bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study
Authors: Ingle Suzanne M , Miro Jose M , May Margaret T , Cain Lauren E , Schwimmer Christine , Zangerle Robert , Sambatakou Helen , Cazanave Charles , Reiss Peter , Brandes Vanessa , Bucher Heiner C , Sabin Caroline , Vidal Francesc , Obel Niels , Mocroft Amanda , Wittkop Linda , d'Arminio Monforte Antonella , Torti Carlo , Mussini Cristina , Furrer Hansjakob , Konopnicki Deborah , Teira Ramon , Saag Michael S , Crane Heidi M , Moore Richard D , Jacobson Jeffrey M , Mathews W Chris , Geng Elvin , Eron Joseph J , Althoff Keri N , Kroch Abigail , Lang Raynell , Gill M John , Sterne Jonathan A C 
Published: March 2023

Abstract

Background
Randomized controlled trials (RCTs) from low- and middle-income settings suggested that early initiation of antiretroviral therapy (ART) leads to higher mortality rates among people with HIV (PWH) who present with cryptococcal meningitis (CM). There is limited information about the impact of ART timing on mortality rates in similar people in high-income settings.

Methods
Data on ART-naive PWH with CM diagnosed from 1994 to 2012 from Europe/North America were pooled from the COHERE, NA-ACCORD, and CNICS HIV cohort collaborations. Follow-up was considered to span from the date of CM diagnosis to earliest of the following: death, last follow-up, or 6 months. We used marginal structural models to mimic an RCT comparing the effects of early (within 14 days of CM) and late (14–56 days after CM) ART on all-cause mortality, adjusting for potential confounders.

Results
Of 190 participants identified, 33 (17%) died within 6 months. At CM diagnosis, their median age (interquartile range) was 38 (33–44) years; the median CD4+ T-cell count, 19/μL (10–56/μL); and median HIV viral load, 5.3 (4.9–5.6) log10 copies/mL. Most participants (n = 157 [83%]) were male, and 145 (76%) started ART. Mimicking an RCT, with 190 people in each group, there were 13 deaths among participants with an early ART regimen and 20 deaths among those with a late ART regimen. The crude and adjusted hazard ratios comparing late with early ART were 1.28 (95% confidence interval, .64–2.56) and 1.40 (.66–2.95), respectively.

Conclusions
We found little evidence that early ART was associated with higher mortality rates among PWH presenting with CM in high-income settings, although confidence intervals were wide.
Forecasting constraints on the mean free path of ionizing photons at z ≥ 5.4 from the Lyman-α forest flux autocorrelation function
Authors: Wolfson Molly , Hennawi Joseph F , Davies Frederick B , Oñorbe Jose 
Published: March 2023

ABSTRACT
Fluctuations in Lyman-α (Ly α) forest transmission towards high-z quasars are partially sourced from spatial fluctuations in the ultraviolet background, the level of which are set by the mean free path of ionizing photons (λmfp). The autocorrelation function of Ly α forest flux characterizes the strength and scale of transmission fluctuations and, as we show, is thus sensitive to λmfp. Recent measurements at z ∼ 6 suggest a rapid evolution of λmfp at z &gt; 5.0 which would leave a signature in the evolution of the autocorrelation function. For this forecast, we model mock Ly α forest data with properties similar to the XQR-30 extended data set at 5.4 ≤ z ≤ 6.0. At each z, we investigate 100 mock data sets and an ideal case where mock data matches model values of the autocorrelation function. For ideal data with λmfp = 9.0 cMpc at z = 6.0, we recover $\lambda _{\text{mfp}}=12^{+6}_{-3}$ cMpc. This precision is comparable to direct measurements of λmfp from the stacking of quasar spectra beyond the Lyman limit. Hypothetical high-resolution data leads to a $\sim 40~{{\ \rm per\ cent}}$ reduction in the error bars over all z. The distribution of mock values of the autocorrelation function in this work is highly non-Gaussian for high-z, which should caution work with other statistics of the high-z Ly α forest against making this assumption. We use a rigorous statistical method to pass an inference test, however future work on non-Gaussian methods will enable higher precision measurements.
A Scoring System to Select the Candidates for Adjuvant Chemotherapy Alone in High-Risk Early-Stage Cervical Cancer Patients With Pelvic Lymph Node Metastases After Surgery
Authors: Yang Xi-Lin , Yang Feng-Leng , Wang Na , Zhang Yue-Er , Kou Ling-Na , Wu Da-Jun , Luo Yi 
Published: March 2023

Background:
The aim was to build a risk scoring system to guide the adjuvant treatment for early-stage cervical cancer patients with pelvic lymph node (LN) metastases after surgery.

Methods:
A cohort of 1213 early-stage cervical cancer patients with pelvic LN metastases (T1-2aN1M0) were selected from the NCI SEER database, of which 1040 patients received adjuvant external beam radiotherapy concurrent with chemotherapy (EBRT+Chemo) and 173 patients received adjuvant chemotherapy alone. The Cox regression analysis was applied to identify the risk factors associated with worse survival. The exp (β) of each independent risk factors from multivariate analysis was assigned to develop the risk scoring system. The total cohort was divided into different risk subgroups accordingly and the efficacy of different adjuvant modalities in each risk subgroups was compared.

Results:
The patients were divided into 3 risk subgroups (Low-risk: total score <7.20, Middle-risk:7.20≤ total score≤ 8.40, High-risk: total score<8.40) based on the scoring system incorporating 5 independent risk factors. The survival analysis suggested that low-risk (hazard ratio [HR]=1.046, 95% CI: 0.586-1.867; P=0.879) and middle-risk patients (HR=0.709, 95% CI: 0.459-1.096; P=0.122) could not benefit more from EBRT+Chemo than Chemo alone. However, EBRT+Chemo remained the superiority to Chemo alone in the high-risk subgroup (HR=0.482, 95% CI: 0.294-0.791; P=0.003).

Conclusion:
A risk scoring system has been built to direct the adjuvant treatment for early-stage cervical cancer patients with pelvic LN metastases after surgery, where Chemo alone was totally enough for low-risk and middle-risk patients stratified by the model while EBRT+Chemo was still recommended for patients in the high-risk subgroup.
Gender Differences in Clinical Practice and Medicare Reimbursement Among Mohs Surgeons
Authors: Motosko Catherine C. , Waldman Abigail , Stevenson Mary L. , Council M. Laurin 
Published: March 2023

OBJECTIVE
To evaluate Medicare reimbursement and clinical activity between male and female dermatologic surgeons.

MATERIALS AND METHODS
A retrospective review of the Medicare Provider Utilization and Payment data from 2018 was performed for all dermatologists performing MMS. Provider gender, place of service, number of services, and average payment per service was recorded for all relevant procedure codes.

RESULTS
Women represented 31.5% of the 2,581 surgeons who performed MMS in 2018. Women were paid significantly less than men (mean difference, -$73,033). On average, women performed 123 fewer cases than their male counterparts. When surgeons were stratified by productivity, remuneration was the same.

CONCLUSION
Remuneration from CMS was disparate between male and female dermatologic surgeons, which may be attributed to submission of fewer charges by women. Further efforts are necessary to better evaluate and address causes for this discrepancy, because greater parity of opportunity and pay would greatly benefit this subspecialty of dermatology.
A Cost Comparison Between Mohs Micrographic Surgery and Conventional Excision for the Treatment of Head and Neck Melanomas In Situ and Thin Melanomas
Authors: Nugent Shannon T. , Cheng Brian , Illenberger Nicholas , Wu Yaxin , Russell Louise B. , Miller Christopher J. , Zullo Shannon W. , Perz Allison , Fix William C. , Etzkorn Jeremy R. , Sobanko Joseph F. 
Published: March 2023

BACKGROUND
Variation in operative setting and surgical technique exists when treating specialty site melanomas. There are limited data comparing costs among surgical modalities.

OBJECTIVE
To evaluate the costs of head and neck melanoma surgery performed with Mohs micrographic surgery or conventional excision in the operating room or office-based settings.

METHODS
A retrospective cohort study was performed on patients aged 18 years and older with surgically treated head and neck melanoma in 2 cohorts, an institutional cohort and an insurance claims cohort, for the years 2008–2019. The primary outcome was total cost of care for a surgical encounter, provided in the form of insurance reimbursement data. A generalized linear model was used to adjust for covariates affecting differences between treatment groups.

RESULTS
In the institutional and insurance claims cohorts, average adjusted treatment cost was highest in the conventional excision-operating room treatment group, followed by the Mohs surgery and conventional excision-office setting (p < .001).

CONCLUSION
These data demonstrate the important economic role the office-based setting has for head and neck melanoma surgery. This study allows cutaneous oncologic surgeons to better understand the costs of care involved in head and neck melanoma treatment. Cost awareness is important for shared decision-making discussions with patients.
An Algorithm for Prevention of Unsightly Facial Scars Considering the Newest Research Insights
Authors: Feinendegen Dominik L. , Grubnik Alexandra , Feinendegen Sandra Y. 
Published: March 2023

Background:Unsightly scars after facial surgery might be a worry for patients and surgeons alike. To prevent unfavorable scars after facial operations, it is inevitable for the surgeon to adhere to different principles and to follow an algorithm: patient assessment, incision planning, surgical technique, suture material, and postoperative scar management. A defined knowledge about the pathophysiology of wound healing is required. The aim of this report is to serve as a teaching purpose and to verify the well-known empirical practices in scar prevention with the corresponding explanatory research. Based on these findings, the suggestion of an appropriate algorithm for the best scar management will be elaborated.Methods:This article elucidates the basics of unsightly scar prevention and the concomitant scientific proofs in detail by reviewing the literature and newest research published in PubMed.Results:The preoperative, intraoperative, and postoperative guidelines for the achievement of acceptable facial scars will be distinguished regarding the valid state of knowledge. Special attention is drawn to the “flat incision technique” as the first surgical step. Based on the newest research, an algorithm of the important preoperative, intraoperative, and postoperative features to achieve scar improvement is presented.Conclusions:To prevent unsightly facial scars, a well-defined algorithm must be followed. In summary, three well-established, empirically proven measures are documented now by the equivalent physiological scientific proof: (1) the flat incision technique, (2) the wound closure with maximal tension reduction, and (3) the postoperative scar management with further tension reduction and more moisturizing of the scar.
Posttraumatic Lip Replantation in a Pregnant Woman
Authors: Caragher Seamus P. , Hwang Charles D. , Gardenier Jason C. , Khouri Kimberly S. , Buta Martin R. , McCarty Justin C. , Ford Olivia A. , Ehret Ashley , Cetrulo Curtis L. 
Published: March 2023

Summary:
Traumatic lip amputation is a devastating injury. No other tissue replicates its unique histology, often limiting the reconstructive outcome. Replantation is a technically challenging procedure, requiring extensive postoperative optimization, including systemic anticoagulation, leech therapy, significant blood loss, and antibiosis. Given the rarity of replantation in the context of pregnancy, there are no documented accounts of lip replantation in pregnant patients. We report a case of a 25-year-old pregnant woman who sustained an avulsion injury of the right upper lip from a dog bite. The patient presented with the amputated lip and emergent microvascular replantation was performed. Postoperative course consisted of management of controlled yet significant blood loss through leech therapy and close collaboration with obstetric colleagues. The patient was ultimately discharged with successful cosmetic and functional outcome and, importantly, with maintenance of a healthy pregnancy.
Management of Free Fillet Flap Transfers in Large Oncologic Resections
Authors: Movtchan Nellie V. , Kandi Lyndsay A. , Teven Chad M. , Reece Edward M. , Rebecca Alanna M. 
Published: March 2023

Background:
The fillet flap is a reliable flap for reconstruction of large deformities following oncologic resection. It provides healthy, nonradiated tissue for coverage with the secondary benefit of preserving other potential donor sites for reconstruction.

Methods:
A retrospective review of the medical records of eight patients who underwent fillet flap reconstruction from 2013 to 2021 at Mayo Clinic, Arizona, were analyzed.

Results:
Eight patients who underwent four hemipelvectomies, three forequarter amputations, and one below the knee amputation were identified. Patients’ ages ranged between 24 and 66 years. All indications for oncologic ablation were curative. Defect sizes ranged from 16 × 20 to 30 × 60 cm. Four pedicled flaps and four free fillet flaps were performed. Indication for free fillet flap was tumor invasion of local vascular structures. There was no flap loss in the pedicled group (follow-up ranged from 1 to 9 years), and one of four free fillet flaps had a successful long-term outcome (follow-up 36 months).

Conclusions:
Successful free fillet flap reconstruction in the setting of oncologic resection is a difficult task to achieve. Changes to the management of case 3F allowed for a successful transfer. Immediate elevation and anastomosis of the flap before oncologic resection, large caliber recipient vessels and isolation from the zone of injury, protection of the anastomosis, and delay in flap inset all contributed to flap survival. It is our belief that applying these general considerations in large oncologic resections with free fillet flap transfer may aid in successful flap transfer and improve its survival odds.
Morphometric Analysis of Gender-affirming Breast Augmentation
Authors: Song Siyou , Parmeshwar Nisha , Steiner Gabriela , Kim Esther A. 
Published: March 2023

Background:
According to cisgender respondents, the “preferred” feminine breast has a 45:55 upper-to-lower pole ratio. Preferred breast ratios have not been evaluated for transgender women undergoing breast augmentation. Therefore, this study aimed to determine the preferred breast ratio according to the transgender population and, thus, better inform surgeon planning.

Methods:
Patients diagnosed with gender dysphoria were sent a survey with morphed breast images of four different upper-to-lower pole ratios: 35:65, 45:55, 50:50, and 55:45. Respondents ranked the images according to aesthetic preference. Rankings were analyzed by the Condorcet method.

Results:
298 survey responses were analyzed: 197 (66.1%) respondents identified as transgender women and 31 (10.4%) as transgender men. Most respondents were younger than 40 (64.8%). Eighty-one (27.2%) had undergone breast augmentation, 136 (45.6%) had not and were not considering it, and 81 (27.2%) had not but were considering it. Across all subgroups, the most preferred ratio was 45:55 (P = 0.046). Those with more masculine genders and assigned female at birth preferred the 45:55 and 50:50 ratios equally. Those in their 30's and younger preferred the 45:55 and 50:50 ratios equally.

Conclusions:
The 45:55 ratio, established as the most preferred morphometrics for breast augmentation by cisgender respondents, is also the most aesthetically preferred proportion among transgender patients. Interestingly, the 50:50 ratio, which projects a larger upper bust compared to the 45:55 ratio, may be equally or more appealing to younger patients and those with more masculine genders. We hope these results improve patient-physician shared decision-making and postoperative expectations.
Avive Soft Tissue Membrane Improves Outcomes of Revision Upper-extremity Nerve Decompression Surgery
Authors: Cox Cameron T. , Douthit Christian R. , McKee Desirae M. , Kharbat Abdurrahman F. , Suryavanshi Joash R. , Maveddat Ashley V. , Bashrum Bryan S. , MacKay Brendan J. 
Published: March 2023

Background:
Revision nerve decompression remains a challenge for surgeons. Avive Soft Tissue Membrane is processed human umbilical cord membrane that may reduce inflammation and scarring, thereby improving tissue gliding. Although synthetic conduits have been reported in revision nerve decompression, the use of Avive has not.

Methods:
Prospective study of revision nerve decompression with Avive application. VAS pain, two-point discrimination, Semmes-Weinstein, pinch and grip strength, range of motion, Quick Disability of Arm, Shoulder & Hand (QuickDASH), and satisfaction were recorded. Using a propensity-matched cohort, VAS pain and satisfaction were retrospectively collected to compare with cohort outcomes.

Results:
In the Avive cohort, 77 patients (97 nerves) were included. Mean follow-up was 9.0 months. Avive was applied to the median nerve in 47.4%, ulnar nerve in 39.2%, and radial nerve in 13.4%. VAS pain was 4.5 preoperatively and 1.3 postoperatively. S4 sensory recovery was achieved in 58% of patients, S3+ in 33%, S3 in 7%, S0 in 2%, and improvement from baseline in 87%. Strength improved in 92%. Mean total active motion was 94.8%. Mean QuickDASH score was 36.1, and 96% reported improved or resolved symptoms. Preoperative pain was not significantly different between Avive cohort and controls (P = 0.618). Postoperative pain was significantly lower in cohort patients (1.3 ± 2.2 versus 2.7 ± 3.0, P = 0.001). In the Avive cohort, more had improved or resolved symptoms (P < 0.0001). Clinically important improvement in pain was reported in 64.9% of Avive group patients versus 40.8% of controls (P = 0.002).

Conclusion:
Avive contributes to improved outcomes in revision nerve decompression.
Wound Complication and Surgical Site Infection in Sarcoma Patients Undergoing Internal Hemipelvectomy
Authors: Katzman Ju Hee , Sun Steven , Patel Raj H. , Joyce David , Greene John N. 
Published: March 2023

Abstract

Background
Hemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding, and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients who have undergone hemipelvectomy.

Methods
We conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at a large tertiary academic cancer center from 2008 to 2016. We used χ
2 (exact Fisher) test to investigate the association between wound complication and categorical variables. We used a t test to evaluate the difference in numerical variables for outcomes.

Results
Among 33 patients, 12 patients (36.4%) experienced wound complications after hemipelvectomy. The average age of patients with wound complications was 63.3 years (57.1 ± 15.4 years), significantly higher than that of patients without wound complications (P = 0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (P = 0.027). Patients with wound complications had longer hospital length of stay (14.8 vs 7.0 days, P = 0.016). Patient and surgical characteristics were not associated with surgical site infection. Five patients (15%) developed surgical site infection, and they had longer hospital stay (19.4 vs 8.1 days, P = 0.001).

Conclusion
Older patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include broad-spectrum coverage to include skin and gastrointestinal flora.
A retrospective cohort study on the cardiotoxicity incidence rates of immune checkpoint inhibitors for oncology patients
Authors: Ho Chin-Chin , Wu Shang-Liang , Tsai Han-Yi , Hu Yu-Wen , Chang Yuh-Lih 
Published: March 2023

Background:
This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs.

Methods:
This was a retrospective hospital-based cohort study using the medical records and the Cancer Registry records from the Taipei Veterans General Hospital. We enrolled patients diagnosed with cancer between 2011 and 2017, who were over 20 years old and had received ICI therapy, including pembrolizumab, nivolumab, atezolizumab, and ipilimumab. Cardiotoxicity was defined by the diagnosis of myocarditis, pericarditis, arrhythmia, heart failure, and Takotsubo syndrome.

Results:
We identified 407 patients who were eligible to participate in this study. We defined the three treatment groups as follows: ICI therapy, ICI combined with chemotherapy, and ICI combined with targeted therapy. Using ICI therapy as a reference group, the cardiotoxicity risk was not significantly higher compared to the ICI combined with chemotherapy group (adjusted hazard ratio 2.1, 95% confidence interval 0.2–21.1, p = 0.528] or to the ICI combined with targeted therapy group (adjusted hazard ratio 1.2, 95% confidence interval 0.1–9.2, p = 0.883). The total incidence rate of cardiotoxicity was 3.6 of 100 person-years, indicating an average incidence time of 1.0 ± 1.3 years (median: 0.5 years; range: 0.1–4.7 years) for 18 cardiotoxicity patients.

Conclusion:
The incidence rate of ICI-related cardiotoxicity is low. Combination of ICI with either chemotherapy or targeted therapy might not significantly increase the risk of cardiotoxicities among cancer patients. Nevertheless, it is recommend being careful in patients treated high-risk cardiotoxicity medications to avoid drug-related cardiotoxicity with a combination of ICI therapy.
Stimulation of angiotensin II type 2 receptor attenuates organ injury in rats with polymicrobial sepsis
Authors: Shih Chih-Chin , Chen Shiu-Jen , Chang Wen-Kuei , Tsai Hsin-Jung , Huang Hsieh-Chou , Wu Chin-Chen , Tsao Cheng-Ming 
Published: March 2023

Background:
Both inflammation and oxidative stress contribute to the pathogenesis of sepsis and its associated organ damage. Angiotensin-(1–7), acting through the Mas receptor and angiotensin II-type 2 receptors (AT2R), could attenuate organ dysfunction and improve survival in rats with sepsis. However, the role of AT2R in inflammation and oxidative stress in rats with sepsis is unclear. Therefore, this study examined the modulatory effects and molecular mechanism of AT2R stimulation in rats with polymicrobial sepsis.

Methods:
Male Wistar rats underwent cecal ligation and puncture (CLP) or sham surgery followed by the administration of saline or CGP42112 (a selective, high-affinity agonist of AT2R, 50 μg/kg intravenously) at 3 hours after sham surgery or CLP. The changes in hemodynamics, biochemical variables, and plasma levels of chemokines and nitric oxide were detected during the 24-hour observation. Organ injury was evaluated by histological examination.

Results:
We found that CLP evoked delayed hypotension, hypoglycemia, and multiple organ injuries, characterized by elevated plasma biochemical parameters and histopathological changes. These effects were attenuated by treatment with CGP42112. CGP42112 significantly attenuated plasma chemokines and nitric oxide production and reduced liver inducible nitric oxide synthase and nuclear factor kappa-B expression. More importantly, CGP42112 significantly improved the survival of rats with sepsis (50% vs. 20% at 24 h after CLP, p < 0.05).

Conclusion:
The protective effects of CGP42112 may be related to anti-inflammatory responses, suggesting that the stimulation of AT2R is a promising therapeutic candidate for the treatment of sepsis.