bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender and sex considerations in HIV and bone health
Authors: Tang Mei J. , Alexander Adrian , Hoy Jennifer F. 
Published: February 2023

Purpose of review
People with HIV (PWHIV) are at increased risk for osteoporosis and fractures, because of the effects of HIV and inflammation and antiretroviral therapy (ART) initiation as well as traditional risk factors. This review from recent literature focuses on sex differences in rates of bone disease, risk of fractures, and effects of ART.

Recent findings
Women with HIV in resource-constrained settings experience bone loss because of the additive effect of initiating TDF-containing ART during pregnancy, lactation, and menopause. Children and adolescents experience lower bone accrual during the pubertal growth years. There has been less focus on bone health in recent trials of ART containing tenofovir alafenamide and/or integrase inhibitors. Very few clinical trials or studies compare sex-specific changes in inflammation, immune activation, response to ART and bone turnover or change in BMD resulting in significant knowledge gaps.

Summary
More data is needed to determine changes in prevalence of osteopenia, osteoporosis, and fractures in the era of immediate initiation of ART at high CD4 cell counts and the use of more bone-friendly ART. The long-term effects of ART and low bone mass on fractures in the ageing population of PWHIV is yet to be realized.
Emulating a Target Trial of Interventions Initiated During Pregnancy with Healthcare Databases: The Example of COVID-19 Vaccination
Authors: Hernández-Díaz Sonia , Huybrechts Krista F. , Chiu Yu-Han , Yland Jennifer J. , Bateman Brian T. , Hernán Miguel A. 
Published: February 2023

Background:
Observational studies are often the only option to estimate effects of interventions during pregnancy. Causal inference from observational data can be conceptualized as an attempt to emulate a hypothetical pragmatic randomized trial: the target trial.

Objective:
To provide a step-by-step description of how to use healthcare databases to estimate the effects of interventions initiated during pregnancy. As an example, we describe how to specify and emulate a target trial of COVID-19 vaccination during pregnancy, but the framework can be generally applied to point and sustained strategies involving both pharmacologic and non-pharmacologic interventions.

Methods:
First, we specify the protocol of a target trial to evaluate the safety and effectiveness of vaccination during pregnancy. Second, we describe how to use observational data to emulate each component of the protocol of the target trial. We propose different target trials for different gestational periods because the outcomes of interest vary by gestational age at exposure. We identify challenges that affect (i) the target trial and thus its observational emulation (censoring and competing events), and (ii) mostly the observational emulation (confounding, immortal time, and measurement biases).

Conclusion:
Some biases may be unavoidable in observational emulations, but others are avoidable. For instance, immortal time bias can be avoided by aligning the start of follow-up with the gestational age at the time of the intervention, as we would do in the target trial. Explicitly emulating target trials at different gestational ages can help reduce bias and improve the interpretability of effect estimates for interventions during pregnancy.
Maternal Smoking During Pregnancy and Risk of Appendicitis in the Offspring
Authors: Fuglsang Cecilia Hvitfeldt , Bakos Istvan , Laugesen Kristina , Troelsen Frederikke Schønfeldt , Horváth-Puhó Erzsébet , Sørensen Henrik Toft 
Published: February 2023

Background:
Existing evidence on the link between smoking and appendicitis is scarce and ambiguous. We therefore conducted a population-based cohort study in Denmark to investigate whether smoking during pregnancy is associated with an increased risk of appendicitis in offspring.

Methods:
We used the Danish Birth Registry to include all singletons born during 1991–2017 and to identify maternal smoking status during pregnancy. We followed the children from birth until date of appendicitis, emigration, death, or administrative end of study (31 December 2018), whichever came first. We calculated crude and adjusted hazard ratios (HRs) of appendicitis with 95% confidence intervals (CIs) comparing children of mothers who smoked during pregnancy to children of nonsmokers. Further, we conducted a bias analysis and sibling analysis.

Results:
We included 1,659,526 singletons of whom 19% were born to mothers who smoked during pregnancy. After maximum 28 years of follow-up, hazard rates for children of smokers were slightly higher than for children of nonsmokers [adjusted HR: 1.07 (95% CI = 1.04, 1.10)]. Stratification by sex revealed no association for males [adjusted HR: 1.02 (95% CI = 0.99, 1.06)], but a higher HR for females [adjusted HR: 1.13 (95% CI = 1.09, 1.18)]. This association increased with increasing length of follow-up, indicating that the association may be mediated by later-life exposures. The bias analysis indicated that misclassification of maternal smoking could attenuate a true association, while the sibling analysis showed no association.

Conclusions:
Maternal smoking during pregnancy and appendicitis in the offspring may be associated.
Validation of Insurance Billing Codes for Monitoring Antenatal Screening
Authors: Nethery Elizabeth , Hutcheon Jennifer A. , Law Michael R. , Janssen Patricia A. 
Published: February 2023

Background:
Prevalence statistics for pregnancy complications identified through screening such as gestational diabetes usually assume universal screening. However, rates of screening completion in pregnancy are not available in many birth registries or hospital databases. We validated screening-test completion by comparing public insurance laboratory and radiology billing records with medical records at three hospitals in British Columbia, Canada.

Methods:
We abstracted a random sample of 140 delivery medical records (2014–2019), and successfully linked 127 to valid provincial insurance billings and maternal–newborn registry data. We compared billing records for gestational diabetes screening, any ultrasound before 14 weeks gestational age, and Group B streptococcus screening during each pregnancy to the gold standard of medical records by calculating sensitivity and specificity, positive predictive value, negative predictive value, and prevalence with 95% confidence intervals (CIs).

Results:
Gestational diabetes screening (screened vs. unscreened) in billing records had a high sensitivity (98% [95% CI = 93, 100]) and specificity (>99% [95% CI = 86, 100]). The use of specific glucose screening approaches (two-step vs. one-step) were also well characterized by billing data. Other tests showed high sensitivity (ultrasound 97% [95% CI = 92, 99]; Group B streptococcus 96% [95% CI = 89, 99]) but lower negative predictive values (ultrasound 64% [95% CI = 33, 99]; Group B streptococcus 70% [95% CI = 40, 89]). Lower negative predictive values were due to the high prevalence of these screening tests in our sample.

Conclusions:
Laboratory and radiology insurance billing codes accurately identified those who completed routine antenatal screening tests with relatively low false-positive rates.
Self-reported Human Papillomavirus Vaccination and Vaccine Effectiveness Among Men Who Have Sex with Men: A Quantitative Bias Analysis
Authors: Chambers Catharine , Deeks Shelley L. , Sutradhar Rinku , Cox Joseph , de Pokomandy Alexandra , Grennan Troy , Hart Trevor A. , Lambert Gilles , Moore David M. , Grace Daniel , Grewal Ramandip , Jollimore Jody , Lachowsky Nathan J. , Mah Ashley , Nisenbaum Rosane , Ogilvie Gina , Sauvageau Chantal , Tan Darrell H.S. , Yeung Anna , Burchell Ann N. 
Published: February 2023

Background:
Self-report of human papillomavirus (HPV) vaccination has ~80–90% sensitivity and ~75–85% specificity. We measured the effect of nondifferential exposure misclassification associated with self-reported vaccination on vaccine effectiveness (VE) estimates.

Methods:
Between 2017–2019, we recruited sexually active gay, bisexual, and other men who have sex with men aged 16–30 years in Canada. VE was derived as 1−prevalence ratio × 100% for prevalent anal HPV infection comparing vaccinated (≥1 dose) to unvaccinated men using a multivariable modified Poisson regression. We conducted a multidimensional and probabilistic quantitative bias analysis to correct VE estimates.

Results:
Bias-corrected VE estimates were relatively stable across sensitivity values but differed from the uncorrected estimate at lower values of specificity. The median adjusted VE was 27% (2.5–97.5th simulation interval = −5–49%) in the uncorrected analysis, increasing to 39% (2.5–97.5th simulation interval = 2–65%) in the bias-corrected analysis.

Conclusion:
A large proportion of participants erroneously reporting HPV vaccination would be required to meaningfully change VE estimates.
Joint Associations of Short-Term Exposure to Ambient Air Pollutants with Hospital Admission of Ischemic Stroke
Authors: Liu Tao , Jiang Yong , Hu Jianxiong , Li Zixiao , Li Xing , Xiao Jianpeng , Yuan Lixia , He Guanhao , Zeng Weilin , Rong Zuhua , Zhu Sui , Ma Wenjun , Wang Yongjun 
Published: February 2023

Background:
Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown.

Methods:
We employed a time-stratified case–crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure–response associations.

Results:
Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%.

Conclusions:
Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8.
Adipose Tissue Transfer in Dynamic Definition Liposculpture—PART I. Back: Latissimus Dorsi and Trapezius Muscles
Authors: Hoyos Alfredo E. , Stefanelli Matt , Perez Mauricio E. , Brenes-Leñero Eduardo , Padilla Mauricio 
Published: February 2023

Background:
The aesthetics for the male posterior torso remain a topic not fully studied in body contouring surgery, neither the lipoinjection of its muscles have been considered before. As a result, we carried out a retrospective cohort study including patients who underwent fat grafting of either the trapezius or the latissimus dorsi muscles as part of dynamic definition liposculpture (HD2).

Methods:
We performed cadaveric dissections to support the fat grafting technique for both the trapezius and the latissimus dorsi muscles. We also searched our records for patients who underwent fat grafting of these muscles in addition to HD2 from January 2016 to November 2021 at a single center in Bogotá, Colombia.

Results:
Thirty-five consecutive patients met the inclusion criteria. In total, 22 (63%) and 7 (20%) of 35 underwent fat grafting at the trapezius and the latissimus dorsi muscles alone, respectively, and 6 out of 35 (17%) of both. Mean age is 39 years (range = 22–63). All patients were men. No complications were recorded related to fat grafting. Almost all patients were satisfied with the procedure (97%). Follow-up period ranged from 2 to 48 months.

Conclusions:
Liposuction might not be enough to achieve the ideal V-shape of the men’s back in some cases; hence, fat grafting of the power muscles becomes the best option. Recognition of the main neurovascular pedicle, proper preoperative markings, and a correct surgical technique ensure both the safety and the reproducibility of the technique.
Do Plastic Surgery Residents Get Sued? An Analysis of Malpractice Lawsuits
Authors: Gibstein Alexander R. , Jabori Sinan K. , Watane Arjun , Slavin Benjamin R. , Elabd Rawan , Singh Devinder 
Published: February 2023

Background:
Trainees may be implicated in malpractice lawsuits. Our study examines malpractice cases involving plastic surgery trainees.

Methods:
Using the LexisNexis database, verdicts and settlements from appellate state and federal cases between February 1988 and 2020 were queried. A nonrepresentative sample of 300 cases was compiled.

Results:
During a 32-year period, 21 lawsuits involving plastic surgery trainees were identified. Of these, 14 (66.67%) involved claims when a trainee was directly named as a defendant. Eighteen (85.7%) cases were due to procedural-related adverse outcomes, while three (14.3%) cases were associated with clinical or diagnostic-related adverse outcomes. Of the procedure-related cases, five (27.8%) occurred when the trainee was the lead surgeon. Allegations included lack of informed consent of procedure complications (11, 52.4%), procedural error (11, 52.4%), failure to supervise trainee (11, 52.4%), inexperience of trainee (eight, 38.1%), incorrect diagnosis or treatment (five, 23.8%), delay in evaluation (three, 14.3%), lack of awareness of resident involvement (three, 14.3%), lack of follow-up (three, 14.3%), and prolonged operative time (one, 4.8%). Median time from injury to lawsuit resolution was 3.8 years [interquartile range (IQR), 3–5 years]. Verdicts were ruled in favor of the defense in eight (38.1%) cases and for plaintiff in six (28.6%) cases. A settlement was made in seven (33.3%) cases. Median payout for plaintiff-won cases was $5,100,000 (IQR, $1,530,000–$17,500,000); the median settlement was $2,500,000 (IQR, $262,500–$4,410,000).

Conclusions:
Procedural error, improper informed consent, improper trainee supervision, and resident inexperience were the most common allegations. These factors can lead to financial and psychological burdens early in a physician’s career.
Real-time Navigation for Vascularized Lymph-node Transplantation Using Projection Mapping with Indocyanine Green Fluorescence
Authors: Tsuge Itaru , Sowa Yoshihiro , Yamanaka Hiroki , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki 
Published: February 2023

Summary:
The medical imaging projection system (MIPS) is a real-time surgical navigation device using indocyanine green (ICG) emission signals and active projection mapping. The difference between the object and the projected image is within 1 mm, and the time lag is within 0.1 seconds. We herein report the application of the MIPS to vascularized lymph-node transplantation (VLNT) surgery for lower extremity lymphedema to detect inguinal lymph nodes and perform color-coded navigation surgery for lymph-node resection. A left superficial inguinal lymph node was planned to be used as a donor for VLNT to the right lower leg in a 73-year-old woman with lower extremity lymphedema. Under general anesthesia, multiple intradermal injections of 0.1 ml of ICG were administered around the left inguinal donor site. The MIPS showed a clear linear projection image from a lateral injected point connecting to a lateral superficial inguinal lymph node. The left superficial circumflex iliac artery and vein were dissected for vascularized VLNT. Intraoperative real-time MIPS navigation continuously guided the transection plane colored by ICG fluorescence signals without shifting the visual focus from the surgical field. This is the first report of the intraoperative use of ICG projection mapping for VLNT donor-site surgery. The MIPS was able to visualize functional lymph nodes to facilitate minimally invasive donor-site surgery.
Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute
Authors: Viscardi Juan A. , Eseme Ebai A. , Gohritz Andreas , Tremp Mathias , Merat Rastine , Kalbermatten Daniel F. , Oranges Carlo M. 
Published: February 2023

Summary:
Large arm defects remain a challenge to the reconstructive surgeon, as local and regional flaps are limited regarding size and free flaps have disadvantages such as poor color match, technical complexity, prolonged operative time, and the risk of total flap loss. Keystone flaps are fascia-based flaps and combine perforator-based vascularity with relative simplicity of nonmicrosurgical techniques and do not distort local anatomy in cases of malignant excision with wide defects. This article highlights the approach of a multistaged procedure to reconstruct a large arm defect using a keystone type I flap and a temporary synthetic skin substitute for closure in a patient referred to our department for wide resection of a large melanoma in situ on the posterior aspect of the left arm. The defect, measuring 14 cm × 8 cm, was initially reconstructed with a keystone type I flap. Part of the wound was temporarily covered with EpiGARD (Biovision GmbH, Ilmenau, Germany) to avoid excessive wound tension. One week later, the wound was partially narrowed, and a smaller EpiGARD was placed in office under local anesthesia. The multistaged approach was completed with direct closure 1 week later after removal of the smaller EpiGARD. No complications occurred and the result was satisfactory with a pleasing cosmetic result after an 8-month follow-up. In conclusion, the keystone flap allows reconstruction of large arm defects. Temporary synthetic skin substitute coverage can serve as a good addition for those cases where tension on the margins is observed at the price of a small in-office procedure.
Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases
Authors: Sơn Trần Thiết , Việt Dung Phạm Thị , Nghĩa Phan Tuấn 
Published: February 2023

Summary:
Reconstruction of functional and aesthetic deformities of the neck after severe burn contracture is challenging. A free anterolateral thigh (ALT) perforator flap may be required, especially if local tissue is affected. To enlarge the surface area of this flap, donor site pre-expansion can be combined with flap transfer. Two patients with large neck defects were treated using pre-expanded free ALT perforator flaps. A rectangular expander was placed under the deep fascia after dissection of the perforator of the descending branch of the lateral circumflex femoral artery. The expansion time was from 3 to 4 months and the final expanded volume was 900–1500 ml. Defect sizes ranged from 14 × 18 to 18 × 27 cm and the expanded ALT flap was measured from 12 × 18 to 27 × 18 cm with one perforator in the flap. After immediate thinning, flap thickness was reduced, ranging from 5 to 11 mm. All flaps survived completely. Two patients were followed for 40 months. The skin color and textures of the flap were good. There was also a clear improvement in appearance and function. In summary, the subfascial expanded ALT perforator flap can be an excellent option for repairing severe neck defects due to its safe harvesting even with the large flaps. The donor area is closed primarily, and the thinned expanded skin is more aesthetically pleasing. The drawbacks are that it is a two-stage procedure, and the expander may be displaced during the expansion period.
Expanding Candidacy for Nipple-sparing Mastectomy in Women with Large or Ptotic Breasts: Staged Reconstruction Outcomes
Authors: Barnes Laura L. , Foster Rob , Mukhtar Rita A. , Esserman Laura J. , Ewing Cheryl , Alvarado Michael , Wong Jasmine , Piper Merisa 
Published: February 2023

Background:
Development of the nipple-sparing mastectomy (NSM) technique has dramatically improved breast reconstruction, and preservation of the nipple–areolar complex (NAC) positively influences patient satisfaction. However, women with large, ptotic breasts have historically not been candidates for NAC preservation due to impaired perfusion of the NAC leading to NAC loss. Although reduction mammoplasty has been reported as a strategy to increase candidacy for NSM, success rates and surgical outcomes for this staged approach are not well described in heterogeneous clinical scenarios.

Methods:
We performed a retrospective chart review of all patients who underwent reduction mammoplasty followed by NSM at our institution between January 2014 and September 2020. Clinical and surgical characteristics were collected. All surgical complications, including NAC loss rates, were analyzed.

Results:
Forty-one patients (74 breasts) underwent staged NSM during the defined time period. The average time between breast reduction mammoplasty and NSM was 213 days. Overall, 94.6% of NSM resulted in successful nipple preservation. There was no significant difference in the time interval from breast reduction mammoplasty to NSM between patients who had NAC loss (208 days) and those who did not (213 days, P = 0.87). Increasing age was significantly associated with risk of NAC loss (P = 0.002) in our cohort.

Conclusions:
In women with breast ptosis (which precludes safe NSM), it is possible to first offer reduction mammoplasty to preserve the NAC for future NSM. Our data suggest that 3 months between staged procedures is a safe time frame.
Limitations of Computed Tomography Angiography in Preoperative Planning of Peroneus Brevis Rotational Flap
Authors: Halverson Sky , Fadell Nicholas , Boyer Martin , Brogan David 
Published: February 2023

Background:
The distally based peroneus brevis (PB) rotational flap has been shown to be a reliable method of coverage of distal third tibial wounds. The flap is perfused via retrograde flow from distal PB perforators located within 8 cm of the lateral malleolus. The ability to assess patency of these vessels preoperatively facilitates surgical planning, and computed tomography angiography (CTA) has been used for perforator assessment of other lower extremity flaps. The purpose of the present study is to establish the potential utility of standard CTA for locating distal PB perforators by examining uninjured lower extremities.

Methods:
Twenty-five patients who underwent bilateral lower extremity CTAs using standard lower extremity protocol were retrospectively identified. Axial two-dimensional images were scanned craniocaudally using our institution’s standard CT image viewing software, Merge Radsuite (Merge Healthcare, Hartland, Wis.).

Results:
The average location of distal-most PB perforators identified on CT angiogram was 13.1 ± 5.1 cm proximal to the distal fibula, or 34.5% ± 13.5% of total fibular length. Standard CTA was only able to locate a pedicle within 8 cm of the lateral malleolus (20.9% of fibular length) in three of 25 patients (12%).

Conclusions:
Previous studies have described a reliable pedicle within 8 cm of the distal fibular tip upon which to design a distally based PB rotational flap. The absence of such perforators in the CT angiogram suggests that standard CT angiogram is not a reliable technique for identifying the patency of such perforators when evaluating the utility of a distally based PB flap.