conclusions:
The POP model accurately estimates postdischarge opioid consumption and risk of developing persistent use in plastic surgery patients. Use of the POP model in clinical practice may lead to more appropriate and personalized opioid prescribing.
The Vicious Circle of Stasis, Inflammation, and Fibrosis in Lymphedema
Authors: Brown Stav , Dayan Joseph H. , Kataru Raghu P. , Mehrara Babak J. 
Published: January 2023

Summary:
Lymphedema is a progressive disease of the lymphatic system arising from impaired lymphatic drainage, accumulation of interstitial fluid, and fibroadipose deposition. Secondary lymphedema resulting from cancer treatment is the most common form of the disease in developed countries, affecting 15% to 40% of patients with breast cancer after lymph node dissection. Despite recent advances in microsurgery, outcomes remain variable and, in some cases, inadequate. Thus, development of novel treatment strategies is an important goal. Research over the past decade suggests that lymphatic injury initiates a chronic inflammatory response that regulates the pathophysiology of lymphedema. T-cell inflammation plays a key role in this response. In this review, the authors highlight the cellular and molecular mechanisms of lymphedema and discuss promising preclinical therapies.
Cosmetic Rhinoplasty
Authors: Boustany Ashley N. , Grover Ritwik , Alnaeem Hassan , Seyidova Nargiz , Rohrich Rod J. , Lin Samuel J. 
Published: January 2023

Learning Objectives:
After studying this article, the participant should be able to: 1. Perform a systematic nasofacial analysis. 2. Identify the underlying anatomical cause of specific external nasal findings. 3. Recognize the interrelated effects of operative maneuvers. 4. Develop an appropriate operative plan to address patient concerns.

Summary:
The rhinoplasty operation is one of the most challenging procedures in plastic surgery, and requires a combination of surgical judgment, knowledge of anatomy, technical skill, and lifelong study. A foundation must be built on clearly defined patient goals and an accurate diagnosis, based on known ideals and their anatomical correlation. It is important to recognize the definitive impact of each operative maneuver to achieve predictable outcomes. This article provides a problem-based approach to common cosmetic nasal deformities.
Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment
Authors: Elmelegy Nader Gomaa 
Published: January 2023

Background:
A more enduring strategy for the treatment of hypertrophic scars of the hand is still a challenge facing restorative dermatologists and plastic surgeons. Nonetheless, with the use of nonablative devices, intense pulsed light and different types of lasers have started to yield promising outcomes and are close to becoming an effective and dependable technique. The advances in radiofrequency energy have brought new life to optical-based frameworks. Radiofrequency current delivers an unadulterated heat effect according to the electrical response characteristics of each tissue. The purpose of this study was to assess the patient satisfaction, safety, and clinical efficacy of the use of electrophotobiomodulation (combined intense pulsed light and radiofrequency energy) in the treatment of postburn hypertrophic scars of the hand.

Methods:
This was a prospective clinical study that was performed on 56 patients who presented with postburn hypertrophic scars on the hands between March of 2013 and January of 2020.

Results:
The clinical appraisal showed excellent results in 33 patients (58.9%), good results in 18 patients (32.2%), fair results in five patients (8.9%), and no poor results.

Conclusion:
The use of radiofrequency energy combined with intense pulsed light was effective for the treatment of hand scars on people with various skin tones.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Host variation in type I interferon signaling genes (MX1), C–C chemokine receptor type 5 gene, and major histocompatibility complex class I alleles in treated HIV+ noncontrollers predict viral reservoir size
Authors: Siegel David A. , Thanh Cassandra , Wan Eunice , Hoh Rebecca , Hobbs Kristen , Pan Tony , Gibson Erica A. , Kroetz Deanna L. , Martin Jeffrey , Hecht Frederick , Pilcher Christopher , Martin Maureen , Carrington Mary , Pillai Satish , Busch Michael P. , Stone Mars , Levy Claire N. , Huang Meei-Li , Roychoudhury Pavitra , Hladik Florian , Jerome Keith R. , Kiem Hans-Peter , Henrich Timothy J. , Deeks Steven G. , Lee Sulggi A. 
Published: January 2023

Objective:
Prior genomewide association studies have identified variation in major histocompatibility complex (MHC) class I alleles and C–C chemokine receptor type 5 gene (CCR5Δ32) as genetic predictors of viral control, especially in ‘elite’ controllers, individuals who remain virally suppressed in the absence of therapy.

Design:
Cross-sectional genomewide association study.

Methods:
We analyzed custom whole exome sequencing and direct human leukocyte antigen (HLA) typing from 202 antiretroviral therapy (ART)-suppressed HIV+ noncontrollers in relation to four measures of the peripheral CD4+ T-cell reservoir: HIV intact DNA, total (t)DNA, unspliced (us)RNA, and RNA/DNA. Linear mixed models were adjusted for potential covariates including age, sex, nadir CD4+ T-cell count, pre-ART HIV RNA, timing of ART initiation, and duration of ART suppression.

Results:
Previously reported ‘protective’ host genetic mutations related to viral setpoint (e.g. among elite controllers) were found to predict smaller HIV reservoir size. The HLA ‘protective’ B∗57:01 was associated with significantly lower HIV usRNA (q = 3.3 × 10−3), and among the largest subgroup, European ancestry individuals, the CCR5Δ32 deletion was associated with smaller HIV tDNA (P = 4.3 × 10−3) and usRNA (P = 8.7 × 10−3). In addition, genomewide analysis identified several single nucleotide polymorphisms in MX1 (an interferon stimulated gene) that were significantly associated with HIV tDNA (q = 0.02), and the direction of these associations paralleled MX1 gene eQTL expression.

Conclusions:
We observed a significant association between previously reported ‘protective’ MHC class I alleles and CCR5Δ32 with the HIV reservoir size in noncontrollers. We also found a novel association between MX1 and HIV total DNA (in addition to other interferon signaling relevant genes, PPP1CB, DDX3X). These findings warrant further investigation in future validation studies.
Perinatal outcomes associated with combination antiretroviral therapy compared with monotherapy
Authors: Portwood Clara , Sexton Harriet , Kumarendran Mary , Brandon Zoe , Johnson Bradley , Kirtley Shona , Hemelaar Joris 
Published: January 2023

Objectives:
Increasing numbers of women living with HIV (WLHIV) worldwide receive combination antiretroviral therapy (cART) during pregnancy. We aimed to assess the risk of adverse perinatal outcomes in pregnant WLHIV receiving cART compared with pregnant WLHIV receiving zidovudine monotherapy.

Design:
Systematic review and meta-analysis.

Methods:
We searched four electronic literature databases (PubMed, CINAHL, Global Health, EMBASE) for studies published between 1 January 1980 and 20 April 2020 using a comprehensive search strategy. Studies reporting data on WLHIV receiving cART compared with WLHIV receiving monotherapy for 11 adverse perinatal outcomes were sought: preterm birth (PTB), very PTB, spontaneous PTB, low birthweight (LBW), very LBW, preterm and term LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted to calculate relative risk (RR) and 95% confidence intervals (95% CI).

Results:
We included 30 studies reporting on 317 101 pregnant women in 27 countries. WLHIV receiving cART were at increased risk of PTB (RR 1.32, 95% CI 1.18–1.46), LBW (1.35, 1.19–1.53), SGA (1.32, 1.13–1.53), VSGA (1.64, 1.34–2.02), and stillbirth (2.41, 1.83–3.17) compared to WLHIV receiving monotherapy. The significance of these results was maintained in subgroup analyses for studies conducted in low and middle-income countries and average quality studies. Additionally, WLHIV receiving nonnucleoside reverse transcriptase inhibitor-based cART were associated with increased risk of PTB, LBW, and stillbirth, while WLHIV receiving protease inhibitor-based cART were associated with increased risk of PTB, compared with WLHIV receiving monotherapy.

Conclusion:
Pregnant WLHIV receiving cART are associated with increased risk of adverse perinatal outcomes, compared with WLHIV receiving monotherapy.
Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa
Authors: Cluver Lucie D. , Zhou Siyanai , Orkin Mark , Rudgard William , Meinck Franziska , Langwenya Nontokozo , Vicari Marissa , Edun Olanrewaju , Sherr Lorraine , Toska Elona 
Published: January 2023

Objective:
We are failing to reach 95–95–95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally.

Design:
A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015–2016, 2017–2018).

Methods:
A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex.

Results:
Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21–0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70–74%) compared with 38% (95% CI 20–56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex.

Conclusion:
Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.
Advanced HIV disease and engagement in care among patients on antiretroviral therapy in South Africa: results from a multi-state model
Authors: Patten Gabriela E. , Euvrard Jonathan , Anderegg Nanina , Boulle Andrew , Arendse Kirsten D. , von der Heyden Erin , Ford Nathan , Davies Mary-Ann 
Published: January 2023

Objective:
Despite improved access to antiretroviral therapy (ART) for people with HIV (PWH), HIV continues to contribute considerably to morbidity and mortality. Increasingly, advanced HIV disease (AHD) is found among PWH who are ART-experienced.

Design:
Using a multi-state model we examined associations between engagement with care and AHD on ART in South Africa.

Methods:
Using data from IeDEA Southern Africa, we included PWH from South Africa, initiating ART from 2004 to 2017 aged more than 5 years with a CD4+ cell count at ART start and at least one subsequent measure. We defined a gap as no visit for at least 18 months. Five states were defined: ‘AHD on ART’ (CD4+ cell count <200 cells/μl), ‘Clinically Stable on ART’ (CD4+ cell count ≥200 or if no CD4+ cell count, viral load <1000 copies/ml), ‘Early Gap’ (commencing ≤18 months from ART start), ‘Late Gap’ (commencing >18 months from ART start) and ‘Death’.

Results:
Among 32 452 PWH, men and those aged 15–25 years were more likely to progress to unfavourable states. Later years of ART start were associated with a lower probability of transitioning from AHD to clinically stable, increasing the risk of death following AHD. In stratified analyses, those starting ART with AHD in later years were more likely to re-engage in care with AHD following a gap and to die following AHD on ART.

Conclusion:
In more recent years, those with AHD on ART were more likely to die, and AHD at re-engagement in care increased. To further reduce HIV-related mortality, efforts to address the challenges facing these more vulnerable patients are needed.
Neutrophil heterogeneity and emergence of a distinct population of CD11b/CD18-activated low-density neutrophils after trauma
Authors: Goretti Riça Ingred , Joughin Brian A. , Teke Martha E. , Emmons Tiffany R. , Griffith Alec M. , Cahill Laura A. , Banner-Goodspeed Valerie M. , Robson Simon C. , Hernandez Jonathan M. , Segal Brahm H. , Otterbein Leo E. , Hauser Carl J. , Lederer James A. , Yaffe Michael B. 
Published: January 2023

INTRODUCTION
Multiple large clinical trauma trials have documented an increased susceptibility to infection after injury. Although neutrophils (polymorphonuclear leukocytes [PMNs]) were historically considered a homogeneous cell type, we hypothesized that injury could alter neutrophil heterogeneity and predispose to dysfunction. To explore whether trauma modifies PMN heterogeneity, we performed an observational mass-spectrometry–based cytometry study on total leukocytes and low-density PMNs found in the peripheral blood mononuclear cell fraction of leukocytes from healthy controls and trauma patients.

METHODS
A total of 74 samples from 12 trauma patients, each sampled at 1 or more time points, and matched controls were fractionated and profiled by mass-spectrometry–based cytometry using a panel of 44 distinct markers. After deconvolution and conservative gating on neutrophils, data were analyzed using Seurat, followed by clustering of principal components.

RESULTS
Eleven distinct neutrophil populations were resolved in control and trauma neutrophils based on differential protein surface marker expression. Trauma markedly altered the basal heterogeneity of neutrophil subgroups seen in the control samples, with loss of a dominant population of resting neutrophils marked by high expression of C3AR and low levels of CD63, CD64, and CD177 (cluster 1), and expansion of two alternative neutrophil populations, one of which is marked by high expression of CD177 with suppression of CD10, CD16, C3AR, CD63, and CD64 (cluster 6). Remarkably, following trauma, a substantially larger percentage of neutrophils sediment in the monocyte fraction. These low-density neutrophils bear markers of functional exhaustion and form a unique trauma-induced population (cluster 9) with markedly upregulated expression of active surface adhesion molecules (activated CD11b/CD18), with suppression of nearly all other surface markers, including receptors for formyl peptides, leukotrienes, chemokines, and complement.

CONCLUSION
Circulating neutrophils demonstrate considerable evidence of functional heterogeneity that is markedly altered by trauma. Trauma induces evolution of a novel, exhausted, low-density neutrophil population with immunosuppressive features.
Recent trends in the management of isolated high-grade splenic injuries: A nationwide analysis
Authors: Aoki Makoto , Onogawa Atsushi , Matsumoto Shokei , Matsushima Kazuhide 
Published: January 2023

BACKGROUND
The feasibility of nonoperative management for high-grade blunt splenic injuries (BSIs) has been suggested in recent studies. The purpose of this study was to assess nationwide trends in the management of isolated high-grade BSIs. We hypothesized that isolated high-grade BSIs are more frequently being managed nonoperatively.

METHODS
The American College of Surgeons Trauma Quality Improvement Program database was queried to identify patients (16 years or older) with isolated high-grade BSIs (Abbreviated Injury Scale, ≥3) between 2013 and 2019. Patients were divided into two groups based on their hemodynamic status (hemodynamically stable [HS] and hemodynamically unstable [HU]). The primary outcome was the rate of total splenectomy each year, and the secondary outcome was the use of splenic angioembolization (SAE). Multiple regression models were created to estimate annual trends in splenectomy and SAE.

RESULTS
A total of 6,747 patients with isolated high-grade BSIs were included: 5,714 (84.7%) and 1,033 (15.3%) in HS and HU groups, respectively. In the HS group, the rate of overall splenectomy was significantly decreased (from 22.9% in 2013 to 12.6% in 2019; odds ratio [OR] for 1-year increment, 0.850; 95% confidence interval [CI], 0.815–0.886; p < 0.001), and the use of SAE was significantly increased (from 12.5% in 2013 to 20.9% in 2019; OR, 1.107; 95% CI, 1.065–1.150; p < 0.001). In the HU group, the overall splenectomy rate was unchanged (from 69.8% in 2013 to 50.8% in 2019; OR, 0.931; 95% CI, 0.865–1.002; p = 0.071), whereas SAE was significantly increased (from 12.7% in 2013 to 28.8% in 2019; OR, 1.176; 95% CI, 1.079–1.284; p < 0.001).

CONCLUSION
We observed significant trends toward more frequent use of nonoperative management in high-grade BSIs with hemodynamic stability. Further studies are warranted to define the role of SAE, especially in patients with hemodynamic instability.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
When is enough enough? Odds of survival by unit transfused
Authors: Loudon Andrew M. , Rushing Amy P. , Hue Jonathan J. , Ziemak Alison , Sarode Anuja L. , Moorman Matthew L. 
Published: January 2023

BACKGROUND
Balanced transfusion is lifesaving for hemorrhagic shock. The American Red Cross critical blood shortage in 2022 threatened the immediate availability of blood. To eliminate waste, we reviewed the utility of transfusions per unit to define expected mortality at various levels of balanced transfusion.

METHODS
A retrospective study of 296 patients receiving massive transfusion on presentation at a level 1 trauma center was performed from January 2018 to December 2021. Units of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets received in the first 4 hours were recorded. Patients were excluded if they died in the emergency department, died on arrival, received <2 U PRBCs or FFP, or received PRBC/FFP >2:1. Primary outcomes were mortality and odds of survival to discharge. Subgroups were defined as transfused if receiving 2 to 9 U PRBCs, massive transfusion for 10 to 19 U PRBCs, and ultramassive transfusion for ≥20 U PRBCs.

RESULTS
A total of 207 patients were included (median age, 32 years; median Injury Severity Score, 25; 67% with penetrating mechanism). Mortality was 29% (61 of 207 patients). Odds of survival is equal to odds of mortality at 11 U PRBCs (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.50–1.79). Beyond 16 U PRBCs, odds of mortality exceed survival (OR, 0.36; 95% CI, 0.16–0.82). Survival approaches zero >36 U PRBCs (OR, 0.09; 95% CI, 0.00–0.56). Subgroup mortality rates increased with unit transfused (16% transfused vs. 36% massive transfusion, p = 0.003; 36% massive transfusion vs. 67% ultramassive transfusion, p = 0.006).

CONCLUSION
Mortality increases with each unit balanced transfusion. Surgeons should view efforts heroic beyond 16 U PRBCs/4 hours and near futile beyond 36 U PRBCs/4 hours. While extreme outliers can survive, consider cessation of resuscitation beyond 36 U PRBCs. This is especially true if hemostasis has not been achieved or blood supplies are limited.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level IV.
Evaluating the Performance of ChatGPT in Ophthalmology: An Analysis of its Successes and Shortcomings
Authors: Antaki Fares , Touma Samir , Milad Daniel , El-Khoury Jonathan , Duval Renaud 
Published: January 2023

ABSTRACTWe tested the accuracy of ChatGPT, a large language model (LLM), in the ophthalmology question-answering space using two popular multiple choice question banks used for the high-stakes Ophthalmic Knowledge Assessment Program (OKAP) exam. The testing sets were of easy-to-moderate difficulty and were diversified, including recall, interpretation, practical and clinical decision-making problems. ChatGPT achieved 55.8% and 42.7% accuracy in the two 260-question simulated exams. Its performance varied across subspecialties, with the best results in general medicine and the worst in neuro-ophthalmology and ophthalmic pathology and intraocular tumors. These results are encouraging but suggest that specialising LLMs through domain-specific pre-training may be necessary to improve their performance in ophthalmic subspecialties.
Cluster Analysis to Find Temporal Physical Activity Patterns Among US Adults
Authors: Guo Jiaqi , Aqeel Marah M. , Lin Luotao , Gelfand Saul B. , Eicher-Miller Heather A. , Bhadra Anindya , Hennessy Erin , Richards Elizabeth A. , Delp Edward J. 
Published: January 2023

AbstractPhysical activity (PA) is known to be a risk factor for obesity and chronic diseases such as diabetes and metabolic syndrome. Few attempts have been made to pattern the time of physical activity while incorporating intensity and duration in order to determine the relationship of this multi-faceted behavior with health. In this paper, we explore a distance-based approach for clustering daily physical activity time series to estimate temporal physical activity patterns among U.S. adults (ages 20-65) from the National Health and Nutrition Examination Survey 2003-2006 (NHANES). A number of distance measures and distance-based clustering methods were investigated and compared using various metrics. These metrics include the Silhouette and the Dunn Index (internal criteria), and the associations of the clusters with health status indicators (external criteria). Our experiments indicate that using a distance-based cluster analysis approach to estimate temporal physical activity patterns through the day, has the potential to describe the complexity of behavior rather than characterizing physical activity patterns solely by sums or labels of maximum activity levels.