bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smell Sensitivity in Primary Open-angle Glaucoma and Pseudoexfoliation Glaucoma
Authors: Dikmetas Ozlem , Aygün Orhan , Kocabeyoglu Sibel , Süslü Ahmet E. , Kilic Büsra , Karakaya Jale , Iester Michele , Irkec Murat 
Published: February 2022

Précis:
This cross-sectional study of 20 patients with primary open-angle glaucoma (POAG), 20 with exfoliative glaucoma (XFG), 20 with exfoliation syndrome (XS) showed that exfoliative group had a significantly lower smell identification level as compared with the control groups.

Purpose:
To investigate smell sensitivity in POAG, XFG, and XFS in comparison with healthy controls.

Materials and Methods:
This prospective, cross-sectional study included 20 patients with POAG, 20 with XFG, and 20 with XFS. The control group consisted of 20 age-matched and sex-matched healthy subjects with no evidence of ocular disease. The Sniffin’ Sticks smell test was used to determine the, threshold values, and to assess the ability of smell identification, and differentiation in all patients One eye per patient was included for statistical purposes. One-way analysis of variance was used to compare the differences between the groups. Tukey honestly significant difference was used as a post hoc test when significant differences were detected among the 3 groups.

Results:
The XFG, POAG, and control groups showed a significant difference in the odor discrimination, odor identification, and threshold discrimination identification scores. The median (minimum-maximum) smell threshold levels for the POAG, XFG, and XFS groups and healthy controls were 4.5 (0 to 7.5), 4 (0 to 7.5), 5 (4.5 to 6), and 5.5 (4 to 7.5), respectively. The smell differentiation values for the POAG, XFG, and XFS groups and healthy controls were 12 (2 to 14), 8 (0 to 13), 11 (10 to 13), and 12 (9 to 14), respectively. Smell sensitivity for the POAG, XFG, and XFS groups and healthy controls were 26 (4 to 30.5), 19 (0 to 29.5), 28.3 (22.8 to 30.5), and 29 (26.5 to 32), respectively. The smell sensitivity and differentiation were significantly different among the groups (P<0.001). The XFG group had a significantly lower smell identification level than the POAG, XFS, and control groups.

Conclusion:
Patients with XFS and XFG revealed reduced smell sensitivity and identification compared with patients with POAG and those without glaucoma. These findings provide new insights into neural degeneration and pseudoexfoliation.
Development of a Preliminary Question Prompt List as a Communication Tool for Adults With Achalasia
Authors: Zhuo Justin , Triadafilopoulos George , Bredenoord Albert J. , Clarke John O. , Fass Ronnie , Gyawali Chandra P. , Hawn Mary , Hwang Joo Ha , Kahrilas Peter J. , Katzka David A. , Low Donald , Massey Benson T. , Patel Dhyanesh , Penagini Roberto , Roman Sabine , Savarino Edoardo , Smout André J. , Swanstrom Lee , Tatum Roger , Vela Marcelo F. , Zaninotto Giovanni , Kamal Afrin N. 
Published: February 2022

Background:
Question prompt lists (QPLs) are structured sets of disease-specific questions that enhance patient-physician communication by encouraging patients to ask questions during consultations.

Aim:
The aim of this study was to develop a preliminary achalasia-specific QPL created by esophageal experts.

Methods:
The QPL content was derived through a modified Delphi method consisting of 2 rounds. In round 1, experts provided 5 answers to the prompts “What general questions should patients ask when given a new diagnosis of achalasia” and “What questions do I not hear patients asking, but given my expertise, I believe they should be asking?” In round 2, experts rated questions on a 5-point Likert scale. Questions considered “essential” or “important” were accepted into the QPL. Feedback regarding the QPL was obtained in a pilot study wherein patients received the QPL before their consultation and completed surveys afterwards.

Results:
Nineteen esophageal experts participated in both rounds. Of 148 questions from round 1, 124 (83.8%) were accepted into the QPL. These were further reduced to 56 questions to minimize redundancy. Questions were categorized into 6 themes: “What is achalasia,” “Risks with achalasia,” “Symptom management in achalasia,” “Treatment of achalasia,” “Risk of reflux after treatment,” and “Follow-up after treatment.” Nineteen patients participated in the pilot, most of whom agreed that the QPL was helpful (84.2%) and recommended its wider use (84.2%).

Conclusions:
This is the first QPL developed specifically for adults with achalasia. Although well-received in a small pilot, follow-up studies will incorporate additional patient feedback to further refine the QPL content and assess its usability, acceptability, and feasibility.
Comparative Study of Modified Silver Nitrate Staining for the Detection of Helicobacter pylori
Authors: Chu Xiaoying , Xu Jian , Niu Li 
Published: February 2022

Background/Aims:Helicobacter pylori(Hp) infection is associated with a variety of diseases, such as benign lesions, precancerous lesions, and malignant lesions, especially diseases in the digestive system. Most people with Hp infection have mild early symptoms that are not easily noticed. Therefore, the diagnosis and treatment of Hp infection is particularly important. At present, there are many methods to detection Hp infection, but there is a lack of effective detection method with high sensitivity and specificity. On the basis of the existing detection methods, the modified silver nitrate staining method in this study improved the sensitivity and specificity of Hp detection.Materials and Methods:We selected gastric antrum and gastric angle mucosal biopsy tissues from 60 inpatients that were archived in the Pathology Department of Zhongnan Hospital of Wuhan University from July to December 2020. An Hp immunohistochemical assay, histochemical assay kit (methylene blue), and modified silver nitrate staining were used to measure the Hp infection positivity rate.Results:Comparison of Hp sensitivity and specificity among the 3 methods showed that the modified silver nitrate staining method was the most excellent. The sensitivity of modified silver nitrate staining method was 98.3%, which is statistically significantly higher compared with the other 2 methods.Conclusion:The modified silver nitrate staining method for Hp detection is convenient and effective, and could be widely used for clinical Hp detection.
Comparing Autologous to Device-Based Breast Reconstruction
Authors: Huang Hao , Wang Marcos Lu , Ellison Angela , Otterburn David M. 
Published: February 2022

Background
Poor breast sensation is common after mastectomy and reconstruction. In this study, we aim to define the temporal pattern of sensory changes after reconstruction and to compare the return in sensation between autologous and device-based reconstruction.

Methods
Women undergoing mastectomy with immediate reconstruction, with either tissue expander (TE) or neurotized deep inferior epigastric perforator (DIEP) flap, were prospectively identified at their preoperative or postoperative visit at defined time points. Neurosensory testing was performed in 9 breast regions using the AcroVal pressure-specified sensory device to determine 1 point-static cutaneous thresholds. Sensitivity data were averaged between patients at each time point and plotted over time.

Results
Eighty-seven patients (153 breasts) were included in this study, including 41 women (75 breasts) with DIEP flap and 46 women (78 breasts) with TE. The groups were comparable in age, body mass index, breast size, chemotherapy, radiotherapy, and number of revisional breast surgeries (P > 0.05). Compared with preoperative baseline, mean cutaneous thresholds in DIEP flap patients were comparable in most outer breast regions at 18 months postoperatively and in the entire breast, except the inner inferior region, at 3 years (P > 0.05). In contrast, mean cutaneous thresholds in TE patients continued to be significantly worse in the entire breast at 5 years postoperatively compared with baseline (P < 0.05).

Conclusions
Autologous breast reconstruction is superior in sensory recovery. Patients undergoing DIEP flap can expect sensory return to preoperative levels by 3 years, with sensation returning by 18 months in some areas of the breast. Patients undergoing device reconstruction should expect a slower and more unpredictable return in breast sensation.
Out-of-Pocket Costs and Provider Payments in Cleft Lip and Palate Repair
Authors: Rochlin Danielle H. , Ma Lucy W. , Sheckter Clifford C. , Lorenz H. Peter 
Published: February 2022

Background
As healthcare spending within the United States grows, payers have attempted to curb spending through higher cost sharing for patients. For families attempting to balance financial obligations with their children's surgical needs, high cost sharing could place families in difficult situations, deciding between life-altering surgery and bankruptcy. We aim to investigate trends in patient cost sharing and provider payments for cleft lip and palate repair.

Methods
The IBM® MarketScan® Commercial Database was queried to extract patients younger than 18 years who underwent primary or secondary cleft lip and/or palate repair from 2007 to 2016. Financial variables included gross payments to the provider (facility and/or physician), net payment as reported by the carrier, coordination of benefits and other savings, and the beneficiary contribution, which consisted of patients' coinsurance, copay, and deductible payments. Linear regression was used to evaluate trends in payments over time. Poisson regression was used to trend the proportion of patients with a nonzero beneficiary contribution. All financial values were adjusted to 2016 dollars per the consumer price index to account for inflation.

Results
The sample included 6268 cleft lip and 9118 cleft palate repair episodes. Total provider payments increased significantly from 2007 to 2016 for patients undergoing cleft lip (median, $2527.33 vs $5116.30, P 0.008) and palate ($1766.13 vs $3511.70, P < 0.001) repair. Beneficiary contribution also increased significantly for both cleft lip ($155.75 vs $193.31, P < 0.001) and palate ($124.37 vs $183.22, P < 0.001) repair, driven by an increase in deductibles (P < 0.002). The proportion of cleft palate patients with a nonzero beneficiary contribution increased yearly by 1.6% (P = 0.002). Higher provider payments and beneficiary contributions were found in the Northeast (P < 0.001) and South (P < 0.011), respectively, for both cleft lip and palate repair.

Conclusions
The US national data demonstrate that for commercially insured patients with cleft lip and/or palate, there has been a trend toward higher patient cost sharing, most pronounced in the South. This suggests that patients are bearing an increased cost burden while provider payments are simultaneously accelerating. Additional studies are needed to understand the impact of increased cost sharing on parents' decision to pursue cleft lip and/or palate repair for their children.
Sensorimotor Outcomes of Upper Extremity End-to-Side Nerve Transfers
Authors: Zeiderman Matthew R. , Fine Jeffrey , Asserson Derek B. , Davé Dattesh R. , Bascone Corey M. , Li Andrew I. , Pereira Clifford T. 
Published: February 2022

Background
End-to-side nerve transfer (ETSNT) for treatment of peripheral nerve injuries is controversial given the myriad anatomic locations, injury types, and indications. Efficacy of ETSNT remains debated. We hypothesized differences in age, sex, transfer location, and time to surgery influence outcomes.

Methods
We performed a search of the PubMed database for ETSNT in the upper extremity from 1988 to 2018. Age, sex, transfer location, time to surgery, donor and recipient axons, and strength and sensation outcomes as measured by Medical Research Council scale were extracted from articles. Meaningful recovery was classified as Medical Research Council Grade 3 or greater. Association between meaningful recovery and younger (<25) and older (≥25) patients, injury mechanism, sex, transfer location, donor axons, and recipient axons were calculated using a χ2 or Fisher exact test. A logistic mixed effect model was used with time to surgery, age (categorical), transfer location, and injury type as a fixed effect, and a random paper effect was included to account for correlation among patients from the same paper.

Results
One hundred fifteen patients from 11 studies were included. Neither age (continuous variable, P = 0.68) nor time to surgery (P = 0.28) affected meaningful recovery. Injury mechanism, sex, and younger age (<25 vs ≥25 years) were not associated with meaningful recovery. Within the brachial plexus ETSNT demonstrated median M4 ± 1 postoperative strength, with trunks/cords as the primary axon donor (P = 0.03). The musculocutaneous nerve demonstrated promising but variable results in 31 patients with median strength M3 ± 4. Digital nerves consistently demonstrated meaningful sensory recovery as both donor and recipient axons (15 of 15, 100%). Logistic regression analysis demonstrated that odds of meaningful recovery after ETSNT are significantly greater for transfers within the brachial plexus compared with the distal arm (odds ratio, 41.9; 95% CI, 1.1–1586.7, P = 0.04), but location does not significantly affect meaningful recovery (P = 0.22).

Conclusions
Patients undergoing ETSNT for digital nerve injury demonstrated meaningful recovery. End-to-side nerve transfer seems to be more efficacious when performed within the brachial plexus. This study did not find sex, injury mechanism, or time to surgery to significantly affect meaningful recovery. Additional study is needed to better evaluate the effectiveness of ETSNT in the upper extremity.
Preventing Rectourethral Fistula Recurrence With Gracilis Flap
Authors: Park Keon Min , Rosli Yenny Y. , Simms Allen , Lentz Rachel , Bharadia Deepak R. , Breyer Benjamin , Hoffman William Y. 
Published: February 2022

Background
Rectourethral fistula (RUF) is an uncommon serious condition with various etiologies including neoplasm, radiation therapy, and surgery. Treatment for RUF remains problematic with a high recurrence rate. Although studies have suggested the recurrence rate of RUF is lower after surgical repair using a gracilis flap, outcomes have varied and the studies were small and inadequately controlled. Here, we compare outcomes of RUF repair with and without gracilis flap to evaluate its efficacy in preventing fistula recurrence and identify risk factors for recurrence.

Methods
We retrospectively reviewed patients who had undergone surgical repair for RUF between 2007 and 2018 at our institution and had at least 30 days of follow-up. Patient demographics, comorbidities, and surgical outcomes were recorded and compared for patients who had gracilis flap repair and those who did not (controls). Single variable logistic regression analysis was used to identify risk factors for recurrence.

Results
The gracilis group (n = 24) and control group (n = 12) had similar demographics and comorbidities. Fistula recurrence was far less frequent in the gracilis group (8% vs 50%, P = 0.009). There were no significant differences in other outcomes including length of hospitalization and surgical complications. When recurrent RUF was treated with a muscle flap (gracilis or inferior gluteus), 83% of the group had no additional fistula recurrence. In the control group, history of radiation (P = 0.04) and urinary incontinence (P = 0.015) were associated with fistula recurrence.

Conclusions
We recommend using a gracilis flap for RUF repair given its association with lower recurrence without increased surgical complications.
A Systematic Review on the Implementation and Educational Value of Resident Aesthetic Clinics
Authors: Chen Jonlin , Lee Erica , el Eter Leen , Cooney Carisa M. , Broderick Kristen P. 
Published: February 2022

Background
Resident aesthetic clinics (RACs) provide plastic surgery residents with hands-on aesthetic surgery training. Although RACs have demonstrated successful surgical outcomes without compromising patient care, few studies have evaluated the efficacy or educational value of RACs to increase resident confidence and competence in procedures. In addition, clinic structures vary widely among institutions, with each clinic offering a unique patient volume, caseload, and degree of resident autonomy that impacts the clinic's educational value. This systematic review identifies existing RAC practices, compares clinic structures, and proposes a curriculum framework to maximize educational value for residents.

Methods
Following PRISMA guidelines, we performed a systematic review of plastic surgery residency training program RACs. We queried PubMed, Embase, and Web of Science from January 2000 to April 2020. Eligible articles were original articles that discussed RAC structure and educational value. Data abstracted included details on clinic structure (eg, volume, location, cost, clinic operations) and trainee-perceived educational value (eg, resident satisfaction, resident confidence in procedures).

Results
Of 1199 identified publications, 10 met the inclusion criteria: 6 single-site studies and 4 national survey studies. Among the single-site studies, annual volumes ranged from 22 to 68 patients/year and 35 to 81 cases/year. Resident aesthetic clinics were all staffed by full-time academic faculty (100%); one-third also were staffed by adjunct faculty and 17% also by community plastic surgeons. Resident involvement varied by hours in clinic and degree of autonomy. The survey studies found that RACs increase resident confidence and competence in performing aesthetic procedures and identified critical challenges to RAC implementation (eg, financial viability, continuity of care) that limited RAC educational value. Based on this review's findings, we propose a 6-step RAC curriculum framework for training programs seeking to establish an RAC and maximize the clinic's educational value.

Conclusions
Resident aesthetic clinics are increasingly important for providing plastic surgery residents with aesthetic training. Patient and case volume, degree of resident autonomy, and clinic attending physicians are critical determinants of the educational value of RACs. We hope our findings can aid plastic surgery training programs in better organizing educational and sustainable RACs.
Optimizing Abdominoplasty Surgical Site Morbidity Profiling Through an Effective and Nationally Validated Risk Scoring System
Authors: Massada Karen E. , Baltodano Pablo A. , Webster Theresa K. , Elmer Nicholas A. , Zhao Huaqing , Lu Xiaoning , Kaplunov Briana S. , Araya Sthefano , Brebion Rohan , Coronado Michael , Patel Sameer A. 
Published: February 2022

Background
Abdominoplasty complication rates are among the highest for cosmetic surgery. We sought to create a validated scoring system to predict the likelihood of wound complications after abdominoplasty using a national multi-institutional database.

Methods
Patients who underwent abdominoplasty in the American College of Surgeons National Surgical Quality Improvement Program 2007–2019 database were analyzed for surgical site complications, a composite outcome of wound disruption, and surgical site infections. The cohort was randomly divided into a 60% testing and a 40% validation sample. Multivariable logistic regression analysis was performed to identify independent predictors of complications using the testing sample (n = 11,294). The predictors were weighted according to β coefficients to develop an integer-based clinical risk score. This system was validated using receiver operating characteristic analysis of the validation sample (n = 7528).

Results
A total of 18,822 abdominoplasty procedures were identified. The proportion of patients who developed a composite surgical site complication was 6.8%. Independent risk factors for composite surgical site complication included inpatient procedure (P < 0.01), smoking (P < 0.01), American Society of Anesthesiologists class ≥3 (P < 0.01), and body mass index ≥25.0 and ≤18.0 kg/m2 (P < 0.01). African American race was a protective factor against surgical site complications (P < 0.01). The factors were integrated into a scoring system, ranging from −5 to 42, and the receiver operating characteristic analysis revealed an area under the curve of 0.71.

Conclusions
We present a validated scoring system for postoperative 30-day surgical site morbidity after abdominoplasty. This system will enable surgeons to optimize patient selection to decrease morbidity and unnecessary healthcare expenditure.
Transcription factor retention through multiple polyploidisation steps in wheat
Authors: Evans Catherine EB , Arunkumar Ramesh , Borrill Philippa 
Published: February 2022

SummaryWhole genome duplication (WGD) is widespread in plant evolutionary history, but the mechanisms of non-random gene loss after WGD are debated. The gene balance hypothesis proposes that dosage-sensitive genes such as regulatory genes are retained in polyploids. To test this hypothesis, we analysed the retention of transcription factors (TFs) in the recent allohexaploid bread wheat(Triticum aestivum).We annotated TFs in hexaploid, tetraploid and diploid wheats; compared the co-expression of homoeologous TF and non-TF triads; and analysed single nucleotide variation in TFs across cultivars.We found that, following each of two hybridisation and WGD events, the proportion of TFs in the genome increased. TFs were preferentially retained over other genes as homoeologous groups in tetraploid and hexaploid wheat. Across cultivars, TF triads contain fewer deleterious missense mutations than non-TFs.TFs are preferentially retained as three functional homoeologs in hexaploid wheat, in support of the gene balance hypothesis. High co-expression between TF homoeologs suggests that neo- and sub-functionalisation are not major drivers of TF retention in this young polyploid. Knocking out one TF homoeolog to alter gene dosage, using TILLING or CRISPR, could be a way to further test the gene balance hypothesis and generate new phenotypes for wheat breeding.