bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reported Pain in Cisgender Female and Transmasculine Patients Seeking Benign Breast Surgery
Authors: Ganor Oren , Almazan Anthony N. , Boskey Elizabeth R. 
Published: August 2023

Background:
Benign breast surgery aims to treat the physical and psychological discomfort that may be associated with excess breast tissue. In this investigation, we present the first systematic examination and comparison of the determinants of pain and related symptomology in cisgender women and transmasculine individuals presenting for benign breast surgery.

Methods:
To complete this study, we abstracted the intake forms of 128 transmasculine and 62 cisgender female patients who presented for benign breast surgery between August 2016 and July 2020.

Results:
Increasing chest size was associated with significantly increased odds of reporting rash (OR 1.10 95% CI [1.01–1.10], P < 0.03), difficulty playing sports (OR 1.19 95% CI [1.09–1.29], P < 0.001), and difficulty finding clothes that fit (OR 1.21, 95% CI [1.11–1.33], P < 0.001). For individuals who bound their chests, size was also associated with difficulty exercising in a binder (OR 1.14 [1.01–1.29], P < 0.03). Looking separately at the two populations, the only factors that remained associated with pain in multivariate models were BMI (β = 0.10 [0.01–0.18], P < 0.03) for cisgender women and history of binding (β = 1.95 [0.37–3.52], P < 0.02) for transmasculine people.

Conclusions:
Pain does not seem to be associated with chest size in either cisgender female or transmasculine patients seeking benign breast surgery. The association between chest binding and pain in transmasculine people supports the provision of gender-affirming chest surgery to eliminate the need to bind and reduce both physical and psychological distress.
Atypical Hyperplasia Found Incidentally during Routine Breast Reduction Mammoplasty: Incidence and Management
Authors: Noorbakhsh Seth , Koenig Zachary A. , Hewitt Noah , Climov Mihail , Hazard-Jenkins Hannah , Flanagan Melina , Woodberry Kerri 
Published: August 2023

Background:
Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) of the breast are premalignant lesions. Although the literature on ADH and ALH as a whole is well-developed, research on ADH and ALH incidentally discovered during breast reduction is less robust.

Methods:
In this study, 355 patients undergoing bilateral reduction mammoplasty at West Virginia University were retrospectively reviewed. A variety of demographic and clinicopathologic variables were collected for each patient, and the incidence of atypical hyperplasia was calculated. Four patients (1.13%) were found to have atypical hyperplasia, three ALH, and one ADH, which is within the range reported in the literature. For patients incidentally found to have atypical hyperplasia, an in-depth analysis of postoperative management was performed.

Results:
Of the four patients with atypical hyperplasia, three were referred to a cancer center, and one patient followed only with plastic surgery. The three patients who were referred to a cancer center saw a breast surgeon, whereas the patient followed only by plastic surgery did not. None of the four patients received anti-estrogen therapy, but each patient who followed with a cancer center was offered treatment and declined.

Conclusions:
As a relatively uncommon finding with complex management guidelines, atypical hyperplasia discovered on breast reduction should be referred to a cancer center for long-term follow-up and management when possible. Further research is needed to assess if the management of atypical hyperplasia discovered incidentally after routine reduction should mimic treatment of atypical hyperplasia found after biopsy for suspicion of malignancy.
Routes to Residency: A National Survey Demonstrating the Pathways to Become a Plastic Surgeon
Authors: Stoehr Jenna R. , Applebaum Sarah A. , Ko Jason H. , Gosain Arun K. 
Published: August 2023

Background:
Plastic and reconstructive surgery (PRS) residency training can be completed through multiple pathways. Current residents’ experiences regarding these different routes have not been previously described. The objective of the present study was to describe the educational pathways taken by current PRS residents in the United States. We hypothesized that there would be a small cohort of current PRS residents who were initially unsuccessful in matching into an integrated residency.

Methods:
An online survey was sent to PRS residents across all training years from October 2020 to January 2021. The survey collected information about residents’ match history, experience after not matching, and narrative comments on their route to residency. Public match data from the past 20 years (2001–2021) were also summarized with descriptive statistics.

Results:
One hundred seventy-four residents responded (response rate 15%; 174/1158). Of these, 133 applied to integrated programs as senior medical students, and 15 (11%) did not match after applying as a senior medical student. Unmatched applicants took multiple different routes to PRS, including participating in the Supplemental Offer and Acceptance Program, reapplying, transferring after some general surgery training, and completing an independent PRS residency. Three-fourths (76%) of independent program residents did not originally apply to the integrated match.

Conclusions:
An initial unsuccessful match result does not portend that one will not be able to train for a career in PRS. Our findings illustrate the potential routes to successful completion of PRS residency training, both for unmatched applicants and residents who develop later interest in PRS.
A Comparative Study of Mucosal Wound Healing after Excision with a Scalpel, Diode Laser, or CO2 Laser
Authors: Bilder Amir , Rachmiel Adi , Ginini Jiriys George , Capucha Tal , Ohayon Chaim , Weitman Efi , Emodi Omri 
Published: August 2023

Background:
We aimed to compare the clinical and histological secondary healing effectiveness of various types of high-level laser versus scalpel excision in mucosa frenectomy.

Methods:
Forty-five Sprague Dawley rats were used in this study. These rats were divided into two laser intervention groups (CO2, n = 15; diode, n = 15) and one control group with scalpel excision (n = 15). The effectiveness of therapy has been assessed based on the comparison of intraoperative, postoperative, and histological parameters on days 7, 21, and 35, and postoperative weight changes as pain indicator.

Results:
Both laser groups demonstrated significantly (P < 0.05) less bleeding than did the control group during the intraoperative stage, whereas the CO2 laser showed more precise cutting compared with the diode laser (P < 0.05). The highest healing score was reported in the CO2 and scalpel groups on the first week of healing than in the diode group (P < 0.05). However, no significant difference was observed between the groups on days 21 and 35. Weight loss was significantly (P < 0.05) demonstrated in the diode group compared to the scalpel and CO2 groups till day 7. Both laser groups demonstrated delayed healing process compared with the scalpel. Nevertheless, the CO2 group followed the scalpel trends after day 7.

Conclusion:
Scalpel and CO2 laser yielded a superior clinical outcome compared with the diode excision of oral mucosa, whereby the CO2 has been proposed as the most effective laser type at the end of the first postoperative month.
Vascularized Fibular Grafts for Failed Liquid Nitrogen–treated Autografts in the Humerus: Report of Two Cases
Authors: Fujisawa Kou , Miyamoto Shimpei , Kobayashi Hiroshi , Okazaki Mutsumi 
Published: August 2023

Summary:
With advances in chemotherapy and surgical techniques, limb salvage and biological reconstruction, including autologous bone grafting, have become the preferred treatment options for primary malignant bone tumors of the extremities. Although autografts, which involve recycling of tumor-bearing bones, have the advantages of easy accessibility and anatomical matching, fracture is a frequent major complication. However, to our knowledge, salvage of refractory autograft failure has not yet been reported. This report describes free vascularized fibular graft implantation for salvaging failed previous reconstructions. We describe two patients (a 4-year-old girl and a 30-year-old man, respectively) with primary malignant bone tumors. Liquid nitrogen-treated autografts had been used to reconstruct the humerus in both cases. The patients sustained autograft fractures that could not be treated conservatively or by internal fixation. Free vascularized fibular grafts were transferred as double-barrel inlay grafts (length 7.2 and 8.2 cm) and a single-strut onlay graft (length 16 cm). The brachial arteries, brachial veins, and cephalic veins were used as recipient vessels. Bone union between the fibular grafts and humerus was achieved after 29 and 15 months of follow-up, respectively. In conclusion, free vascularized fibular grafts can be used to salvage refractory autograft fractures.
Auricular Protection after Ear Reconstruction Using an Antipressure Alarm
Authors: Liu Di , Su Xueshang , Hu Jintian 
Published: August 2023

Summary:
Auricular protection is an important part of postoperative care for ear reconstruction and has an important impact on the expected outcome of the surgery. Therefore, we developed an antipressure alarm to protect the reconstructed ear in the supine position. The device consists of three components: an alarm, a pressure detector, and an adjustable elastic band. When the patient is in a supine position, the pressure sensor is located above the back of the reconstructed ear. When the head is rotated to the affected side, the pressure detector senses the pressure signal in advance compared with the reconstructed ear, and then triggers an alarm to remind the patient to adjust his position in time to avoid pressing the reconstructed ear. The device has been applied to more than 100 patients and has achieved satisfactory clinical results.
Medial Pedicle Wise-pattern Breast Reduction for Gigantomastia: A Single-center Retrospective Review
Authors: Hinson Chandler , Bouillon Victoria , Brooks Ronald 
Published: August 2023

Background:
Gigantomastia causes severe back pain, postural imbalance, intertrigo, and psychosocial disablement. Multiple breast reduction techniques exist. Breast reduction with free nipple graft reconstruction is the preferred treatment. We found that the medial pedicle Wise-pattern (MPWP) technique is an equally safe and effective technique.

Methods:
Review of our institution’s electronic medical record between February 2020 and February 2023 identified women with gigantomastia who underwent bilateral reduction with more than 1500 g resected in at least one breast. Multinomial logistical regressions were used to identify associations between comorbidities, operative techniques, postoperative complications, and nipple areolar complex function.

Results:
Thirty-one patients underwent bilateral reduction mammaplasty. Total bilateral resection weight and average body mass index (BMI) were 3828 g and 40 kg per m2. Common comorbidities were hypertension (38%) and tobacco use (26%). MPWP was used predominantly (65%), followed by inferior pedicle (16%) and superior-medial pedicle (10%). Complications included loss of nipple areolar complex sensation (23%) and wound dehiscence (16%). Reduction technique was not associated with increased surgical complications (odds ratio = 0.75, P = 0.273). Age, excision amount, use of postsurgical drains, and BMI were not associated with increased complications (P = 0.29, P = 0.55, P = 0.74, P = 0.41). Rates of areolar sensation loss were higher in larger BMIs, but this was not statistically significant (P = 0.051).

Conclusions:
The MPWP reduction technique is an equally safe and effective treatment of gigantomastia when compared with reduction with free nipple graft reconstruction. There is the added benefit of preserved nipple sensation without increased postoperative complications.
Microsurgical Needle Retention Does Not Cause Pain or Neurovascular Injury in a Rat Model
Authors: Arora Jagmeet S. , Kim Joshua K. , Pakvasa Mikhail , Sayadi Lohrasb R. , Lem Melinda , Widgerow Alan D. , Leis Amber R. 
Published: August 2023

Background:
Approximately 20% of retained foreign bodies are surgical needles. Retained macro-needles may become symptomatic, but the effect of microsurgical needles is uncertain. We present the first animal model to simulate microsurgical needle retention. Given a lack of reported adverse outcomes associated with macro-needles and a smaller cutting area of microsurgical needles, we hypothesized that microsurgical needles in rats would not cause changes in health or neurovascular compromise.

Methods:
Male Sprague-Dawley rats (x̄ weight: 288.9 g) were implanted with a single, 9.0 needle (n = 8) or 8.0 needle (n = 8) orthogonal to the right femoral vessels and sutured in place. A control group (n = 8) underwent sham surgery. Weekly, a cumulative health score evaluating body weight, body condition score, physical appearance, and behavior for each rat was determined. Infrared thermography (°C, FLIR one) of each hindlimb and the difference was obtained on postoperative days 15, 30, 60, and 90. On day 90, animals were euthanatized, hindlimbs were imaged via fluoroscopy, and needles were explanted.

Results:
The mean, cumulative health score for all cohorts at each weekly timepoint was 0. The mean temperature difference was not significantly different on postoperative days 15 (P = 0.54), 30 (P = 0.97), 60 (P = 0.29), or 90 (P = 0.09). In seven of eight rats, 8.0 needles were recovered and visualized on fluoroscopy. In six of eight rats, 9.0 needles were recovered, but 0/8 needles were visualized on fluoroscopy.

Conclusions:
Microsurgical needle retention near neurovascular structures may be benign, and imaging for needles smaller than 8.0 may be futile. Further studies should explore microsurgical needle retention potentially through larger animal models.
The outcomes and prognostic factors of patients with hepatocellular carcinoma and Child-Turcotte-Pugh class B
Authors: Fu Chia-Chu , Chen Yu-Jen , Su Chien-Wei , Wei Cheng-Yi , Chu Chi-Jen , Lee Pei-Chang , Huo Teh-Ia , Huang Yi-Hsiang , Huang Hui-Chun , Wu Jaw-Ching , Hou Ming-Chih 
Published: August 2023

Background:
The Child-Turcotte-Pugh (CTP) score is widely used for assessing the liver’s functional reserve in patients with advanced chronic liver disease (ACLD) and hepatocellular carcinoma (HCC). This study aims to explore the outcomes of patients with HCC and CTP class B and to investigate the prognostic accuracy of prediction models for ACLD in these patients.

Methods:
We retrospectively enrolled 1143 patients with HCC and CTP class B between 2007 and 2022. We divided the patients into three subgroups based on their CTP scores: CTP-B7, CTP-B8, and CTP-B9. We compared the corrected Akaike information criterion among each mortality prediction model, including the CTP score, albumin-bilirubin (ALBI) score, modified ALBI score, the model for end-stage liver disease (MELD), and MELD 3.0.

Results:
Among the enrolled patients, 576 (50.3%) were in the CTP-B7 group, 363 (31.8%) were in the CTP-B8 group, and 204 (17.9%) were in the CTP-B9 group. After a median follow-up of 4.6 months (interquartile range IQR 1.8–17.2 months), 963 patients died, and the 5-year overall survival (OS) rate was 11.4%. The 5-year OS rates were 11.6%, 13.6%, and 8.3% in the CTP-B7, CTP-B8, and CTP-B9 groups, respectively. Patients in the CTP-B7 group and CTP-B8 group had comparable OS (p = 0.089), both of which were better than those in the CTP-B9 group (p < 0.001). Furthermore, the MELD 3.0 score had the lowest corrected akaike information criteria value and provided a more accurate mortality prediction than the MELD score, ALBI grade, modified ALBI grade, and CTP score.

Conclusion:
Patients in the CTP-B7 and CTP-B8 groups had comparable OS, both of which were better than those in the CTP-B9 group. Moreover, MELD 3.0 provided the most accurate mortality prediction in patients with HCC and CTP class B.
Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities in Division I Collegiate Athletes From a Variety of Sports
Authors: Cushman Daniel M. , Carefoot Andrea , Corcoran Blake , Vu Leyen , Fredericson Michael , Fausett Cameron , Teramoto Masaru , Eby Sarah F. 
Published: August 2023

Objective:
This study aimed to determine the prevalence of ultrasound abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among a large cohort of collegiate student-athletes.

Design:
Observational cross-sectional study.

Setting:
Three Division I institutions.

Participants:
243 student-athletes participated in this study. Exclusion criteria included those younger than 18 years or who underwent prior surgery/amputation of structures, including anterior cruciate ligament (ACL) surgeries with patellar tendon grafts.

Interventions:
Ultrasound examination of the Achilles tendon, patellar tendon, and plantar fascia of each leg was performed. An experienced sonographer reviewed each tendon video in a blinded manner, with a separate experienced sonographer separately reviewing to establish inter-rater reliability.

Main Outcome Measures:
The primary outcome measured was the presence of any sonographic abnormality including hypoechogenicity, thickening, or neovascularity.

Results:
Ultrasound abnormalities were identified in 10.1%, 37.2%, and 3.9% of all Achilles tendons, patellar tendons, and plantar fasciae, respectively. Abnormalities were significantly associated with the presence of concurrent pain for all structures (P < 0.01). Specifically, athletes with sonographic abnormalities were approximately 4 times [relative risk (RR) = 4.25; 95% confidence interval (CI), 2.05-8.84], 6 times (RR = 5.69; 95% CI, 2.31-14.00), and 5 times (RR = 5.17; 95% CI, 1.76-15.25) more likely to self-report pain in the Achilles tendon, patellar tendon, and plantar fascia, respectively.

Conclusions:
This multi-institutional study completed at 3 Division I institutions is the largest study of its kind to identify the prevalence of sonographic abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among collegiate student-athletes of various sports.
Effectiveness of an Occupational Well-being Intervention Among Nurse Educators
Authors: Rinne Jenni , Leino-Kilpi Helena , Saaranen Terhi , Tarvainen Mika P. , Pasanen Miko , Koskinen Sanna , Salminen Leena 
Published: August 2023

Background:
Occupational well-being supports the retention of the nurse educator workforce and their ability to manage workload. There is a research gap regarding interventions promoting occupational well-being.

Purpose:
To evaluate the effectiveness of an 8-workweek digital occupational well-being intervention using self-conducted exercises among nurse educators in secondary vocational nursing schools in Finland.

Methods:
A quasi-experimental study design was applied using an intervention group (n = 37) and a control group (n = 40). Data were collected at baseline, post, and 1-month follow-up using a questionnaire and a heart rate sensor to assess the resource-workload-balance and its associating and promoting factors.

Results:
This study found no statistical effects on the resource-workload-balance. Positive effects were found on associating factors (general well-being) and promoting factors (recovery experiences and self-regulation).

Conclusions:
Self-Help INtervention for Educators (SHINE) has the potential to promote recovery experiences during working hours; however, the intervention needs more investigation.
The Impact of Noise on Nursing Preceptors’ Assessment of Student Performance
Authors: Najm Danielle , Whittall Dawn , Pillay Kamini , Morphet Julia 
Published: August 2023

Background:
Noise is a relatively new concept highlighting the variability of cognitive inputs people grapple with when making a judgment. In this case, preceptors make a judgment of students’ clinical performance during clinical practicum. There is scant literature examining the impact of noise on nursing student assessment.

Purpose:
This article explores the noise that influences nursing preceptors’ assessment of students in clinical practice.

Method:
A qualitative descriptive design was used, and interviews were conducted with preceptors from the clinical setting.

Results:
Three themes were identified, describing the tensions faced by preceptors when assessing students and the noise that impacted those assessments.

Conclusion:
Both system noise and individual noise impacted the process and outcome of nursing student assessment during clinical practicum.
Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study
Authors: Campos-Miño Santiago , Figueiredo-Delgado Artur , Zárate Patricia , Zamberlan Patricia , Muñoz-Benavides Eliana , Coss-Bu Jorge A. ,   on behalf of the Nutrition Committee, Latin American Society of Pediatric Intensive Care (SLACIP)
Published: August 2023

OBJECTIVES:
To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations.

DESIGN:
The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding.

SETTING:
Four-one PICUs in 13 LA countries.

PATIENTS:
Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than –2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively.

CONCLUSIONS:
The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.