bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-Year Clinical Outcomes and Quality of Life after Retromuscular Resorbable Mesh Repair Using Fibrin Glue
Authors: Morris Martin P. , Patel Viren , Christopher Adrienne N. , Broach Robyn , Harbison Sean P. , Fischer John P. 
Published: April 2022

Background:
With 400,000 hernias repaired annually, there is a need for development of efficient and effective repair techniques. Previously, the authors’ group compared perioperative outcomes and hospital costs of patients undergoing ventral hernia repair with retromuscular mesh using suture fixation versus fibrin glue. This article reports on 3-year postoperative outcomes, including hernia recurrence, long-term clinical outcomes, and patient-reported quality of life.

Methods:
Patients who underwent ventral hernia repair performed by a single surgeon between 2015 to 2017 were identified. Patients with retromuscular resorbable mesh placed were included and matched by propensity score. Primary outcomes included hernia recurrence, surgical-site infection, surgical-site occurrence, and surgical-site occurrence/surgical-site infection requiring procedural interventions. Secondary outcomes included quality of life as assessed by the Hernia-Related Quality of Life Survey.

Results:
Sixty-three patients were eligible, and 46 patients were matched (23 suture fixation and 23 fibrin glue), with a median age of 62 years, a median body mass index of 29 kg/m2, and a median defect size of 300 cm2 (interquartile range, 180 to 378 cm2). Median follow-up was 36 months (interquartile range, 31 to 36 months). There was no difference in the incidence of hernia recurrence (13.0 percent for suture fixation and 8.7 percent for fibrin glue; p = 0.636) or other postoperative outcomes between techniques (all p > 0.05). Five patients required reoperation because of a complication (10.9 percent). Overall quality of life improved preoperatively to postoperatively at all time points (all p < 0.05), and no differences in quality-of-life improvement were seen between techniques (p > 0.05).

Conclusion:
Ventral hernia repair with atraumatic resorbable retromuscular mesh fixation using fibrin glue demonstrates equivalent postoperative clinical and quality-of-life outcomes when compared to mechanical suture fixation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Free Tissue Transfer–Masquelet–Reamer-Irrigator-Aspirator Bone Graft Orthoplastic Approach for Lower Extremity Reconstruction
Authors: Maruccia Michele , Vicenti Giovanni , Carrozzo Massimiliano , Caizzi Gianni , Di Summa Pietro G. , Moretti Biagio , Giudice Giuseppe , Elia Rossella 
Published: April 2022

Summary:
The management of critical-sized bone and soft-tissue defects of the lower extremity poses unique challenge to reconstructive surgeons. The aim of this article is to present the authors’ current orthoplastic approach for the management of extended (more than 6 cm) osteocutaneous defects of the lower extremity, based on a sequential combination of two stages: free flap for soft-tissue coverage and the Masquelet technique (first step) followed by reamer-irrigator-aspirator cancellous bone graft and definitive osteosynthesis (second step). This study was a single-center observational retrospective review of prospectively collected data. Adult patients (>18 years of age) with segmental bone loss of the lower extremity caused by acute trauma (Gustilo type IIIB fracture) or nonunion (septic/aseptic) who were treated with the free flap for soft-tissue coverage–Masquelet technique–reamer-irrigator-aspirator approach between January of 2017 and December of 2020 were included. Time of consolidation and early and late complications were recorded. A total of 11 patients (nine male patients and two female patients) with a mean age of 45.8 years were identified. The average bone gap length (standard deviation) was 87.3 (24.9) mm. An anterolateral thigh flap was harvested in all cases. The average duration of the first stage (i.e., time from antibiotic cement spacer placement and free flap to time of bone grafting) was 50.4 days (range, 40 to 62 days). Bone consolidation was achieved in all cases after an average period (standard deviation) of 20.4 (3.3) weeks, with acceptable functional outcomes. The free flap for soft-tissue coverage–Masquelet technique–reamer-irrigator-aspirator approach could be considered a viable option in patients with segmental critical-sized bone defects associated with a large soft-tissue deficit of the lower extremity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
An Anatomic Analysis of Fibula Flap Mandible Reconstructions: Implications for Endosseous Implant Placement
Authors: Rosen Evan B. , Kyle Gazdeck R. , Goldman Debra A. , Panchal Hina , Jones Emily , Nguyen Jennifer P. , Allen Robert J. , Nelson Jonas A. , Huryn Joseph M. , Matros Evan 
Published: April 2022

Background:
Precise planning and evaluation of the fibula bone are necessary if immediate endosseous implant placement is considered. Limited information is available on the anatomical dimensions or density of fibula used in mandibular reconstructions. This study aimed to describe the morphology and dimensions of the fibula used to reconstruct segmental mandibular defects and contrast the findings with the native mandible.

Methods:
A retrospective analysis was performed of patients who underwent segmental mandibulectomy reconstructed with osteocutaneous fibula flaps and had at least one postoperative computed tomography scan. Fibula cross sectional dimensions and densities were evaluated with three-dimensional software. Radiographic measurements were obtained from the contralateral mandible medial to the first molar for comparison.

Results:
Four hundred seventy-seven fibula cross sections from 159 segments were evaluated. Cross-sectional oval, quadrilateral, triangular, and pentagonal shapes differed significantly in proportion (p < 0.001). Thirty-eight percent of segments (95 percent CI, 30 to 46 percent) had differences in cross-section height greater than 1 mm (p < 0.001). Between segments within the same patient, the median height difference was 1.58 mm (range, 0.14 to 6 mm). The superior cortex density was significantly higher for the fibula than the native mandible; however, the medullary space density was significantly lower (p < 0.001).

Conclusions:
The current study comprises the most comprehensive description of fibula morphology in mandibular reconstructions and highlights the significant variability that exists. The findings provide justification for the added time and cost of computer-aided design and computer-aided manufacturing in centers interested in performing immediate dental implant placement, as the technology provides the necessary precision and accuracy.
Common Revisions after Penile Inversion Vaginoplasty: Techniques and Clinical Outcomes
Authors: Morris Martin P. , Wang Chien-Wei , Lane Megan , Morrison Shane D. , Kuzon William M. 
Published: April 2022

Summary:
Up to one-third of patients are reported to undergo secondary surgical revision to address functional and aesthetic concerns after penile inversion vaginoplasty. The most commonly performed revisions are posterior introital web release, clitoroplasty, labiaplasty, and urethroplasty. To illustrate effective strategies for each of these revisions, this Video Plus article reviews the case of a 32-year-old transgender woman undergoing revision surgery to correct functionally limiting posterior introital webbing and to improve clitoral and labial appearance. Intraoperative steps and postoperative considerations are detailed in the accompanying videos.
External Genital Revisions after Gender-Affirming Penile Inversion Vaginoplasty: Surgical Assessment, Techniques, and Outcomes
Authors: Dy Geolani W. , Salibian Ara A. , Blasdel Gaines , Zhao Lee C. , Bluebond-Langner Rachel 
Published: April 2022

Background:
Following gender-affirming penile inversion vaginoplasty or vulvoplasty, patients may seek vulvar revision procedures for a variety of common aesthetic and functional concerns. These indications for revision and accompanying techniques are not well-described in the literature.

Methods:
Patients who underwent vulvar revision surgery at the authors’ institution were identified, and patient demographics, surgical indications, operative details, and complications were described. Common complaints requiring external genital revision were sorted into four categories: clitoral, labial, introital, and urethral.

Results:
Thirty-five patients with a history of vaginoplasty underwent vulvar revision between May of 2017 and December of 2019. The mean age at surgical correction was 38.9 years. Ten patients (28.6 percent) had undergone prior secondary procedures (range, 1 to 3). Mean follow-up after revision surgery was 10.7 ± 8.7 months (range, 0 to 30.6 months). The majority of patients underwent concurrent revisions in multiple “categories”. Labial aesthetic concerns were most common (n = 27, 77.1 percent), followed by clitoral (n = 20, 57.1 percent), urologic (n = 17, 48.6 percent), and introital complaints (n = 12, 34.3 percent). Twelve patients (34.3 percent) had canal stenosis requiring concurrent robot-assisted canal revision with peritoneal flaps. Complications included labial abscess (n = 1) and deep vein thrombosis (n = 1). Three patients (8.6 percent) underwent subsequent external genital revisions. Management approaches and surgical techniques for each of these common revision categories are provided.

Conclusion:
As more individuals seek vaginoplasty and vulvoplasty, surgeons must be prepared to address a range of common aesthetic and functional complaints requiring vulvar revision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Dose-Limiting Bone Marrow Toxicities After Peptide Receptor Radionuclide Therapy Are More Prevalent in Women Than in Men
Authors: Minczeles Noémie S. , de Herder Wouter W. , Konijnenberg Mark W. , Feelders Richard A. , Brabander Tessa , Hofland Johannes 
Published: April 2022

Purpose
Peptide receptor radionuclide therapy (PRRT) can cause dose-limiting toxicities (DLTs) of the bone marrow, liver, and kidneys. It is yet unknown whether women and men are equally at risk of these DLTs.

Methods
Neuroendocrine tumor patients treated with 177Lu-DOTATATE between 2000 and 2015 in our phase II trial with available laboratory data were included. For all DLTs, the highest Common Terminology Criteria for Adverse Events (version 4.03) grades that occurred from the start of PRRT until 3 months after the last cycle were scored.

Results
At baseline, women (n = 439) had a significantly lower body mass index, Karnofsky Performance Score, hemoglobin level, and creatinine clearance and a significantly higher platelet level than men (n = 534). Both groups received a median activity of 29.6 GBq (800 mCi). After the start of PRRT, women more frequently developed grade ≥2 thrombocytopenia compared with men (25% vs 18%, P = 0.004) due to a significant increase in grade ≥3 thrombocytopenia (11% vs 6%, P = 0.008). Furthermore, the incidence of grade ≥3 anemia was higher in women (7% vs 3%, P = 0.002). In the multivariable regression model, female sex (odds ratio, 2.50; 95% confidence interval, 1.67–3.74) was confirmed to be an independent risk factor for grade ≥2 thrombocytopenia, among baseline platelet count, bone metastases, uptake on 111In-DTPA-octreotide scan, Karnofsky Performance Score, alkaline phosphatase, lymphocytes, albumin, and renal function.

Conclusions
Female neuroendocrine tumor patients more often experienced PRRT-induced toxicities of platelets and hemoglobin than males, but this did not lead to a lower cumulative activity.
Incidental Diagnosis of Right Renal Subcapsular Urinoma on an 18F-FDG PET/CT Scan Performed for Staging of Cervical Cancer
Authors: Liu Weiting , Yao Xilan , Ou Xiaohong 
Published: April 2022

Abstract
A 53-year-old woman with cervical cancer underwent FDG PET/CT staging, which demonstrated an avid cervical mass with right parametrial involvement and presence of bilateral lymph node metastases. The right ureter was encased, resulting in obstruction and renal pelvic dilatation. Avid right renal subcapsular lesions were also noted, which were hyperintense on T2-weighted imaging compatible to encapsulated fluid collections. These lesions were diagnosed as subcapsular urinoma due to transmitted back pressure caused by obstruction of the right ureter.
Is Glucagon Administration Compatible With FDG PET/MRI?
Authors: Maucherat Bruno , Movassaghi Roshanack , Fleury Vincent , Le Thiec Maelle , Geffroy Delphine , Labbe-Devilliers Catherine , Rousseau Caroline 
Published: April 2022

Abstract
Digestive peristalsis generates many artifacts that limit the abdominal and pelvic MRI interpretation. Apart from the hypoglycemia treatment in patients with diabetes, glucagon analog is also indicated for the digestive peristalsis reduction to reduce MRI artifacts. However, its use in PET/MRI is not described, given the risk of interaction with the metabolism of FDG. To assess the importance of this interaction on the FDG PET images, we report FDG PET/MRI images obtained with and without glucagon analog injection.
Neuro-Ophthalmological Complications of the COVID-19 Vaccines: A Systematic Review
Authors: Lotan Itay , Lydston Melissa , Levy Michael 
Published: April 2022

Background:
A worldwide mass vaccination campaign against the coronavirus disease 2019 (COVID-19) pandemic is currently underway. Although the safety data of the clinical trials did not report specific concerns regarding neuro-ophthalmological adverse events, they involved a limited number of individuals and were conducted over a relatively short time. The aim of the current review is to summarize the available postmarketing data regarding the occurrence of neuro-ophthalmological and other ocular complications of the COVID-19 vaccines.

Evidence Acquisition:
Electronic searches for published literature were conducted using Ovid MEDLINE, Embase, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search strategy incorporated controlled vocabulary and free-text synonyms for the concepts of COVID, vaccines, and visual and neuro-ophthalmologic diseases and symptoms.

Results:
A total of 14 case reports and 2 case series have been selected for inclusion in the final report, reporting 76 cases of post-COVID-vaccination adverse events. The most common adverse event was optic neuritis (n = 61), followed by uveitis (n = 3), herpes zoster ophthalmicus (n = 2), acute macular neuroretinopathy (n = 2), optic disc edema as an atypical presentation of Guillain–Barré syndrome (n = 1), (arteritic anterior ischemic optic neuropathy; n = 1), abducens nerve palsy (n = 1), oculomotor nerve palsy (n = 1), Tolosa–Hunt syndrome (n = 1), central serous retinopathy (n = 1), acute zonal occult outer retinopathy (n = 1), and bilateral choroiditis (n = 1). Most cases were treated with high-dose steroids and had a favorable clinical outcome.

Conclusion:
Since the implementation of the COVID-19 vaccination campaign in the past year, several post-COVID-vaccination neuro-ophthalmological complications have been described. However, considering the number of individuals that have been exposed to the vaccines, the risk seems very low, and the clinical outcome in most cases is favorable. Therefore, on a population level, the benefits of the vaccines far outweigh the risk of neuro-ophthalmological complications.
Ganglion Cell Layer Thickness Variance Using SPECTRALIS Optical Coherence Tomography
Authors: Mallory Paul , Wagley Sushant , Chen John , McClelland Collin M. , Downie Peter A. , Lindgren Bruce , Lee Michael S. 
Published: April 2022

Background:
To determine the normal variance of the mean macular ganglion cell layer (GCL) volume among subjects without significant ocular pathology using SPECTRALIS optical coherence tomography (OCT).

Methods:
Fifty subjects underwent a baseline scan using SPECTRALIS OCT followed by 2 more studies with (reg-ON) and without (reg-OFF) eye registration all taken at the same session. The mean GCL volume was measured using built-in SPECTRALIS software. Eyes with macular pathology were excluded. The reproducibility of the measurements of the GCL volume was evaluated with Bland–Altman plots and limits of agreement, intraclass correlation coefficient (ICC), and the coefficient of repeatability (CR).

Results:
A total of 98 eyes met criteria for the analysis. The mean GCL volume difference was 0.0002 ± 0.029 and −0.0005 ± 0.035 mm3 for scans 1 versus 2 (baseline vs reg-ON) and 3 (baseline vs reg-OFF), respectively. The ICCs were 0.985 and 0.977 for the baseline vs reg-ON and reg-OFF groups. The CR for baseline vs reg-ON was 0.056 while CR for baseline vs reg-OFF was 0.069. Ninety percent of eyes fell within 0.04 mm3 of test–retest reliability.

Conclusions:
Our model found a predictable threshold of 0.07 mm3 or less for SPECTRALIS OCT mean GCL volume variance, which did not significantly change with eye registration in eyes without macular pathology. Clinicians may also consider a threshold of 0.04 mm3 when determining stable vs progressive changes in mean GCL volume using this device.
Does Angiosarcoma of the Breast Need Nodal Staging?
Authors: Herb Joshua , Maduekwe Ugwuji N , Goel Neha , Rosenberger Laura H , Spanheimer Philip M 
Published: April 2022

BACKGROUND:
Breast angiosarcoma is a rare malignancy classically associated with hematogenous metastases. We sought to determine the prevalence of pathologic nodal involvement in patients with nonmetastatic, resected breast angiosarcoma and its association with overall survival.

STUDY DESIGN:
The National Cancer Database was used to identify patients with nonmetastatic angiosarcoma of the breast who underwent surgical resection from 2004 to 2017. The prevalence of regional lymph node operation and nodal positivity was calculated. The Kaplan–Meier method was used to evaluate overall survival among node-positive and node-negative patients. Cox proportional hazard modeling was used to evaluate the adjusted association of nodal positivity with overall survival.

RESULTS:
We included 991 patients with angiosarcoma. The median age was 69 years (interquartile range 57 to 78), and the cohort was 99% female. A total of 298 patients (30%) had pathologic regional nodal evaluation. Of those, 15 (5.0%) had positive regional lymph nodes. Node-positive patients had significantly worse survival than patients with negative regional lymph nodes. After adjusting for patient, tumor, and treatment factors, a positive regional lymph node was associated with worse overall survival compared with patients with no nodal evaluation (hazard ratio 3.20; 95% CI 1.75 to 5.86; p < 0.001).

CONCLUSIONS:
Patients with nonmetastatic angiosarcoma of the breast have a 5% regional lymph node positivity rate, which is at a common threshold to consider evaluation, and identifies patients with poor survival. A prospective study to determine performance characteristics of sentinel lymph node biopsy is warranted.
Validated Risk-Score Model Predicting Lymph Node Metastases in Patients with Non-Functional Gastroenteropancreatic Neuroendocrine Tumors
Authors: Shannon Adrienne B , Straker Richard J , Fraker Douglas L , Miura John T , Karakousis Giorgos C 
Published: April 2022

BACKGROUND:
The incidence of, and factors associated with, lymph node metastasis (LN+) in non-functional gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are not well characterized.

METHODS:
Patients were identified from the 2010–2015 National Cancer Database who underwent surgical resection with lymphadenectomy for clinical stage I–III non-functional GEP NETs. Among a randomly selected training subset of 75% of the study population, variables associated with LN+ were identified using multivariable logistic regression analysis, and these variables were used to create a risk-score model for LN+, which was internally validated among the remaining 25% of the cohort.

RESULTS:
Of 12,228 patients evaluated, 6,902 (56.4%) had LN+. Among the training set, variables associated with LN+ included age (70 years of age or older: odds ratio [OR] 1.12, 95% CI 1.00–1.24; ref: less than 70 years), tumor location (stomach: OR 3.72, 95% CI 2.94–4.71; small intestine: OR 19.60, 95% CI 17.31–22.19; ref: pancreas), tumor grade (moderately differentiated: OR 1.47, 95% CI 1.30–1.67; poorly differentiated/anaplastic: OR 1.53, 95% CI 1.21–1.95; ref: well-differentiated), tumor size (2–4 cm: OR 2.40, 95% CI 2.13–2.70; >4 cm: OR 5.25, 95% CI 4.47–6.17; ref: <2 cm), and lymphovascular invasion (OR 5.62, 95% CI 5.08–6.21; ref: no lymphovascular invasion). After internal validation, a risk-score model for LN+ using these variables was developed composed of low- (N = 2,779), intermediate- (N = 2,598), high- (N = 3,433), and very-high-risk (N = 3,418) groups; within each group the rate of LN+ was 8.7%, 48.6%, 64.9%, and 92.8%, respectively.

CONCLUSIONS:
This developed risk-score model, including both patient and tumor variables, can be used to calculate the risk for LN metastases in patients with GEP NETs.
Concurrent Validity Evidence for Entrustable Professional Activities in General Surgery Residents
Authors: Brazelle Morgan , Zmijewski Polina , McLeod Chandler , Corey Britney , Porterfield John R , Lindeman Brenessa 
Published: April 2022

BACKGROUND:
A subset of Entrustable Professional Activities (EPAs) has been developed for general surgery. We aim to contribute validity evidence for EPAs as an assessment framework for general surgery residents, including concurrent validity compared to ACGME milestones, the current gold standard for evaluating competency.

STUDY DESIGN:
This is a cross-sectional study in a general surgery training program within a tertiary academic medical center. EPA assessments were submitted using a mobile app and scored on a numerical scale, mirroring milestones. EPA score distribution was analyzed with respect to post-graduate year (PGY) level and phase of care. Proportional odds logistic regression identified significant predictors. Spearman rank and Wilcoxon rank tests were used for comparisons with milestone ratings.

RESULTS:
From August 2018 to December 2019, 320 assessments were collected. EPA scores increased by PGY level. Operative phase EPA scores were significantly lower than nonoperative phase scores. PGY level, operative phase, and case difficulty significantly influenced entrustment scoring. EPA scores demonstrated strong correlation with nonoperative milestones patient care-1, medical knowledge-1, interpersonal and communication skills-2, interpersonal and communication skills-3, professionalism-1, professionalism-3, and practice-based learning and improvement-2 (ρ > 0.5, p < 0.05) and a weaker correlation with operative milestones patient care-3 and medical knowledge-2 (ρ < 0.5, p < 0.05).

CONCLUSIONS:
The influence of PGY level and operative phase on entrustment scoring supports the validity of EPAs as a formative evaluation framework for general surgery resident performance. In addition, evident correlations between EPA scores and respective milestone ratings provide concurrent validity evidence.