bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-living vs. living animal models for microvascular surgery training: a randomized comparative study.
Authors: Le Hanneur Malo , BouchÉ Pierre-Alban , Vignes Jean-Luc , Poitevin Nathalie , Legagneux Josette , Fitoussi Franck 
Published: May 2023

Background
Ethical and financial considerations have encouraged the use of non-living models for simulation-based training in microsurgery, such as commercially available chicken thighs. The purpose of this study was to compare the non-living chicken thigh model to the one currently considered as the gold standard, namely the living rat model, in the setting of an initiation microsurgery course.

Methods
Applicants to the 3-day basic microsurgery course of our School of Surgery were randomly assigned to either one group that received the regular training of the School (RT group), including 4 hands-on sessions using only living rat models, or one group that received a modified curriculum in which a non-living chicken thigh model was used for the first hands-on session (CT group). During the following session, all trainees were evaluated on living rat models, using a global rating scale (GRS) and two task-specific scales (TSS – knot-tying and anastomosis); rates of anastomosis patency, animal survival, and technique completion were recorded.

Results
Ninety-three residents were enrolled. GRS, knot-tying and anastomosis TSS scores were significantly higher in the CT group (n=51), with mean differences of 2.6 points (p=.0001), 1.3 points (p<.0001) and 1.4 points (p<.0001), respectively. Patency and survival rates were significantly higher in the CT group, with mean differences of 22% (p=.0020) and 27% (p<.0001), respectively; completion rates were not statistically different.

Conclusions
Subject to the use of validated models, such as the chicken thigh, non-living animal models are a suitable alternative to the living rat model in microsurgery initial training.

Level of evidence:
Not applicable – Animal study.
“Modifiable Risk Factors for Prevention in Dupuytren’s Disease: A UK Biobank Case-Control Study.”
Authors: Kang Youngjoo , Stewart Max , Patel Manal , Furniss Dominic , Wiberg Akira 
Published: May 2023

Background:
Dupuytren’s disease is associated with significant co-morbidity and mortality, and has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren’s disease, and to investigate associations with other diseases.

Methods:
Using UK Biobank data, this case-control study analysed the association between phenotypic variables and Dupuytren’s disease through multivariable logistic regression. Exposures assessed were Age, Sex, Body Mass Index, Waist-Hip Ratio, Townsend Deprivation Index, Smoking status, Alcohol intake, Diabetes Mellitus, Hypertension, Cancer, Liver disease, Respiratory disease, Rheumatoid arthritis, Epilepsy, Psoriasis, and Gout.

Results:
There were 4,148 cases and 397,425 controls. Male sex (OR 3.23, 95%CI 2.90 – 3.60, P=1.07×10 -100), increasing age (OR 1.08, 95% CI 1.07 – 1.08, P=6.78×10 -167), material deprivation (OR 1.01, 95%CI 1.00 – 1.02, P=0.0305), HDL cholesterol (OR 1.76, 95%CI 1.58 – 1.96, P=3.35×10 -24), smoking exposure and alcohol intake were all associated with increased odds of Dupuytren’s disease. With increasing obesity class, there was approximately 25% decreased odds (OR 0.774, 95% CI 0.734 – 0.816, P=4.71×10 -21). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren’s disease (OR 2.59, 95%CI 1.92 – 3.44, P=1.92×10 -10). Within this group, increasing HbA1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR 1.31 95%CI 1.13 – 1.51, P=2.19×10 -4).

Conclusions:
Diabetes and poor glycemic control are major risk factors for Dupuytren’s disease, which present an opportunity for prevention.
Three-dimensional comparative changes in the pharyngeal airway of patients with cleft after two-jaw orthognathic surgery
Authors: Chen Pin-Ru , Kwon Soo-Ha , Lo Lun-Jou , Chou Pang-Yun 
Published: May 2023

Background:
The present study evaluated the three-dimensional changes of the pharyngeal airway after orthognathic surgery (OGS) in patients with unilateral and bilateral clefts, and in unilateral cleft patients with and without pharyngeal flap (PF).

Methods:
Forty-five patients with unilateral or bilateral clefts receiving OGS were enrolled. Cone-beam computed tomography images were obtained before (T0) and after (T1) OGS. We measured the pharyngeal airway volumes, minimal cross-sectional area, and the horizontal displacement of facial landmarks.

Results:
The patients with bilateral cleft exhibited smaller initial velopharyngeal volume (unilateral: 8623 mm 3; bilateral: 7781 mm 3; p = 0.211), while the velopharyngeal volume increased significantly with median of 744 mm 3 after OGS (p = 0.031). The median horizontal displacement of A point was 2.9 and 2.6 mm among the patients with unilateral and bilateral clefts, respectively (p = 0.276), and the median horizontal displacement of B point was −2.9 and −3.3 mm among patients with unilateral and bilateral clefts, respectively (p = 0.618). The unilateral cleft patients with PF exhibited lower initial velopharyngeal volume (PF+: 7582 mm 3; PF–: 8756 mm 3; p = 0.129) and a lower increase in velopharyngeal volume (PF+: 437 mm 3; PF–: 627 mm 3; p = 0.739) after OGS.

Conclusions:
Midface hypoplasia and the decrease in the velopharyngeal volume were more prominent among the bilateral cleft patients and the unilateral cleft patients with PF. After OGS, the velopharyngeal volume considerably increased among the bilateral cleft patients, but no considerable differences were noted among the unilateral cleft patients with PF.
Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments
Authors: Chen Peter Ruei-Feng , Chuang Kai-Ti , Hsu Sam Sheng-Pin , Chen Yu-Ray , Chen Chien-Tzung 
Published: May 2023

Background:
Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry.

Methods:
This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups.

Results:
Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients (P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients (P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment.

Conclusion:
The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Kaban–Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia
Authors: Barrero Carlos E. , Pontell Matthew E. , Ryan Isabel A. , Wietlisbach Larissa E. , Wagner Connor S. , Salinero Lauren , Swanson Jordan W. , Liao Eric C. , Bartlett Scott P. , Taylor Jesse A. 
Published: May 2023

Background:
Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population.

Methods:
Patient demographics, airway function, Kaban–Pruzansky (KP) grade, and Cormack–Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.

Results:
Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade (P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status (P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age (P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade (P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients.

Conclusions:
KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy
Authors: Liou Yu-Jia , Chen Pin-Ru , Tsai Tzong-Yueh , Lin Susie , Chou Pang-Yun , Lo Chiu-Mei , Chen Yu-Ray 
Published: May 2023

Background:
Clear aligner therapy has an aesthetic advantage over fixed appliance therapy. However, to our knowledge, no study has objectively compared patient orthodontic and aesthetic outcomes between clear aligner and fixed appliance therapies administered after orthognathic surgery (OGS).

Methods:
This study included patients with no history of congenital craniofacial deformities who underwent surgery-first OGS and received clear aligner or fixed appliance therapy. The patients’ grades on the Dental Health Component (DHC) and Aesthetic Component of the Index of Orthodontic Treatment Need and scores on the Peer Assessment Rating (PAR) index were calculated before OGS (T0), after OGS (T1), and after orthodontic therapy (T2).

Results:
This study included 33 patients (clear aligner therapy, n = 19; fixed appliance therapy, n = 14). No considerable between-group differences were noted in the DHC and AC grades at T0, T1, or T2. Furthermore, percentage of reduction in the PAR index score was more significant in the clear aligner group (74.4%) than in the fixed appliance group (63.2%) from T0 to T1 (P = 0.035); however, no between-group differences were noted from T1 to T2 or from T0 to T2. Both groups exhibited substantially improved DHC grades, Aesthetic Component grades, and PAR index scores at T1 and T2.

Conclusions:
Patient outcomes were similar between the clear aligner and fixed appliance groups after orthodontic therapy. However, the former group exhibited more favorable immediate results after OGS than did the latter group. Thus, as an adjunct therapy for patients with malocclusion, clear aligner therapy may be more effective than fixed appliance therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Sensitivity and Accuracy of High-Resolution Ultrasound for Diagnosis of Flexor Tendon Repair Integrity.
Authors: Hinckley Nathaniel B. , Renfree Sean , Dahiya Nirvikar , Zhang Nan , Renfree Kevin J. 
Published: May 2023

Purpose:
Is ultrasound sensitivity, specificity, and accuracy in identifying intact repairs or flexor tendon gapping following zone II repair affected by the number of suture strands crossing the repair or gap, and/or imaging modality (static versus dynamic)?

Methods:
One hundred and forty-four fresh-frozen cadaveric digits (thumbs excluded) were randomized to either an intact repair (0-mm gap) or simulated “failed” repair (4 mm gap), as well as to either a 2 or 8 strand locked cruciate repair of a Zone 2 flexor digitorum profundus tendon laceration using 4-0 Fiberwire. Examinations were performed by a blinded musculoskeletal ultrasonographer in static and dynamic modes using an 18 MHz transducer. Gaps were remeasured after scanning, and the final gap width recorded. McNemar’s exact test was used to determine if there were differences between sensitivity, specificity, and accuracy affected by modality (static vs. dynamic), and Chi-square test was used to compare sensitivity, specificity and accuracy between number of strands (2 vs. 8) crossing the intact repair or repair gap (>/=4mm).

Results:
Sensitivity, specificity and accuracy improved with: 1. increased number of suture strands crossing repair/gap (8 vs 2), irrespective of modality (static vs. dynamic), and 2. dynamic compared to static scanning modes, irrespective of number of suture strands crossing repair or gap site.

Conclusion:
The most sensitive and accurate means of assessing flexor tendon repair integrity and gapping was seen using dynamic scanning mode. Increased number of suture strands does not negatively affect sensitivity, specificity, nor accuracy, regardless of scanning mode (dynamic vs. static).
Incidental Detection of Ectopic Ovary Varices by 99mTc–Red Blood Cell Bleeding Scintigraphy in a Patient With Cirrhosis
Authors: Lu Xia , Feng Lijuan , Wang Wei , Yang Jigang 
Published: May 2023

AbstractA 72-year-old woman with cirrhosis underwent a99mTc-labeled red blood cell (RBC) bleeding scan because of recurrent gastrointestinal bleeding. The images showed abnormal99mTc-RBC accumulation in a mass in the region of the left ovary. Contrast-enhanced CT showed expansion of left ovary vein from the left renal vein, which twisted into an enhanced round mass in the left ovary area. Finally, a diagnosis of ectopic ovary varices was made, which is secondary to cirrhosis with portal hypertension. Ovary varices should be included as differential diagnoses of99mTc-RBC bleeding scintigraphy.
Encouraging Study in Health Sciences
Authors: Moro Christian , Phelps Charlotte 
Published: May 2023

Introduction
Although commonly considered postgraduate-level study, universities are increasingly providing options for direct undergraduate entry into health professional programs. This presents a need to inform high school students about the wide variety of careers available in the medical and allied health professions.

Methods
To accomplish this, the developed “Health Simulation Experience” uses a case-based learning approach to introduce high school students to careers in health through the management and care of simulated patients. Participants worked through 3 simulated scenarios during the 1-day event and reported their perceptions on written feedback forms at the conclusion. A qualitative research approach was used to identify whether the simulation-based structure was an appropriate approach to assist with enhancing their understanding of career options within the primary and allied healthcare systems.

Results
Of the 528 student attendees who engaged with the program between 2018–2022, 333 provided ratings of their experience (94% overall satisfaction) and written feedback. From qualitative analysis of written comments, the following 3 key themes emerged: the approach provided insights into health professions careers; they enjoyed the authentic and immersive approach to learning; and the event developed an understanding of commonly performed clinical skills.

Conclusions
Overall, the use of case-based learning with interprofessional hands-on experiences is an effective approach to introduce students to future study options and career pathways in primary and allied health.
Operationalizing the Culture of Burnout and Well-Being: Multicenter Study of Value Congruence and Flourishing in General Surgery Residency
Authors: Cevallos Jenny R , Gonzales Paul Adam , Berler Michael H , Greenberg Anya L , Lebares Carter C ,   for the General Surgery Research Collaborative on Resident Well-being
Published: May 2023

BACKGROUND:
Value congruence (VC) is the degree of alignment between worker and workplace values and is strongly associated with reduced job strain and retention. Within general surgery residency, the impact of VC and how to operationalize it to improve workplace well-being remain unclear.

STUDY DESIGN:
This 2-part mixed-methods study comprised 2 surveys of US general surgery residents and qualitative interviews with program directors. In Part 1, January 2021, mixed-level surgical residents from 16 ACGME-accredited general surgery residency programs participated in survey #1. This survey was used to identify shared or conflicting perspectives on VC concerning well-being initiatives and resources. In April 2021, interviews from 8 institutions were conducted with 9 program directors or their proxies. In Part 2, May to June 2022, a similar cohort of surgical residents participated in survey #2. Unadjusted logistic and linear regression models were used in this survey to assess the association between VC and individual-level global well-being (ie flourishing), respectively.

RESULTS:
In survey #1 (N = 300, 34% response rate), lack of VC was an emergent theme with subthemes of inaccessibility, inconsiderateness, inauthenticity, and insufficiency regarding well-being resources. Program directors expressed variable awareness of and alignment with these perceptions. In survey #2 (N = 251, 31% response rate), higher VC was significantly associated with flourishing (odds ratio 1.91, 95% CI 1.44 to 2.52, p < 0.001).

CONCLUSIONS:
Exploring the perceived lack of VC within general surgery residency reveals an important cultural variable for optimizing well-being and suggests open dialogue as a first step toward positive change. Future work to identify where and how institutional actions diminish perceived VC is warranted.
Point-of-Care Biomarker Assay for Rapid Multiplexed Detection of CRP and IP-10
Authors: Wilson Claire S. , Vashi Bhavya , Genzor Pavol , Gregory Melissa K. , Yau Jason , Wolfe Lauren , Lochhead Michael J. , Myatt Chris , Pettrone Kristen , Blair Paul W. , Krishnan Subramaniam , Chenoweth Josh G. , Clark Danielle V. 
Published: May 2023

AbstractRapid and accurate measurements of immune protein markers are essential for diagnosis and treatment in all clinical settings. The recent pandemic has revealed a stark need for developing new tools and assays that could be rapidly used in diverse settings and provide useful information to clinicians. Here, we describe the development and test application of a novel one-step CRP/IP-10 duplex assay for the LightDeck platform capable of delivering reproducible and accurate measurements in under eight minutes. We used the optimized assay to measure CRP and IP-10 levels in human blood and serum samples from healthy, COVID-19-positive, and influenza-like illness (ILI) presenting patients. Our results agreed with previously published analyte levels and enabled us to make statistically significant comparisons relevant to multiple clinical parameters. Our duplex assay is a simple and powerful tool for aiding diagnostic decisions in diverse settings.
Neuroprotection of low dose carbon monoxide in Parkinson’s disease models commensurate with the reduced risk of Parkinson’s among smokers
Authors: Rose KN , Zorlu M , Xue X , Fassini A , Cai W , Lin S , Webb P , Schwarzschild MA , Chen X , Gomperts SN 
Published: May 2023

ABSTRACTParadoxically, cigarette smoking is associated with a reduced risk of Parkinson’s disease (PD). This led us to hypothesize that carbon monoxide (CO) levels, which are constitutively but modestly elevated in smokers, might contribute to neuroprotection. Using rodent models of PD based on α-synuclein (αSyn) accumulation and oxidative stress, we show that low-dose CO mitigates neurodegeneration and reduces αSyn pathology. Oral CO administration activated signaling cascades mediated by heme oxygenase-1 (HO-1), which have been implicated in limiting oxidative stress, and in promoting αSyn degradation, thereby conferring neuroprotection. Consistent with a neuroprotective effect of smoking, HO-1 levels in cerebrospinal fluid were higher in human smokers compared to nonsmokers. Moreover, in PD brain samples, HO-1 levels were higher in neurons without αSyn pathology. Thus, CO in rodent PD models reduces pathology and increases oxidative stress responses, phenocopying possible protective effects of smoking evident in PD patients. These data highlight the potential for low-dose CO modulated pathways to slow symptom onset and limit pathology in PD patients.
Transcranial stimulation of alpha oscillations modulates brain state dynamics in sustained attention
Authors: Brown Joshua A. , Clancy Kevin J. , Chen Chaowen , Zeng Yimeng , Qin Shaozheng , Ding Mingzhou , Li Wen 
Published: May 2023

AbstractThe brain operates an advanced complex system to support mental activities. Cognition is thought to emerge from dynamic states of the complex brain system, which are organized spatially through large- scale neural networks and temporally via neural synchrony. However, specific mechanisms underlying these processes remain obscure. Applying high-definition alpha-frequency transcranial alternating-current stimulation (HD α-tACS) in a continuous performance task (CPT) during functional resonance imaging (fMRI), we causally elucidate these major organizational architectures in a key cognitive operation— sustained attention. We demonstrated that α-tACS enhanced both electroencephalogram (EEG) alpha power and sustained attention, in a correlated fashion. Akin to temporal fluctuations inherent in sustained attention, our hidden Markov modeling (HMM) of fMRI timeseries uncovered several recurrent, dynamic brain states, which were organized through a few major neural networks and regulated by the alpha oscillation. Specifically, during sustain attention, α-tACS regulated the temporal dynamics of the brain states by suppressing a Task-Negative state (characterized by activation of the default mode network/DMN) and Distraction state (with activation of the ventral attention and visual networks). These findings thus linked dynamic states of major neural networks and alpha oscillations, providing important insights into systems-level mechanisms of attention. They also highlight the efficacy of non-invasive oscillatory neuromodulation in probing the functioning of the complex brain system and encourage future clinical applications to improve neural systems health and cognitive performance.