bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis
Authors: Haddock Nicholas T. , Wen Y. Edward , Steppe Cyrus , Shang Zhiguo , Teotia Sumeet S. 
Published: February 2023

Background:
Skin-to-skin operative time (OT) as a risk factor for adverse postoperative outcomes in microvascular breast reconstruction has not been thoroughly investigated. This study evaluates OT’s impact on length of stay (LOS), overall morbidity, individual complications, and unplanned reoperation (UR) in deep inferior epigastric artery perforator (DIEP) flaps, with a primary objective of identifying a clinically relevant time of decreased odds.

Methods:
Patients who underwent bilateral DIEP flaps from 2010 to 2021 by two senior surgeons (N.T.H. and S.S.T.) with standardized surgical and postoperative protocols were retrospectively reviewed. One thousand flaps (500 patients) were analyzed with extensive multivariate regression equations to adjust for potential confounders, including intraoperative complexity. The odds of postoperative complication, extended LOS (eLOS, defined as ≥5 days) were compared across OT per hour and OT intervals.

Results:
After risk-adjustment, each hour of OT increased morbidity by 19%, UR by 8.7%, and LOS by 6.5 hours (all P < 0.001). For eLOS, procedures ≤5 hours had 9.5 times lower odds than ≥5 hours (P = 0.050), 5–7 hours had comparable odds (P = 0.540), and 7–9 hours had 5.5 times lower odds than procedures ≥ 9 hours (P < 0.001). Last, a multivariate linear regression showed that LOS can be calculated from OT: LOS (days) =1.527 + 0.272 × OT (hours) (R2 = 0.308; P < 0.001).

Conclusions:
OT (per hour) independently predicts morbidity, UR and LOS in DIEP flaps. Furthermore, 5 and 9 hours are critical cutoffs for eLOS. These findings emphasize the benefits of decreasing OT through efficiency models, such as process analysis, team-based intraoperative protocols, and co-surgery model.
A Pilot Investigation into Targeted Muscle Reinnervation for Complex Regional Pain Syndrome, Type II
Authors: Shin Stephanie E. , Haffner Zoë K. , Chang Brian L. , Kleiber Grant M. 
Published: February 2023

Background:
Complex regional pain syndrome (CRPS) is a debilitating condition, characterized by severe pain with vascular, motor, or trophic changes. Varied presentations make this a diagnostic and therapeutic challenge. There is a lack of high-quality evidence demonstrating efficacy for most existing therapies, particularly with surgical intervention for type II CRPS (CRPS-II). Targeted muscle reinnervation (TMR) is a surgical technique to transfer the terminal end of a divided nerve to a recipient motor nerve, shown to limit phantom limb pain, residual limb pain, and postamputation neuroma pain.

Methods:
Herein, we describe a series of 13 patients undergoing TMR for CRPS-II by a single surgeon from 2018 to 2021 in the upper (38%) and lower extremities (62%). All patients had a diagnosis of CRPS-II with either traumatic or postsurgical etiology, each seeking TMR with or without concomitant treatment to control their pain after previous therapies had failed. Three patients had previous lower extremity amputation, whereas three others received lower extremity amputation at the time of TMR, each indicated for control of CRPS pain.

Results:
Of the patients receiving TMR within 1 year of CRPS diagnosis, all three reported improved function, and two patients were able to tolerate a prosthetic for ambulation after previous pain prevented prosthetic use. Of the entire cohort, all but one patient reported reduced pain interference or improved function.

Conclusions:
These outcomes suggest that TMR may provide some benefit to reducing pain severity patients with CRPS, even after a more chronic disease course. Further prospective trials are warranted.
Preclinical Study of Radiation on Fat Flap Regeneration under Tissue-engineering Chamber: Potential Consequences for Breast Reconstruction
Authors: Cleret Damien , Gradwohl Marion , Dekerle Lucie , Drucbert Anne-Sophie , Idziorek Thierry , Pasquier David , Blanchemain Nicolas , Payen Julien , Guerreschi Pierre , Marchetti Philippe 
Published: February 2023

Background:
Use of a tissue-engineering chamber (TEC) for growth of fat flap is a promising approach for breast reconstruction. Here, we evaluated in a preclinical model the effects of radiation on adipose tissue growth either before or after 3D-printed bioresorbable TEC implantation.

Methods:
Twenty-eight female Wistar rats were distributed into three groups: TEC implantation as nonirradiated controls (G1), TEC insertion followed by irradiation 3 weeks later (G2), and irradiation 6 weeks before TEC insertion (G3). G2 and G3 received 33.3 Gy in nine sessions of 3.7 Gy. Growth of the fat flap was monitored via magnetic resonance imaging. At 6 months after implantation, fat flaps and TECs were harvested for analysis.

Results:
Irradiation did not alter the physicochemical features of poly(lactic-co-glycolic acid)-based TECs. Compared with G1, fat flap growth was significantly reduced by 1.6 times in irradiated G2 and G3 conditions. In G2 and G3, fat flaps consisted of mature viable adipocytes sustained by CD31+ vascular cells. However, 37% (3 of 8) of the G2 irradiated adipose tissues presented a disorganized architecture invaded by connective tissues with inflammatory CD68 + cells, and the presence of fibrosis was observed.

Conclusions:
Overall, this preclinical study does not reveal any major obstacle to the use of TEC in a radiotherapy context. Although irradiation reduces the growth of fat flap under the TEC by reducing adipogenesis and inducing inconsistent fibrosis, it does not impact flap survival and vascularization. These elements must be taken into account if radiotherapy is proposed before or after TEC-based breast reconstruction.
Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
Authors: Liao Christopher D. , Deccico John-Brandon , Cuzzone Daniel , George Finny , Xipoleas George D. 
Published: February 2023

Background:
Negative-pressure wound therapy (NPWT) has improved split-thickness skin graft (STSG) survival rates, but prolonged application increases bacterial bioburden. Antimicrobial NPWT adjuncts have demonstrated efficacy, but strong evidence is lacking. We hypothesized that simultaneously replacing NPWT dressings within 48–72 hours and cleansing with Dakin's solution—a well-known antimicrobial agent—would increase STSG take.

Methods:
We performed a controlled retrospective case series on three groups of STSG patients treated between January 2014 and December 2020: bolster dressings, continuous NPWT (C-NPWT), and Dakin's NPWT (D-NPWT). Patients with documented measurements of STSG survival were included. The primary outcome was the percentage of STSG take calculated by survival area using surgical tape measures 2 weeks after surgery.

Results:
Fifty-nine patients were followed up for greater than or equal to 3 months. Average wound size for bolsters was smaller than that for D-NPWT (83 cm2 versus 204 cm2; P < 0.05). Average treatment time was 6.4 ± 2.4 days (bolsters), 6.5 ± 0.9 days (C-NPWT), and 2.8 ± 0.9 days (D-NPWT; P < 0.01). Average percentage of STSG take was 92% ± 0% (bolsters), 82% ± 0% (C-NPWT), and 99% ± 0% (D-NPWT; P < 0.01); there were significant differences between bolsters versus C-NPWT (P < 0.05) and C-NPWT versus D-NPWT (P < 0.05), but not between bolsters and D-NPWT.

Conclusions:
Interrupting NPWT with 0.125% Dakin’s solution cleansing is associated with increased STSG survival compared with standard NPWT protocols, but not bolster dressings. These findings warrant further investigation due to limitations of this retrospective case series.
Intraocular Fibrin Glue to Lower the Risk of Postoperative Vitreous Hemorrhage After Diabetic Pars Plana Vitrectomy
Authors: Mansour Hana A. , Mahmoudzadeh Raziyeh , Hsu Jason 
Published: February 2023

Purpose:
To investigate the use of intraocular fibrin glue to lower the risk of vitreous hemorrhage (VH) after pars plana vitrectomy (PPV) in eyes with diabetic VH or traction retinal detachment.

Methods:
A matched, case–control, single-surgeon, pilot study of patients undergoing PPV for diabetic VH or traction retinal detachment with versus without fibrin glue was performed.

Results:
Thirty-nine patients (13 glue and 26 control patients) were included. In the glue group, mean (SD) logarithm of the minimum angle of resolution visual acuity (Snellen) significantly improved from 1.53 (0.6) (20/678) to 0.99 (0.9) (20/195) at postoperative month 6 (P = 0.03). In the control group, mean logarithm of the minimum angle of resolution visual acuity also improved from 1.45 (0.8) (20/564) to 1.17 (0.9) (20/296) at postoperative Month 6 (P = 0.3). Persistent post-PPV VH was similar between the 2 groups (15.4% in both groups, P > 0.99). However, early recurrent VH (<3 months post-PPV) was seen in 34.6% in the control group and none in the glue group (P = 0.02). No intraocular inflammatory events were seen in the glue group.

Conclusion:
Intraocular fibrin glue may be a safe adjuvant in diabetic vitrectomy and may reduce the rate of early recurrent postoperative VH.
COVID-19 VACCINE–INDUCED ACUTE EXUDATIVE POLYMORPHOUS VITELLIFORM MACULOPATHY: CASE REPORTS
Authors: Baddar Dina , Fayed Alaa E. , Tawfik Caroline A. , Bassily Sherry , Gergess Maged M. , El-Agha Mohamed-Sameh H 
Published: February 2023

Background:
Acute exudative polymorphous vitelliform maculopathy is a presumed retinal pigment epithelium abnormality that has been reported in patients with neoplasms and under certain classes of drugs. The pathophysiology remains unclear, despite the typical clinical features.

Purpose:
To report two cases of acute exudative polymorphous vitelliform maculopathy occurring after vaccination with a COVID-19 vaccine.

Case Reports:
Two adult patients presented with visual disturbance after inoculation with a COVID-19 vaccine. The patients were otherwise healthy and have no family history of retinal dystrophies. Both cases exhibited the following features on multimodal imaging: multifocal hyporeflective lesions involving the macula, elongated photoreceptors, accumulated vitelliform material exhibiting autofluorescence, and lack of fluorescein dye leakage. Evidence of retinal pigment epithelium dysfunction was confirmed by electrooculography.

Conclusion:
Two cases of acute exudative polymorphous vitelliform maculopathy occurring after COVID-19 vaccination were reported. A relationship between the vaccine and the retinal pigment epithelial abnormality development that led to acute exudative polymorphous vitelliform maculopathy was postulate, possibly through autoantibodies against the severe acute respiratory syndrome coronavirus 2 virus structural surface glycoprotein antigens that cross react with the normal retinal pigment epithelial cells.
“An Unusual Case of Primary Vitreoretinal Lymphoma: A Transformed Lymphoma”
Authors: Ustaoglu Melih , Patel Rooshil , Wang Wei , Shah Sanket , Barr Charles 
Published: February 2023

Abstract

Purpose:
To report a case of primary vitreoretinal lymphoma (VRL) presenting as diffuse large b-cell lymphoma (DLBCL) 19 years after initial systemic follicular lymphoma.

Method:
A case report.

Results:
An 81-year-old male patient presented with a 1-month history of floaters and blurry vision in the left eye. He had a history of follicular non-Hodgkin lymphoma treated with systemic chemotherapy in 2002 and prostate cancer treated surgically in 2004. Ophthalmic examination revealed vitritis, retinal whitening, perivascular sheathing, and a vascularized cream-colored retinal mass in the superonasal periphery of the left eye. Diagnostic vitrectomy with retina and vitreous biopsies demonstrated DLBCL. Positron emission tomography/computed tomography confirmed the isolated lesion in the left eye without systemic involvement. Treatment with systemic and intraocular chemotherapy was planned.

Conclusion:
To the best of our knowledge, this is the first reported case of primary VRL of DLBCL transformed from follicular lymphoma. Intravitreal and systemic chemotherapy, including rituximab, should be consideered in the management of patients with transformed VRL.
OCCLUSIVE CYTOMEGALOVIRUS PANUVEITIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: Kim Hyun Jun , Brill Daniel , Giuliari Gian Paolo 
Published: February 2023

Purpose:
To report a case of unilateral cytomegalovirus (CMV) panuveitis with occlusive vasculitis after injection of intravitreal dexamethasone implant in a patient with type 2 diabetes mellitus.

Methods:
Observational case report.

Results:
A 60-year-old immunocompetent man with well-controlled type 2 diabetes mellitus was treated with intravitreal dexamethasone implant for recurrent uveitis that was responsive to steroids. Three months after implantation, the patient develops panuveitis with occlusive vasculitis. Anterior chamber tap confirms diagnosis of cytomegalovirus retinitis. Intravitreal foscarnet and oral valganciclovir led to quiescent disease.

Conclusions:
Patients treated with local immunosuppressants should be monitored carefully to assess treatment response and complications, even in the absence of frank immunodeficiency. Quantitative viral PCR can be an effective way to monitor treatment response to antiviral therapy.
Technique for the Management of Extensive Ocular Surface Lipodermoid Involving the Cornea of Children
Authors: Franco Elena , Gagrani Meghal , Lalgudi Vaitheeswaran G. , Shah Parth R. , Lenhart Phoebe , Bhola Rahul , Nischal Ken K. 
Published: February 2023

Purpose:
Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation.

Methods:
After verifying sparing of Descemet membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral simple limbal epithelial transplantation to promote rapid reepithelialization of the residual stromal bed. Temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing.

Results:
Three eyes of 3 children with grade III large ocular surface lipodermoids that encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared and eyelid closure was improved. At the last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in 1 case, while 2 eyes developed small pseudopterygium; best spectacle–corrected visual acuity improved from 20/200 to 20/70 in the first case, from fix and follow to 20/50 in the second case, and remained fix and follow in the last case, but this child had congenital hydrocephalus with severe developmental delay.

Conclusions:
This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.
Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon
Authors: Akai Ryota , Yunoki Tatsuya , Otsuka Mitsuya , Hayashi Atsushi 
Published: February 2023

Purpose:
To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma.

Methods:
Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis.

Results:
The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively (p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries (p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03–40.26; p = 0.04).

Conclusion:
Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.
Trending Proinflammatory Markers to Prognosticate Mechanical Ventilation in COVID-19
Authors: Kozak Paul T. , Koziol Sophia M. , Mariano Andrew T. , Abraham Raju Z. , Phillips Martin T. , Anderson Michael J. 
Published: February 2023

Abstract

Background
Proinflammatory markers and clinical assessment have been used to help identify patients who need closer monitoring and possible mechanical ventilation (MV) in patients diagnosed with COVID-19. Retrospective analysis of proinflammatory markers before and after MV may aid in identifying proinflammatory markers that are most useful for predicting MV.

Methods
The study is a retrospective observational study at a single hospital in a community setting from May 2020 to June 2021. The population includes all adult patients hospitalized with COVID-19 with more than 1 measured value of white blood cell count (WBC), C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer. If the patient did not require MV, admission proinflammatory markers were compared with the maximum proinflammatory marker during the hospital stay. If a patient did require MV, admission proinflammatory markers were compared with proinflammatory marker level on the day of intubation or the first available level after intubation.

Results
Among 242 hospitalized patients with polymerase chain reaction–confirmed COVID-19 diagnosis, an increase in LDH (P = 0.01458) and d-dimer (P = 0.00284) were associated with patients requiring MV. An increase in WBC (P = 0.19428), CRP (P = 0.58770), or ferritin (P = 0.09302) was not significantly associated with an increased need for MV during our study period.

Conclusions
Serial monitoring LDH and d-dimer can serve as biochemical markers in identifying patients at high risk for MV. WBC, ferritin, and CRP trends may not have utility in determining risk of MV. Cessation of indiscriminate trending of these markers may be an avenue for cost savings.
A Case Report
Authors: Khot Rajashree , Jafri Shahnawaz , Rathod Bharatsing , Joshi Prashant P. 
Published: February 2023

Abstract
Acute respiratory distress syndrome (ARDS) became synonymous with COVID-19 infection during the recent pandemic. We report this case who presented with fever and ARDS and had bilateral pneumonia on chest x-ray. After hospitalization, he deteriorated and required invasive ventilatory support. His real-time reverse transcription–polymerase chain reaction for COVID 19 was twice negative. Hence, he was screened for other infections causing ARDS. He had no eschar clinically but had other clues, such as leucocytosis, transaminitis, hypoalbuminemia, and thrombocytopenia. On investigations, his serology for scrub typhus was positive. He was given doxycycline to which he responded dramatically and was weaned off ventilator.
If real-time reverse transcription–polymerase chain reaction for COVID-19 infection is negative, other rare but treatable respiratory infections leading to ARDS should be considered.
Contraceptive counseling for adolescents in the emergency department: A novel curriculum for nurse practitioners and physician assistants
Authors: Gabler Laurel S. , Shankar Michelle , Ketterer Tara , Molnar Jennifer , Adams Amber , Min Jungwon , Miller Elizabeth , Barral Romina L. , Akers Aletha , Miller Melissa K. , Mollen Cynthia 
Published: February 2023

ABSTRACT
Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) and physician assistants (PAs) serve a vital role in the provision of consistent care to adolescents in the ED. The purpose of this study was to create a curriculum to train NPs and PAs at two pediatric institutions to provide patient-centered contraceptive counseling to adolescents in the pediatric ED regardless of their chief complaint. To do this, we created a four-part webinar followed by an in-person training session. Participants completed training and then conducted counseling sessions with adolescents in the ED. Counseling sessions were recorded and reviewed for fidelity to delineated counseling principles, and data from post-counseling surveys were collected. 27 NPs and PAs completed the training and conducted 99 counseling sessions. Nearly all sessions incorporated essential content and communication principles such as shared decision making (90%) and teach-back methods (75%). All NPs and PAs who participated reported satisfaction and subjective improvement in knowledge and competence from the training. This curriculum offers a novel and feasible approach to train NPs and PAs to deliver patient-centered contraception counseling to adolescents in the ED setting, and it can serve as a model for how to educate different providers to incorporate reproductive health education into the busy ED visit.