bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteosarcopenia in the Spine Beyond Bone Mineral Density
Authors: Haffer Henryk , Muellner Maximilian , Chiapparelli Erika , Dodo Yusuke , Zhu Jiaqi , Han Yi Xin , Donnelly Eve , Tan Ek T. , Shue Jennifer , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Hughes Alexander P. 
Published: April 2023

Study Design.
Prospective cross-sectional study.

Objective.
To determine if an accumulation of advanced glycation endproducts (AGEs) is associated with impaired paraspinal muscle composition.

Background.
Impaired bone integrity and muscle function are described as osteosarcopenia. Osteosarcopenia is associated with falls, fragility fractures, and reduced quality of life. Bone integrity is influenced by bone quantity (bone mineral density) and quality (microarchitecture and collagen). The accumulation of AGEs stiffens collagen fibers and increases bone fragility. The relationship between paraspinal muscle composition and bone collagen properties has not been evaluated.

Methods.
Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with multiphoton microscopy for fluorescent AGE cross-link density (fAGEs). Preoperative magnetic resonance imaging measurements at level L4 included the musculus (m.) psoas and combined m. multifidus and m. erector spinae (posterior paraspinal musculature, PPM). Muscle segmentation on axial images (cross-sectional area, CSA) and calculation of a pixel intensity threshold method to differentiate muscle (functional cross-sectional area, fCSA) and intramuscular fat (FAT). Quantitative computed tomography was performed at the lumbar spine. Univariate and multivariable regression models were used to investigate associations between fAGEs and paraspinal musculature.

Results:
One hundred seven prospectively enrolled patients (50.5% female, age 60.7 y, BMI 28.9 kg/m2) were analyzed. In all, 41.1% and 15.0% of the patients demonstrated osteopenia and osteoporosis, respectively. Univariate linear regression analysis demonstrated a significant association between cortical fAGEs and CSA in the psoas (ρ=0.220, P=0.039) but not in the PPM. Trabecular fAGEs revealed no significant associations to PPM or psoas musculature. In the multivariable analysis, higher cortical fAGEs were associated with increased FAT (β=1.556; P=0.002) and CSA (β=1.305; P=0.005) in the PPM after adjusting for covariates.

Conclusion.
This is the first investigation demonstrating that an accumulation of nonenzymatic collagen cross-linking product fAGEs in cortical bone is associated with increased intramuscular fat in the lumbar paraspinal musculature.
Median Nerve Neuropathy Caused by Persistent Median Artery Thrombosis
Authors: Miyashima Yusuke , Gotani Hiroyuki , Okamoto Kotaro , Yagi Hirohisa , Tanaka Yoshitaka 
Published: April 2023

Summary:
Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.
Expression of Human Papillomavirus and the p16 Gene in Oral Potentially Malignant Disorders (OPMD): a Comparative Study With Oral Squamous Cell Carcinoma
Authors: Baddevithana Asinsala K. , Jayasinghe Ruwan D. , Tilakaratne Wanninayake M. , Illeperuma Rasika P. , Siriwardena Bogahawatte S.M.S. 
Published: April 2023

Background:
The incidence of oral squamous cell carcinoma (OSCC) of the tongue is increasing in the younger population without traditional risk habits that lead researchers to find other related factors such as diet and viruses, especially human papillomavirus (HPV). It is noteworthy that many OSCCs develop from oral potentially malignant disorders (OPMDs). Correct diagnosis and timely management of OPMDs may help to prevent malignant transformation, and therefore it is worth seeing the involvement of HPV in OPMDs and oral cancers, as the preventive and curative measures in HPV-induced cancer types are different from the conventional types of OPMDs and OSCCs. Therefore, the main objective of this study was to identify a relationship between HPV and p16 in OPMDs and compare it with OSCC.

Methods:
This study was conducted on 83 cases of known OSCCs and OPMDs (oral submucous fibrosis, leukoplakia, and oral lichen planus). Assays, such as polymerized chain reaction (PCR) and reverse transcription-PCR, were carried out for HPV and p16. The results were compared with clinical information and with the literature. The results were analyzed using SPSS 16.0 for windows.

Results:
P16 expression was mostly seen in males than in female patients. Out of 21 cases of keratosis with dysplasia, 19% expressed p16. Of 26 oral lichen planus patients, 29% showed the p16 gene with immunohistochemistry. Interestingly, a high percentage of OSF cases expressed p16 (48.27%). Minimal expression was observed in OSCC (6.25%). HPV DNA was detected in 2.4% of the total sample. Both p16 and HPV were detected in a single case of OSCC. OPMDs expressed a significant amount of the p16 gene by immunohistochemistry and reverse transcription-PCR technique when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. HPV and p16 are mostly negative in our OSCC sample, exhibiting low prevalence.

Conclusions:
OPMDs expressed a significant amount of the p16 gene when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. Although OSF expressed p16, HPV was not detected, suggesting that over-expression could be independent of HPV. OSCC shows low HPV prevalence.
Moving from Vaccine Hesitancy to Acceptance: Engaging Underrepresented Employees in a Pediatric Academic Medical Center
Authors: Connor Jean A. , Fynn-Thompson Francis , Horgan James J. , Luff Donna , Hickey Patricia A. , Ward Valerie L. 
Published: April 2023

Introduction:
Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described among hospital employees, the employees’ experiences from an underrepresented population cohort have not been reported. We, therefore, sought to understand employees’ vaccine experiences, hesitancy, and ways to enhance ongoing COVID-19 vaccine education and communication to build a hospital-wide culture of vaccine acceptance.

Methods:
We invited interprofessional staff from 5 clinical departments to participate in qualitative focus groups. Guiding questions were used to explore the experiences and perceptions of the staff. Using content analysis, we identified themes and recommendations for improvement.

Results:
We conducted 5 focus group sessions with over 50 participants. Four themes emerged; “Vaccine Fears Past and Present,” “Access to Information,” “Worries for Families,” and “Our Hospital is a Trusted Name.” Participants also provided recommendations for improvement in the messaging around the vaccine rollout. Consideration of how different employees access information, listening to staff needs, and recognizing the role of race and history were critical to engaging and improving the underrepresented employees’ vaccine acceptance.

Conclusions:
Exploring the concerns and fears of the COVID-19 vaccine within groups of underrepresented staff members through qualitative methods was key to understanding their vaccine hesitancy and implementing strategies to move toward vaccine acceptance in the hospital.
Short-term Quality of Life after Autologous Compared to Alloplastic Breast Reconstruction: A Prospective Study
Authors: Sadok Nadia , Krabbe-Timmerman Irene S. , Buisman Nina H. , van Aalst Vera C. , de Bock Geertruida H. , Werker Paul M.N. 
Published: April 2023

Background:
The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more physically demanding surgery and increased risk of severe complications of autologous BR.

Methods:
Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.

Results:
Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on “satisfaction with breasts” (p=0.001), “psychosocial well-being” (p=0.024) and “sexual well-being” (p=0.007). Postoperative “physical well-being: chest” was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.

Conclusion:
In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.
Mini-Shaped Kiss Flap Design for Palmar and Digital Soft Tissue Resurfacing
Authors: Zheng Youmao , Hallock Geoffrey G. , Levin L. Scott , Zhang Yixin , Min Peiru 
Published: April 2023

Background:
Although palmar and digital soft tissue resurfacing with intrinsic flaps may provide functional and aesthetic reconstruction, the donor site may result in a tight closure or need for a skin graft once the flap is raised. In this series, the “mini-shaped kiss” flap was utilized to increase the resurfacing efficiency while preserving hand function.

Methods:
The mini-shaped kiss flaps based on common palmar digital arteries, princeps pollicis artery and ulnar palmar digital artery were developed for the resurfacing of distal or proximal finger areas. The tiny skin paddles were kissed together and transferred as pedicled in proposed dimensions and shape. The flap size, donor/recipient site, perforator source, whether free or pedicled, surgical outcome and donor site morbidity were evaluated.

Results:
20 mini-shaped kiss flaps were harvested for the purpose of palmar and digital resurfacing. The flap sizes varied from 3×1.2cm to 5×2cm. All 19 patients aged 6 to 52 years (mean 35 years) achieved successful reconstruction without major complications after 6 to12 months follow-up.

Conclusions:
The mini-shaped kiss flap technique exhibited favorable surgical outcomes with excellent color and texture match to the recipient sites. The reverse midpalm, thenar and hypothenar island flap can be raised at the cost of an unnoticeable linear scar with minimized functional compromise in the donor area.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Vascularized Origami Medial Femoral Condyle Flap for Finger Joint Reconstruction
Authors: Hachisuka Hiroki , Ishibashi Shigeki , Shimose Shoji , Adachi Nobuo 
Published: April 2023

Summary:
Total finger joint reconstruction is challenging. Vascularized toe joint transfer is currently used for reconstruction, but it is difficult to perform, fails to achieve maximal joint flexibility, and is associated with donor site complications. As an alternative, we developed a vascularized medial femoral condyle flap technique, wherein the vascularized cortico-periosteum is shaped via origami, folding the donor tissue to fit the recipient site. Herein, we describe the use of this method for reconstruction of interphalangeal and metacarpophalangeal joints with a reduced range of motion. In our study, the mean age of the patients (three men, four women) was 51 years (range, 36–68 years), and the mean follow-up period was 3 years and 1 month (range, 4 months to 5 years). In the reconstructed joints, the mean range of motion; disabilities of the arm, shoulder, and hand score; and pinch strength of the unaffected side were 55° (range, 24°–90°), 2.3 (range, 0–6), and 98% (range, 70%–138%), respectively. No donor site morbidities were observed. Radiography and computed tomography revealed joint-like grafted tissue remodeling. The study findings suggest that the origami medial femoral condyle flap is useful for functional finger joint reconstruction. The procedure requires fabrication before grafting, but tissue harvest is relatively easy.

Level of Evidence: Therapeutic Level IV
Fingertip Replantation – Surgical Technique, and Tips and Tricks –
Authors: Hayashi Kota , Hattori Yasunori , Chia Dawn Sinn Yii , Sakamoto Sotetsu , Sonezaki Shicho , Doi Kazuteru 
Published: April 2023

Successful replantation of fingertip amputations restores the original tissue and is the ideal treatment to provide the best aesthetic and functional outcome. However, successful fingertip replantation is considered challenging because it requires supermicrosurgery techniques.
This article provides a detailed surgical technique for fingertip replantation and our preferences and recommendations. In our experience, the most important factors for successful fingertip replantation are meticulous vascular dissection, reliable arterial repair and venous anastomosis to avoid postoperative venous congestion. Proximal arterial dissection until pulsatile bleeding is encountered avoids the zone of vascular injury, and is particularly important in crush or avulsion amputations. Distal arterial dissection is performed until undamaged intima is identified. We believe anastomosis to the central artery is reliable even in Tamai zoneⅡ amputation. When an arterial defect is present, we recommend using a vein graft to anastomose to the central artery. In additional, we highly recommend at least one venous anastomosis to avoid postoperative venous congestion. In Tamai zoneⅠ, available veins can be found on the palmar side of the pulp. It is important to search directly below the dermis and remove adipose tissue around the vessels to secure space for anastomosis. We consider nerve suture in Tamai zoneⅠ and Ⅱ replantations inessential, because spontaneous sensory recovery can be expected. Postoperative management of venous congestion, spasm in artery, and arterial thrombosis are as important as surgery.
Prognosis of Performing Split-Rib Bone Graft for Cranial Bone Defects
Authors: Hong Hyun Ki , Ryu Jeong Yeop , Lee Joon seok , Yang Jung Dug , Chung Ho Yun , Cho Byung Chae , Choi Kang Young 
Published: April 2023

Background:
Frontal sinus anterior wall defects occur because of various diseases, causing not only aesthetic problems, such as forehead bulging and upper eyelid ptosis, but also exerting physical pressure on the brain or optic nerve. Therefore, this study aimed to evaluate the prognosis of performing split-rib bone graft for frontal sinus anterior wall defect.

Methods:
This study included 30 patients who received a split-rib bone graft for a frontal sinus anterior wall defect. The siz es and volumes of the defects and grafts were measured using three-dimensional computed tomography before, after, and every 6 months for 2 years after the surgery. The Medical Imaging Interaction Toolkit was used for analysis.

Results:
The average size and volume of the graft were 27.29 cm 2 and 5.88 cm 3, whereas they were 23.76 cm 2 and 4.80 cm 3 at 24 months after the surgery, respectively. In a graft size and volume of <27 cm 2 or 6 cm 3, the rate of graft take was >80% during long-term observation. The younger the age, the higher the rate of graft take. No difference was found in the defect causes. Absorption occurred for up to 18 months.

Conclusions:
Frontal bone defect reconstruction revealed the stable results of the split-rib bone graft over a long period when the size and volume were <27 cm 2 and 6 cm 3, respectively. Furthermore, bone resorption was seen in more than 20%–30% of the patients, and the rate of resorption increased with age; thus, it is appropriate to consider overcorrection and other reconstruction methods.
Adverse Tumour and Host Biology May Explain the Poorer Outcomes Seen in Emergency Presentations of Colon Cancer
Authors: Golder Allan M. , Conlan Owen , McMillan Donald C. , Mansouri David , Horgan Paul G. , Roxburgh Campbell S. 
Published: April 2023

Objective:
To examine the association between tumor/host factors (including the systemic inflammatory response), mode of presentation, and short/long-term outcomes in patients undergoing curative resectional surgery for TNM I to III colon cancer.

Background:
Emergency presentations of colon cancer are associated with worse long-term outcomes than elective presentations despite adjustment for TNM stage. A number of differences in tumor and host factors have been identified between elective and emergency presentations and it may be these factors that are associated with adverse outcomes.

Methods:
Patients undergoing curative surgery for TNM I to III colon cancer in the West of Scotland from 2011 to 2014 were identified. Tumor/host factors independently associated with the emergency presentation were identified and entered into a subsequent survival model to determine those that were independently associated with overall survival/cancer-specific survival (OS/CSS).

Results:
A total of 2705 patients were identified. The emergency presentation was associated with a worse 3-year OS and CSS compared with elective presentations (70% vs 86% and 91% vs 75%). T stage, age, systemic inflammatory grade, anemia (all P < 0.001), N stage (P = 0.077), extramural venous invasion (P = 0.003), body mass index (P = 0.001), and American Society of Anesthesiologists Classification classification (P = 0.021) were independently associated with emergency presentation. Of these, body mass index [hazard ratio (HR), 0.82], American Society of Anesthesiologists Classification (HR, 1.45), anemia (HR, 1.29), systemic inflammatory grade (HR. 1.11), T stage (HR, 1.57), N stage (HR, 1.80), and adjuvant chemotherapy (HR, 0.47) were independently associated with OS. Similar results were observed for CSS.

Conclusions:
Within patients undergoing curative surgery for colon cancer, the emergency presentation was not independently associated with worse OS/CSS. Rather, a combination of tumor and host factors account for the worse outcomes observed.
Pre-existing left bundle branch block and clinical outcomes after transcatheter aortic valve replacement
Authors: Saito Tetsuya , Inohara Taku , Tsuruta Hikaru , Yashima Fumiaki , Shimizu Hideyuki , Fukuda Keiichi , Ohno Yohei , Nishina Hidetaka , Nakajima Yoshifumi , Izumo Masaki , Asami Masahiko , Naganuma Toru , Mizutani Kazuki , Yamawaki Masahiro , Tada Norio , Yamanaka Futoshi , Shirai Shinichi , Noguchi Masahiko , Ueno Hiroshi , Takagi Kensuke , Watanabe Yusuke , Yamamoto Masanori , Hayashida Kentaro 
Published: April 2023

AbstractBackgroundThere are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB. This study aimed to investigate the association with pre-existing or new-onset LBBB and clinical outcomes after TAVR.MethodsUsing data from the Japanese multicenter registry, 5996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportinal hazard models and propensity score analysis to adjust the differences in baseline characteristics.ResultsOf 5996 patients who underwent TAVR, 280 patients (4.6%) had pre-existing LBBB and new onset LBBB occurred in 1658 patients (27.6%). Compared with no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated with a higher 2-year all-cause (adjusted hazard ratio [aHR]: 1.39; 95% confidence interval [CI]: 1.06-1.82; p =0.015) and cardiovascular mortality (aHR: 1.62; 95% CI: 1.05-2.54; p =0.027), but also with higher all-cause (aHR:1.43, 95% CI:1.07-1.91; p =0.016) and cardiovascular mortality (aHR: 1.84, 95% CI: 1.14-2.98; p =0.012) than new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group.ConclusionsPre-existing LBBB was independently associated with poor clinical outcomes reflecting increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.What is Known?There are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB.What the Study Add?Patients with pre-existing LBBB not only had a higher mortality than those without LBBB, but also had a worse prognosis than those with new onset LBBB.This was because patients with pre-existing LBBB had more heart failure deaths.Patients with pre-existing LBBB should be carefully monitored after TAVR. Further investigation will be required to corroborate our findings.