bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Radiation-induced Tissue Injuries: A Review of Current Treatment Strategies
Authors: Simman Richard , Bach Karen , Abbas Fuad , Klomparens Kara , Brickman Bradley Joseph 
Published: June 2023

Background:
Although radiation therapy remains an integral component in cancer treatment, the sequela of tissue damage can result in long-term morbidity and mortality for patients. This article aimed to perform a comprehensive review of the current literature for both nonsurgical and surgical management strategies for radiation-induced injuries.

Methods:
A literature search was performed on PubMed to review the current described management and treatment options for radiation-induced injuries. Patient demographics, medical diagnoses, complications, strategies of management care, and outcomes were reviewed.

Results:
The most commonly described management options and reconstructive techniques of radiation wounds were analyzed and reported.

Conclusions:
Consideration of current techniques and outcomes in the management of radiation-induced wounds demonstrates that impaired wound healing remains a major problem. This literature review provides a detailed overview of the most frequently used therapies with recommendations for surgeons.
Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future
Authors: Nasr Hani Y. , Friedlander Paul , Chiu Ernest S. 
Published: June 2023

Background:
Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications.

Methods:
Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded.

Results:
The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered.

Conclusions:
The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.
Recent Trends and Future Directions for the Integrated Plastic Surgery Match
Authors: Fijany Arman J. , Zago Ilana , Olsson Sofia E. , Troia Thomas , Givechian Kevin Bijan , Boctor Michael J. , Pekarev Maxim 
Published: June 2023

Summary:
The integrated plastic surgery residency match has risen to be the most competitive specialty in the 2022 match. This reality has prompted medical students to reach a high level of personal achievements, including pursuing research fellowships to boost research productivity. The competitive nature of this specialty has highlighted several barriers for applicants, such as those from groups underrepresented in surgery, of lower socioeconomic backgrounds, or without a home program. In recent years, there have been several changes to the match that stand to attenuate disparities among applicants, such as the transition to virtual interviews and the shift of the United States Medical Licensing Examination Step 1 score to pass-fail. The introduction of the Plastic Surgery Common Application and standardized letters of recommendation has altered the application process for the plastic surgery match. Given these recent trends, evaluating the current landscape and looking toward future directions for the integrated plastic surgery match becomes necessary. Understanding these changes will not only benefit medical students by giving them a transparent look into the match process but also provide a framework for other specialties to follow to increase accessibility to their specific specialty.
Conversion to Glaucoma in Pediatric Glaucoma Suspects
Authors: Cardakli Nur , Gore Rujuta A. , Kraus Courtney L. 
Published: June 2023

Précis:
In this retrospective review of pediatric glaucoma suspects, 11.5% of eyes progressed to glaucoma over an average of 6.5 years; eyes with ocular hypertension had an 18-fold increased risk of progression compared with eyes with suspicious disc appearance.

Purpose:
The purpose of this study was to describe the rate of progression to glaucoma of a large cohort of pediatric glaucoma suspects at a quaternary academic center.

Design:
Retrospective case series

Participants:
One thousand three hundred seventy-five eyes (824 individuals) followed as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.

Methods:
Retrospective study of pediatric patients monitored as glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.

Main Outcome Measures:
Progression to glaucoma, defined according to Childhood Glaucoma Research Network criteria or by surgical intervention; initiation of intraocular pressure-lowering therapy.

Results:
One hundred fifty-eight (11.5%) eyes from 109 unique patients met the criteria for conversion to glaucoma during follow-up; rates of conversion ranged between 34.1% for eyes monitored for ocular hypertension, 16.2% for eyes with prior lensectomy, 12.1% for eyes monitored for other ocular risk factors, 2.4% for eyes with suspicious disc appearance, and 0.4% for eyes monitored for systemic risk factors. The first criterion met for conversion to glaucoma was ocular hypertension in 149 eyes (94.3%) and enlarged cup-to-disc ratio (CDR) in 9 eyes (5.7%); the most common second criterion met was the enlargement of CDR since initial presentation (45 eyes, 28.5%), surgical intervention (33 eyes, 20.9%), visual field changes (21 eyes, 13.3%), and asymmetric CDR change compared with fellow eye (20 eyes, 12.7%). The Kaplan-Meier survival curves across the different indications for being monitored as a glaucoma suspect significantly differed (P<0.0001). Eyes being monitored for ocular hypertension had an 18-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance [hazard ratio (HR) 18.33, 95% CI, 10.05–33.41). Eyes monitored for prior lensectomy and for other ocular risk factors had a 6-fold and 5-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance, respectively (HR: 6.20, 95% CI, 3.66–10.51; HR: 5.43, 95% CI, 3.00–9.84). Eyes followed for ocular hypertension were nearly 4 times more likely to convert to glaucoma than those followed for prior lensectomy (HR: 3.72, 95% CI, 2.28–6.07).

Conclusions:
Eyes being followed as pediatric glaucoma suspects for ocular hypertension had higher rates of progression to glaucoma than eyes being monitored for prior lensectomy, other ocular risk factors, suspicious disc appearance, or systemic risk factors.
Five-Year Outcomes of Graft-Free Tube Shunts and Risk Factors for Tube Exposures in Glaucoma
Authors: Youn Saerom , Yan David Benedict 
Published: June 2023

Précis:
Use of a scleral tunnel technique instead of a patch graft can be considered in most cases of tube shunt implantation. Grafts may still be considered in younger (<65 y old) East Asians.

Purpose:
(1) To assess the risk factors for tube exposure with a graft-free implantation technique and (2) to examine 5-year outcomes of graft-free tube shunt insertion.

Methods:
This was a retrospective case series of 204 consecutive eyes undergoing a glaucoma tube shunt implantation with a scleral tunnel technique in lieu of a graft. Preoperative and postoperative best-corrected visual acuity, intraocular pressure, and number of glaucoma medications were compared. Failure was defined as the following: (1) intraocular pressure >21 mm Hg or ≤5 mm Hg on 2 consecutive visits after 3 mo; (2) required additional glaucoma surgery; (3) loss of light perception. Univariable and multivariable regression analyses were conducted to identify risk factors of tube exposures.

Results:
Intraocular pressure and the number of glaucoma medications were significantly decreased at all postoperative time points (P<0.001). Success rates were 91% at year 1, 75% at year 3, and 67% at year 5. The most common early (<3 mo) complication was tube malpositioning. The most common late (>3 mo to 5 y) complications were corneal complications and uncontrolled intraocular pressure. By year 5, 6.9% of tubes were exposed. Multivariable regression showed that age less than 65 years old (odds ratio: 3.66, P=0.04) and East Asian ethnicity (odds ratio: 3.36, P=0.04) were associated with significantly increased risk of tube exposure.

Conclusions:
Graft-free glaucoma tube implantation has comparable long-term outcomes and complication rates to shunts with a graft. Younger (<65 y old) East Asians are at greater risk of tube exposure without a graft.
Extramedullary plasmacytoma of the orbit with intracranial invasion: A case report
Authors: Kim Yoo Jin , Moon Sang Woong , Park , In-Ki , Shin Jae-Ho 
Published: June 2023

Rationale:
Plasmacytoma is a disease caused by the proliferation of monoclonal immunoglobulin-producing plasma cells and divided into multiple myeloma, solitary bone plasmacytoma, and extramedullary plasmacytoma. We report a case of orbital extramedullary plasmacytoma invading the dura mater in a patient with exophthalmos and diplopia.

Patient concerns:
A 35-year-old female patient with exophthalmos in the right eye and diplopia visited the clinic.

Diagnoses:
The thyroid function tests showed nonspecific results. Orbital computed tomography and magnetic resonance imaging revealed a homogeneously enhancing orbital mass infiltrating the right maxillary sinus and adjacent brain tissue in the middle cranial fossa through the superior orbital fissure.

Interventions:
To diagnose and alleviate the symptoms, an excisional biopsy was performed, which revealed a plasmacytoma.

Outcomes:
One month after the surgery, the protruding symptoms and eye movement restriction in the right eye improved, and the visual acuity in the right eye was restored.

Lessons:
In this case report, we present a case of an extramedullary plasmacytoma that originated in the inferior wall of the orbit and invaded the cranial cavity. To our knowledge, no previous reports have described a solitary plasmacytoma that originated in the orbit, causing exophthalmos and invading the cranial cavity at the same time.
Effects of continuous bicycle ergometer and step exercises from admission to discharge in a patient with myelodysplastic syndrome undergoing myeloablative conditioning and hematopoietic stem cell transplantation: A case report
Authors: Kawanishi Makoto , Nishimura Yukihide , Kinoshita Tokio , Hashizaki Takamasa , Umemoto Yasunori , Nishiyama Kazunari , Tajima Fumihiro 
Published: June 2023

Background:
In myelodysplastic syndromes (MDS), in addition to disease-related symptoms, many adverse events are associated with anticancer agents, myeloablative conditioning (MAC), and allogeneic hematopoietic stem cell transplantation (allo-HSCT). Isolation and bed rest in a clean room severely limit physical activity, resulting in cardiopulmonary and muscle weakness. In addition, post-transplant patients may experience general fatigue, gastrointestinal symptoms, and infections associated with a weakened immune system, as well as graft-versus-host disease, which causes further decline in physical function and activities of daily living (ADL). Most reports on the rehabilitation of patients with hematopoietic tumors involve interventions before and after chemotherapy or transplantation. However, an important issue is to establish effective and feasible exercise programs in a clean room setting, where activity is severely limited and physical function is most likely to decline.

Case report:
This case report describes the treatment progress of a 60-year-old man with MDS and thrombocytopenia scheduled to receive MAC and allo-HSCT, who continued bicycle ergometer and step exercises from admission to discharge. The patient was admitted for allo-HSCT, and on day 4, he started bicycle ergometer and step exercise in a clean room and continued until discharge. As a result, exercise tolerance and lower-extremity muscle strength were maintained at the time of hospital discharge. Furthermore, the patient was able to continue rehabilitation in a restricted environment without adverse events.

Conclusions:
The rehabilitation and treatment course of this case may provide valuable information for patients with MDS and thrombocytopenia.
Difficult endotracheal intubation due to a large epiglottic cyst: A case report
Authors: Zhang Ran , Jiang Xian , Feng Jianguo 
Published: June 2023

Rationale:
An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion. In such cases, the glottis is not visible as it is covered by the enlarged epiglottic cyst. When conventional anesthesia is administered in such patients, they might have difficulty ventilation since the epiglottic cyst can easily form a flap and move with external pressure changes and can cause the blockage of the glottis due to the loss of consciousness and the relaxation of the throat muscles of the patient. If endotracheal intubation is not initiated and effective ventilation is not established, the patient may suffer from hypoxia and other accidents.

Patient concerns:
A 48-year-old male presented to the otolaryngology department with a foreign body sensation in the throat.

Diagnoses:
A large epiglottic cyst was diagnosed.

Interventions:
The patient was planned to undergo epiglottis cystectomy under general anesthesia. After induction of anesthesia, the cyst severely covered the glottis and made endotracheal intubation difficult. The anesthesiologist rapidly adjusted the position of the laryngeal lens; thus, the endotracheal intubation was successful under the visual laryngoscope.

Outcomes:
The endotracheal intubation was successful under the visual laryngoscope and the operation went well.

Lessons:
Patients with epiglottic cysts are more likely to have difficult airways after induction of anesthesia. Anesthesiologists should take preoperative airway assessment seriously, efficiently handle difficult airway and intubation failure, and make quick and correct choices to ensure patient safety.
An acquired BMF with FANCL gene heterozygous mutation: Case report
Authors: Zhang Nan , Wang Xiao , Miao Xiao-Juan , Zhang Xu-Pai , Xia Xin-Yu , Li Li , Sun Hao-Ping 
Published: June 2023

Rationale:
Bone marrow failure (BMF) includes inherited and acquired BMFs. Acquired BMF can be secondary to various factors, such as autoimmune dysfunction, benzene, drugs, radiation, viral infection and so on. Fanconi anemia (FA) complementation group L (FANCL) is an E3 ubiquitin ligase that participates in the repair of DNA damage. Homozygous or compound heterozygous mutations of FANCL can lead to the onset of FA, which is one of the most common inherited BMFs.

Patient concerns and Diagnoses:
Here, we report a case of acquired BMF. This patient had a history of benzene exposure for half a year before the onset of the disease, and presented with progressive pancytopenia, especially the reduction of erythrocytes and megakaryocyte, without malformation. Interestingly, this patient and his brother/father had a heterozygous (non-homozygous/compound heterozygous) mutation (Exon9, c.745C > T, p.H249Y) in the FANCL gene.

Interventions and Outcomes:
The patient successfully underwent unrelated and fully compatible umbilical cord blood hematopoietic stem cell transplantation.

Lessons subsections:
We report for the first time an acquired BMF case with FANCL gene heterozygous mutation, and the mutation site (Exon9, c.745C > T, p.H249Y) has never been reported. This case suggests that heterozygous mutations in FANCL gene may be associated with increased susceptibility to acquired BMF. Based on current reports and this case, we speculate that heterozygous mutations in the FA complementation gene may exist in a certain proportion of tumor and acquired BMF patients, but have not been detected. We recommend routine screening for FA complementation gene mutations in tumor and acquired BMF patients in clinical practice. If positive results are found, further screening can be conducted on their families.
Interleukin-4 expression is increased in patients with tuberculosis: A systematic review and meta-analysis
Authors: He Jie , Song Lingmeng , Zheng Pengcheng 
Published: June 2023

Background:
Interleukin-4 (IL-4) is an important cytokine in the Th2 differentiation of CD4+ T cells, which modulates immune responses and participates in host defense against Mycobacterium tuberculosis. The present study aimed to evaluate the significance of IL-4 concentration in patients with tuberculosis. Data from this study will be helpful in understanding the immunological mechanisms of tuberculosis and in clinical practice.

Method:
A data search was conducted from January 1995 to October 2022 in electronic bibliographic databases such as China National Knowledge Infrastructure, Wan Fang, Embase, Web of Science, and PubMed. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Heterogeneity between the studies was assessed using I
2 statistics. Publication bias was determined by funnel plot, and Egger’s test was used to confirm the presence of publication bias. All qualified studies and statistical analyses were performed using Stata 11.0.

Results:
Fifty-one eligible studies comprising 4317 subjects were included in the meta-analysis. The results depicted a considerably increased level of serum IL-4 in patients with tuberculosis than in the controls (standard mean difference [SMD] = 0.630, [95% confidence interval (CI), 0.162–1.092]). However, there was no significant difference in plasma IL-4 levels between patients with TB and controls (SMD = 0.290, [95% CI, −0.430 to 1.010]). In addition, the infection status, TB focus location, drug resistance, race, research design type, and detection method divided the subjects into different subgroups for the meta-analysis. The results of the comparison of healthy controls and TB subjects showed that in the Asian population, the serum IL-4 level in patients with TB was higher than that in controls (SMD = 0.887, [95% CI, 0.202 to −1.573]) and patients with active TB as well as people with pulmonary TB showed increased serum IL-4 levels compared to controls (SMD = 0.689, [95% CI, 0.152–1.226]). In the case of the control group with latent TB, the active TB group had higher serum IL-4 levels than the control group (SMD = 0.920, [95% CI, 0.387–1.452]).

Conclusion:
The present meta-analysis showed that serum IL-4 varied in healthy individuals and patients with TB. Patients with active TB may also exhibit higher IL-4 concentrations.
Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Authors: Zhong Wu , Liu Chuanyuan , Fang Chuanfa , Zhang Lei , He Xianping , Zhu Weiquan , Guan Xueyun 
Published: June 2023

Background:
The efficacy of laparoscopic surgery (LS) for the treatment of colonoscopic perforation is still controversial. The purpose of this meta-analysis was to evaluate the effectiveness and safety of LS versus open surgery (OS) for colonoscopic perforation.

Methods:
All clinical trials that compared laparoscopic with OS for colonoscopic perforation published in English were identified in PubMed, EMBASE, Web of Science, and Cochrane Library searches. A modified scale was used to assess the quality of the literature. We analyzed the age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, type of procedure, size of perforation, operation time, postoperative fasting time, hospital stay, postoperative complication morbidity, and postoperative mortality. Meta-analyses were performed using weighted mean differences for continuous variables, and odds ratios for dichotomous variables.

Results:
No eligible randomized trials were identified, but eleven nonrandomized trials were analyzed. In the pooled data of 192 patients who underwent LS and 131 OS, there were no significant differences in age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, perforation size, and operative time between the groups. LS group had shorter time of hospital stay and postoperative fasting time, less postoperative complication morbidity, but there were no significant difference in postoperative mortality rate between LS group and OS group.

Conclusions:
Based on the current meta-analysis, we conclude that LS is a safe and efficacious technique for colonoscopic perforation, with fewer postoperative complications, less hospital mortality, and faster recovery compared with OS.
Triple Strut Concept for the Nasal Tip Projection in Small Lower Lateral Cartilages and Septum
Authors: Suh Jeongsoo , Suh Man-Koon , Choi Hongseo 
Published: June 2023

Introduction:
This study aimed to evaluate the effectiveness of the triple strut graft technique for nasal tip projection in Asian patients with weak and small lower lateral cartilages and septum. The technique uses a combination of septal angle strut and, columellar strut grafts and lateral crural repositioning to provide support for the nasal tip.

Methods:
The study included 30 Asian patients who underwent primary rhinoplasty using this technique between January 2019 and December 2021. The surgical procedure involved making an open rhinoplasty incision and performing a scroll area release. A small triangular-shaped septal angle strut graft was then placed, and the lower lateral cartilages were suspended anteriorly and placed on the anterior end of the septal angle after a columellar strut graft was performed between both medial crura. The lateral crura of the lower lateral cartilages were transposed medially on top of the upper lateral cartilages and maintained in place by spanning sutures at the cephalic margins of both lateral crura.

Results:
The triple strut graft technique was shown to be effective in providing stable tip projection in Asian noses with weak and small lower lateral cartilages and septum. Statistically significant differences were found between the preoperative and postoperative values of the nasal tip projection ratio and Rhinoplasty Outcome Evaluation (P < 0.05).

Conclusions:
The triple strut graft tip projection technique can be an effective surgical option for Asian patients who have weak and small medial crura combined with a small septum, providing stability for the nasal tip projection.