bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of carbon dioxide laser therapy compared with sham for genitourinary syndrome of menopause management: a meta-analysis of randomized clinical trials
Authors: Gunawan Yuliana W. , Erlina Yunita 
Published: July 2023

Abstract

Importance
Data on whether the carbon dioxide (CO2) laser is useful for treatment of genitourinary syndrome of menopause (GSM) are inconsistent.

Objective
This meta-analysis evaluated the benefits and safety of CO2 laser compared with sham treatment of GSM.

Evidence Review
A relevant literature search of Europe PMC, MEDLINE, Scopus, and ClinicalTrials.gov databases using specific keywords was conducted. The results of continuous variables were pooled into the standardized mean difference (SMD), whereas dichotomous variables were pooled into odds ratio with 95% confidence intervals (95% CI) using random-effects models. A funnel plot was used to assess for the presence of publication bias.

Findings
A total of six randomized clinical trials were included. Pooled analysis revealed that CO2 laser therapy was associated with a higher reduction in the Vaginal Assessment Scale (SMD, −0.81 [95% CI, −1.59 to −0.04]; P = 0.04; I
2 = 88%) and Urinary Distress Inventory short form (SMD, −0.45 [95% CI, −0.84 to −0.06]; P = 0.02; I
2 = 0%), and greater patient satisfaction rate (odds ratio, 5.46 [95% CI, 2.23 to 13.37]; P = 0.0002; I
2 = 0%) when compared with sham-only treatment. Meanwhile, the Female Sexual Function Index, Vaginal Health Index, and Patient Global Impression Improvement did not differ significantly between groups. Adverse events were only mild with no serious adverse events reported.

Conclusions and Relevance
CO2 laser therapy may improve the overall treatment of GSM with a relatively good safety profile. However, further randomized clinical trials with larger sample sizes are still needed to confirm the results of this study.
Displacement of submacular hemorrhage with vitrectomy combined with subretinal balanced salt solution and air
Authors: Handa Sabia , Dogra Mohit , Tigari Basavraj , Katoch Deeksha , Singh Ramandeep 
Published: July 2023

ABSTRACT

Purpose:
To describe a technique of displacement of submacular hemorrhage (SMH) using subretinal injection of balanced salt solution and filtered air.

Methods:
Patients presenting within two weeks of massive SMH (>4 disc diameter) were prospectively included. All patients underwent 25 gauge pars plana vitrectomy (PPV), posterior vitreous detachment, injection of subretinal balanced salt solution and filtered air followed by partial fluid air exchange, 20% sulfur hexafluoride (SF6) tamponade and heads up positioning post-operatively. Degree of displacement of SMH was assessed at 1 month and change in best corrected visual acuity (BCVA) was assessed at 3 months.

Results:
10 patients with massive SMH who underwent the aforementioned procedure were included. Complete displacement of bleed from the macula was achieved in 9 (90%) out of 10 eyes at one month. There was significant improvement in BCVA from baseline both at 1 month (p=0.015) and 3 months (p=0.043).

Conclusion:
PPV with injection of subretinal balanced salt solution and filtered air was well tolerated and efficacious in displacing large and thick SMH in patients operated within two weeks of onset of symptoms.
Efficacy of vitrectomy combined with intravitreal antibiotics for severe post-traumatic endophthalmitis
Authors: Yu Jiaxuan , Sun Xiaolei , Shan Tianhui , Zhang Dawei , Liu Chunli , Yuan Gongqiang , Zhang Jingjing 
Published: July 2023

Abstract

PURPOSE:
To explore clinical efficacy of vitrectomy combined with intravitreal antibiotics in treating severe endophthalmitis following open-globe trauma in patients.

Methods:
The records of all patients received vitrectomy combined with intravitreal for the severe post-traumatic endophthalmitis with light perception or worse between 2010 and 2022 were rertospectively reviewed. Patients received vitrectomy combined with intravitreal antibiotics, repeated intravitreal antibiotics with/without vitreous aspiration, and retinal repair after the infection was controlled. Efficacy of severe post-traumatic endophthalmitis were analyzed.

Results:
121 patients (121 eyes) were included in this study. The mean BCVA improved from 4.03±0.18 logMAR to 1.75 ± 1.41 logMAR(P < 0.001) at the end of the follow-up period, which increased in 106 eyes (87.60%). Infection was successfully controlled in all eyes, 88 eyes within 2 operations. Pathogens including Streptococci(OR=6.68,P＜0.001), fungi(OR=15.23,P＜0.001) and mixed infection(OR=6.67,P＜0.05) were related to the number of operations. Finally, 60(49.59%) eyes received silicone oil filling and 25 received gas tamponade, the remaining 36 no tamponade, complete vitrectomy were performed in all eyes with intraocular tamponade. All eyes for gas tamponade and no tamponade had been remained stable without RD and PVR after 6-month follow-up. The rate of recurrent RD after silicone oil tamponade was 4.96%(6 eyes), including 1.65%(2 eyes) of PVR, these eyes underwent reoperation of RD repair.

Conclusion:
Vitrectomy combined with intravitreal antibiotics may be an effective treatment option for severe post-traumatic endophthalmitis.
Use of a Backflush Needle with a Silicone Tip Cannula to Embed Lamellar Hole-associated Epiretinal Proliferation
Authors: Fukushima Masaki , Hayashi Atsushi , Kusaka Shunji , Kamei Motohiro , Tsuboi Kotaro 
Published: July 2023

Abstract

Purpose:
For the treatment of lamellar macular hole (LMH), the recent development of a lamellar hole-associated epiretinal proliferation (LHEP) embedding technique is likely to improve functional and anatomical results. However, the peeling of LHEP is often technically challenging. We have developed a new technique using a backflush needle with a silicone tip cannula that seems safer and more effective for use in LHEP embedding.

Methods:
A 25-gauge vitrectomy system with an enhancing visual acuity (EVA) system (D.O.R.C., Zuidland, Netherlands) was used in all cases. After core vitrectomy, triamcinolone acetonide (Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) was used to visualize the membrane. A 25-gauge backflush needle with a silicone tip cannula was used to remove the thin preretinal membrane centripetally, leaving an LHEP on the edge of the hole. Brilliant blue G (ILM Blue®; D.O.R.C.) was then used to stain the ILM.

Results:
This technique was used in 6 eyes with LMH. In all cases, peeling and embedding of the LHEP was effectively performed without damaging the ILM or causing retinal hemorrhage. No other intra- or postoperative complications were experienced.

Conclusion:
Using a silicone-tipped backflush needle with passive aspiration was a simple and effective technique for peeling and embedding of LHEPs in this small series.
Psychological treatments for the management of pain after musculoskeletal injury: a systematic review and meta-analysis
Authors: Aaron Rachel V. , Rassu Fenan S. , Wegener Stephen T. , Holley Amy L. , Castillo Renan C. , Osgood Greg M. , Fisher Emma 
Published: July 2023

Abstract
Musculoskeletal injury is a leading cause of pain and disability worldwide; 35% to 75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment, and psychological distress but are not widely used after injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain after musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics and primary (eg, pain intensity, functional impairment, depression, anxiety, and PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. Twenty-four randomized controlled trials (N = 1966) were included. Immediately posttreatment, people who received psychological treatments (versus any control) reported lower pain intensity (standardized mean differences [SMD] = −0.25, 95% confidence interval [−0.49, −0.02]), functional impairment (SMD = −0.32 [−0.55, −0.09]), and symptoms of depression (SMD = −0.46 [−0.64, −0.29]), anxiety (SMD = −0.34 [−0.65, −0.04]), and PTSD (SMD = −0.43 [−0.70, −0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Owing to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment after musculoskeletal injury; they may result in improved depression immediately posttreatment and at follow-up. More research is needed to identify treatments that result in enduring effects.
Comparison of a 2.7-mm and 3.5-mm locking compression plate for ulnar fractures: a biomechanical evaluation
Authors: Wahbeh Jenna M. , Kelley Benjamin V. , Shokoohi Cyrus , Park Sang-Hyun , Devana Sai K. , Ebramzadeh Edward , Sangiorgio Sophia N. , Jeffcoat Devon M. 
Published: July 2023

Abstract

Objectives:
Implant prominence after ulnar fracture fixation may be mitigated by the use of lower profile plates. The biomechanical strength and stability of 2.7-mm and 3.5-mm locking compression plates for fixation were compared.

Methods:
Two fracture conditions, transverse (N = 10) and oblique (N = 10), were evaluated in an in vitro study. Half of the specimens for each condition were fixed with 2.7-mm plates and the other half with 3.5-mm plates, all fixed with conventional dynamic compression mechanisms. Specimens were loaded under ±2 Nm of cyclic axial torsion, then under 10 Nm of cyclic cantilever bending, and bending to failure. Interfragmentary motion and strain were analyzed to determine construct stability as a function of fracture pattern and plate size.

Results:
Interfragmentary motion was significantly larger in all constructs fixed with 2.7-mm plates, compared with 3.5-mm plates (P < 0.01). The 2.7-mm constructs with transverse fractures had the greatest motion, ranging between 5° and 10° under axial rotation and 5.0–6.0 mm under bending. Motions were the lowest for 3.5-mm constructs with oblique fractures, ranging between 3.2 and 4.2 mm under bending and 2°–3.5° for axial rotation. For oblique fractures, the bending moment at ultimate failure was 31.4 ± 3.6 Nm for the 2.7-mm constructs and 10.0 ± 1.9 Nm for 3.5-mm constructs (P < 0.01). Similarly, for transverse fractures, the bending moment was 17.9 ± 4.0 Nm for the 2.7-mm constructs and 9.7 ± 1.3 Nm for the 3.5-mm constructs (P < 0.01).

Conclusions:
Although 3.5-mm plates were more effective at reducing fracture motion, they were consistently associated with refracture at the distal-most screw hole under load to failure. By contrast, 2.7-mm plates plastically deformed despite excessive loads, potentially avoiding a subsequent fracture.

Level of Evidence:
Level V.
Lung Nodule Detection With Modern Low-Field MRI (0.55 T) in Comparison to CT
Authors: Hinsen Maximilian , Nagel Armin M. , May Matthias S. , Wiesmueller Marco , Uder Michael , Heiss Rafael 
Published: July 2023

Objectives
The aim of this study was to evaluate the accuracy of modern low-field magnetic resonance imaging (MRI) for lung nodule detection and to correlate nodule size measurement with computed tomography (CT) as reference.

Materials and Methods
Between November 2020 and July 2021, a prospective clinical trial using low-field MRI at 0.55 T was performed in patients with known pulmonary nodules from a single academic medical center. Every patient underwent MRI and CT imaging on the same day. The primary aim was to evaluate the detection accuracy of pulmonary nodules using MRI with transversal periodically rotated overlapping parallel lines with enhanced reconstruction in combination with coronal half-Fourier acquired single-shot turbo spin-echo MRI sequences. The secondary outcome was the correlation of the mean lung nodule diameter with CT as reference according to the Lung Imaging Reporting and Data System. Nonparametric Mann-Whitney U test, Spearman rank correlation coefficient, and Bland-Altman analysis were applied to analyze the results.

Results
A total of 46 participants (mean age ± SD, 66 ± 11 years; 26 women) were included. In a blinded analysis of 964 lung nodules, the detection accuracy was 100% for those ≥6 mm (126/126), 80% (159/200) for those ≥4–<6 mm, and 23% (147/638) for those <4 mm in MRI compared with reference CT. Spearman correlation coefficient of MRI and CT size measurement was r = 0.87 (P < 0.001), and the mean difference was 0.16 ± 0.9 mm.

Conclusions
Modern low-field MRI shows excellent accuracy in lesion detection for lung nodules ≥6 mm and a very strong correlation with CT imaging for size measurement, but could not compete with CT in the detection of small nodules.
Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision
Authors: Sanchez Daisy , Bloomquist Erica , Wright Heather , Barnavon Yoav 
Published: July 2023

Abstract
Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins—5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using “sickle” flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.
New Approach for Superthin Anterolateral Thigh Flap Elevation
Authors: Bali Zülfükar Ulaş , Aksoy Alper , Tuluy Yavuz , Parspanci Aziz , Keçeci Yavuz , Yoleri Levent 
Published: July 2023

Background
Anterolateral thigh (ALT) flaps are widely used for soft tissue reconstructions. They have several advantages, most notably a long pedicle, an appropriate pedicle caliber, low donor site morbidity, and the possibility of 2 teams working simultaneously. However, conventional, thick ALT flaps used for reconstructions of head and neck and lower extremity defects may cause postoperative range of motion limitations and cosmetic problems. The aim of this study was to develop and propose strategies to facilitate the harvest of superthin ALT flaps and minimize technical difficulties. This article provides step-by-step instructions for simple, quick, and reliable dissections of superthin ALT flaps.

Methods
This study retrospectively analyzed data from 60 free superthin ALT flaps used for soft tissue reconstructions in 56 patients between January 2018 and February 2019. Superthin flaps were elevated just above the superficial Scarpa's fascia using a vertical approach.

Results
Thirty-eight of the patients were operated on for lower extremity wounds, 16 were for head and neck defects, and 6 were for upper extremity wounds. The mean follow-up period was 7 months. The median hospital stay was 10 days. Total flap loss was observed in 4 cases (6.6%), and partial flap loss was observed in another 4 cases (6.6%).

Conclusions
The superthin elevated ALT flap is a reliable and effective option for the reconstruction of soft tissue defects. In our vertical approach, the wide field of view of the flap perforator provides easy dissection, making it easier to elevate the superthin ALT flap.
Real Face Analysis of Masculinity-Femininity, Facial Ratios, and Attractiveness
Authors: Villavisanis Dillan F. , Blum Jessica D. , Liou Latham , Cho Daniel Y. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A. 
Published: July 2023

Background
Previous studies have evaluated the influence of facial features in determining male and female sex using prototypical renderings or artificially altered faces in relatively small sample sizes. Using a large set of human photographs and raters, this study hypothesized that certain anatomic facial ratios are associated with perceptions of masculinity/femininity, can interact to predict sex, and are associated with ratings of attractiveness differently in males and females.

Methods
Ratings of masculinity-femininity and binary self-identification (male or female) were compared with facial anatomic ratios from 827 frontal facial photographs. Ratios were used to characterize facial feature relativity, where higher ratio scores indicated relatively more facial feature representation.

Results
Femininity was associated with prominent middle third ratio, nose length, lip vermillion height, eye height, and eye width ratios; masculinity was associated with prominence of the upper and lower facial thirds, nose width, chin height, and philtrum height ratios (all P < 0.01). Subgroup analysis demonstrated many of these relationships persisted when evaluating masculinity in females and femininity in males. Misgendering in males was associated with greater middle third ratio and upper lip ratio, whereas misgendering in females was associated with increased nose width ratio.

Conclusions
This study demonstrates associations of femininity with increased horizontal middle third representation, and masculinity was associated with increased upper and lower horizontal representation. These facial ratios interact to predict male and female sex, which could have implications for optimizing facial feminization/masculinization outcomes and building algorithms for artificial intelligence analysis of faces.
How Does Surgeons’ Autonomic Physiology Vary Intraoperatively? A Real-time Study of Cardiac Reactivity
Authors: del Rosario Kareena , West Tessa V. , Mendes Wendy Berry , Basir Kunduzi  , Mamode Nizam , Gogalniceanu Petrut 
Published: July 2023

Objective:
Physiologic responses of surgery team members under varying levels of intraoperative risk were measured.

Background:
Measurement of intraoperative physiological responses provides insight into how operation complexity, phase of surgery, and surgeon seniority impact stress.

Methods:
Autonomic nervous system responses (interbeat intervals, IBIs) were measured continuously during operations. Role (attending surgeon, surgical resident, operating room nurse), risk of operation (high, low), and primary operator (attending surgeon, resident) predicted IBI reactivity. Physiologic synchrony captured the degree of correspondence between individuals’ physiologic responses within timepoint.

Results:
10,005 observations of IBI reactivity were recorded in 26 participants during 16 high-risk (renal transplant and laparoscopic donor nephrectomy) and low-risk (arteriovenous fistula formation) operations. Attending surgeons showed greater IBI reactivity (faster heart rate) than residents and nurses during high-risk operations and while actively operating (ps < .001). Residents showed lower reactivity during high-risk (relative to low-risk) operations (P < .001) and similar reactivity regardless of whether they or the surgeon was operating (P = .10). Nurses responded similarly during low and during high-risk operations (P = .102) but were more reactive when the resident was operating compared to the surgeon (P < .001). In high-risk operations, attending surgeons had negative physiologic covariation with residents and nurses (P <.001). In low-risk operations, only attending surgeons and nurses were synchronized (P < .001).

Conclusion:
Attending surgeons’ physiologic responses were well-calibrated to operative demands, and residents’ and nurses’ responses were not, suggesting that risk sensitivity is an adaptive response to stress that surgeons acquire.
Treatment for Urinary Incontinence in Women Older Than 65 Years
Authors: Lane Giulia I. , Erekson Elisabeth , Austin Andrea , Carmichael Donald , Minassian Vatche A. , Grodstein Francine , Bynum Julie PW 
Published: July 2023

Importance
Urinary incontinence (UI) is common among women older than 65 years and negatively affects quality of life. However, the prevalence of UI treatment and determinants of treatment are largely unknown.

Objectives
The aim of this study was to identify rates of UI treatment and factors associated with treatment in older women with self-reported UI.

Study Design
This is a retrospective cohort analysis of a data set linking UI symptoms from the Nurses’ Health Study to Medicare claims. We evaluated use of pharmacotherapy, noninvasive, and procedural treatments for UI within 1 year before symptom survey. For pharmacotherapy, we used multivariable logistic regression to estimate odds ratios (ORs) of UI treatment.

Results
Of the 67,587 Nurses’ Health Study respondents, 15,088 had linkage to Medicare, subscribed to part D, and answered UI questions. Of these, 8,332 (55.2%) women reported UI, and 10.9% with UI had a Medicare claim for treatment; pharmacotherapy represented 94.6% of all treatments.
On regression analysis, women with more severe and longer-term UI had higher odds of treatment (severe vs slight UI: OR, 3.1; 95% confidence interval [CI], 2.2–4.3) (longer vs new UI: OR, 1.9; 95% CI, 1.5–2.3). Women with mixed (OR, 2.5; 95% CI, 1.9–3.2) or urgency UI (OR, 3.0; 95% CI, 2.2–3.9) had greater odds of treatment compared with women with stress UI.

Conclusions
We estimate that only approximately 1 in 9 older women with self-reported UI underwent treatment within the year before reporting symptoms, of which pharmacotherapy was the most common UI intervention, and women with more severe and longer duration of symptoms were most often treated.