bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiprocedural Facial Feminization Surgery: A Review of Complications in a Cohort of 31 Patients
Authors: Hazkour Nissim , Palacios Jose , Lu Weiying , Goote Paige , Rivera Robin , Bastidas Nicholas 
Published: September 2022

Objective:
Facial feminization surgery (FFS) is instrumental in gender affirmation for transgender patients. Multiprocedural FFS, the combination of multiple facial feminization procedures across multiple depths and planes during one surgery, crosses sterile and nonsterile planes in the oropharynx, nose, and frontal sinus. A closer look at the prevention and management of resulting complications of such reconstruction is necessary.

Methods:
We performed a retrospective review of patient demographics, operative variables, and postoperative complications on 31 FFS patients. Patients who underwent FFS between January 2020 and June 2021 were eligible for inclusion. Associations between prevention methods, procedure type, and complications were assessed by the Fisher exact test. The main effect of patient age and number of procedures on complication rate was assessed via the nonparametric Kruskal-Wallis test.

Results:
A total of 31 patients, with a mean age of 37 years (range: 19–65 y, SD: 13.3 y), underwent 257 procedures. Patients underwent a mean of 8 procedures (SD: 2.2) lasting 3.5 to 6 hours (mean: 5.0 h, SD: 0.9 h). Overall, 68% of patients experienced no complications. Six patients experienced a postoperative infection; 4 of these patients required return for a washout. Preventative measures implemented include: preoperative dental check, intraoperative antibiotic irrigation, locking sutures, and postoperative antibiotics. After measures were implemented, there were no further procedure-related infections recorded.

Conclusions:
Patients do not suffer from major complications after multiprocedural FFS. Factors such as age, irrigation method, and dental history may be important variables affecting FFS outcomes.
Auricular Framework Construction Using Cadaveric Costal Cartilage in Type III Microtia: Preliminary Results
Authors: Bastidas Nicholas , Hazkour Nissim , Palacios Jose , Raza Syed A. , Atamian Elisa , Pessino Kenneth 
Published: September 2022

Purpose:
Non/minimally irradiated Cadaveric Costal Cartilage (NCCC) is commonly used for grafts in nasal reconstruction; however, no information exists on its use in total ear reconstruction for type III microtia. In this case series we describe preliminary results from the novel use of NCCC for auricular framework construction in 7 ear reconstructions.

Methods:
Patients requiring total ear reconstruction from August 2020 to October 2021 were eligible and underwent ear reconstruction using NCCC from MTF Biologics (Edison, NJ). Patients were evaluated for surgical site infection, skin necrosis, cartilage exposure, warping, and resorption during regular follow up visits.

Results:
Seven ears were reconstructed using NCCC across 5 patients with type III microtia. Patients ranged from 5 to 51 years old at the time of surgery. Follow up time ranged from 12 to 78 weeks (mean: 46 wk). No patients experienced surgical site infections or significant cartilage resorption. All procedures were done outpatient, total time under anesthesia was <90 minutes in 5/7 cases and postoperative narcotics for pain management were not needed in 5/7 cases. Complications included minor skin necrosis that was repaired via primary closure, construct exposure in the immediate postoperative period, which was successfully salvaged with a local flap, and explantation of one construct after reconstruction for a complicated revision surgery involving a previous temporoparietal fascial flap.

Conclusion:
NCCC serves as an immediately available alternative to alloplastic and autologous materials for construction of auricular frameworks during ear reconstruction. Longer follow up times and a larger sample size will further elucidate long-term efficacy.
Burden of respiratory problems in low-income and middle-income countries
Authors: Clark Joseph , Kochovska Slavica , Currow David C. 
Published: September 2022

Purpose of review
Chronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middle-income countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems.

Recent findings
We report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs.

Summary
Prevention and treatment of respiratory diseases is essential for improved wellbeing. We identify missed opportunities for measurement and understanding of burden caused by respiratory problems within efforts to measure illness prevalence. We highlight need for symptom management interventions, developed in context of local cultural beliefs and behaviours.
Social dimensions of chronic respiratory disease: stigma, isolation, and loneliness
Authors: Brighton Lisa Jane , Chilcot Joseph , Maddocks Matthew 
Published: September 2022

Purpose of review
Social wellbeing is a core component of heath. However, people with chronic respiratory disease report unmet social needs, particularly in relation to stigma, social isolation, and loneliness. This review considers recent advances in understanding these social concepts within the context of chronic respiratory disease.

Recent findings
A growing body of qualitative work illustrates the detrimental impacts of stigma in chronic respiratory disease, contributing towards poorer psychological health and self-management, and reduced engagement with professional support. Stigma, alongside physical limitations stemming from respiratory symptoms, can also contribute to social isolation and loneliness. Social isolation and loneliness are associated with poorer mental health and quality of life, declines in function, and in some cases, increased hospital admissions. Although close or cohabiting relationships can ameliorate some social challenges, isolation and loneliness can also impact informal carers of people with chronic respiratory disease.

Summary
Increasing evidence illustrates the direct and indirect influences of social dimensions on health outcomes for people living with chronic respiratory disease. Although there is increased understanding of the lived experiences of stigma, less is understood about the complexities of social isolation and loneliness in chronic respiratory disease, and optimal interventions to address social challenges.
Crisis Preparedness: A Systems-Based Framework for Avoiding Harm in Surgery
Authors: Gogalniceanu Petrut , Karydis Nikolaos , Costan Victor-Vlad , Kessaris Nicos , Sevdalis Nick , Mamode Nizam 
Published: September 2022

BACKGROUND:
Highly performing healthcare organizations benefit from robust failure management systems. This involves the ability to respond and recover from critical events, as well avoiding harm in the first place (crisis preparedness). Currently, the surgical community may lack an integrated toolbox for crisis readiness. The study aims to create a practical framework for crisis preparedness in surgery.

STUDY DESIGN:
A multimethod qualitative study was designed to identify and translate crisis preparedness interventions from high-reliability industries to clinical practice. The tools and strategies identified were subsequently developed and clinically adapted for healthcare use. The study used (1) observational fieldwork in commercial aviation; (2) semi-structured interviews with senior airline pilots, and (3) mixed focus groups with healthcare and aviation safety experts. A crisis preparedness framework was derived by thematic analysis using the framework method. Clinical adaptation was achieved using expert consensus methodology.

RESULTS:
Twenty-two aviation and healthcare experts participated in 17 interviews and 3 focus groups. A framework for crisis preparedness was derived, consisting of 6 behavioral interventions: (1) anticipate threats and errors by building situational awareness using cognitive tools; (2) brief teams about goals, deviations, operational risks, and contingency plans; (3) implement standard operating procedures using checklists; (4) rehearse emergency drills before critical phases of work; (5) set the tone for a positive working environment by establishing cultural norms and empowering individuals to speak up about safety issues; and (6) debrief performance outcomes to derive learning lessons.

CONCLUSIONS:
Surgical crisis preparedness requires integrated systems rather than isolated safety interventions. This study provides a framework and the tools to achieve this.
NSQIP Quality Benchmarking and Evaluation of Potential Bias Associated with Higher- or Lower-Risk Operation Case Mix
Authors: Cohen Mark E , Liu Yaoming , Hall Bruce L , Sachs Amy J , Lapsley Jakob C , Byrd Claudia M , Ko Clifford Y 
Published: September 2022

BACKGROUND:
To ensure validity and acceptance of NSQIP risk-adjusted benchmarking, it is important that adjustments adequately control for hospitals that vary in their proportions of lower- or higher-risk operations (combined risk for procedure and patient). This issue was addressed in separate empirical and simulation studies.

STUDY DESIGN:
For the empirical study, potential miscalibration bias favoring hospitals that do lower-risk operations or disfavoring hospitals that do higher-risk operations was evaluated for 14 modeled outcomes using NSQIP data. A determination was also made as to whether there was a relationship between mean hospital operation risk and benchmarking results (log odds ratio). In the simulation study of the same 14 outcomes, hospital benchmarked performance was evaluated when sampled cases were reconstituted to include either a larger proportion of lower-risk operations or a larger proportion of higher-risk operations.

RESULTS:
Miscalibration favoring either lower- or higher-risk operations was absent, as were important associations between operative risk and hospital log odds ratios (most model R2 less than 0.01). In the simulation, there were no substantial changes in log odds ratios when greater percentages of either lower- or higher-risk operations were included in a hospital’s sample (nonsignificant p values and effect sizes less than 0.1).

CONCLUSIONS:
These results should enhance NSQIP participants’ confidence in the adequacy of NSQIP patient and procedure risk-adjustment methods. NSQIP participants may rely on benchmarking findings, and implement quality improvement efforts based on them, without concern that they are biased by a preponderance of lower or higher risk operations.
Association of Implementation of Operating Room-Based Parathyroid Hormone Testing with Operative Time and Cost
Authors: Xie Steven , Kuriakose Jonathan , Beninato Toni , Carayannopoulos Mary , Trooskin Stanley Z , Libutti Steven K , Laird Amanda M 
Published: September 2022

BACKGROUND:
Intraoperative parathyroid hormone (IOPTH) testing facilitates focused parathyroidectomy to establish biochemical cure but may be time-consuming. A dedicated immunoassay machine was relocated to the operating room for IOPTH. These data seek to determine association of operating room–based IOPTH with operative time, laboratory turnaround time (TAT), and cost.

METHODS:
Patients who underwent parathyroidectomy from June 2017 to February 2020 were reviewed. Clinical and demographic data, operative time, and TAT were collected. Patients were compared by operation dates pre- or post-machine acquisition. A cost model was created to evaluate cost of care before and after operating room–based testing.

RESULTS:
A total of 285 patients were included. Post-machine, median operative time decreased from 69 minutes (interquartile range [IQR] 60 to 84) to 57 minutes (IQR 50 to 84.5), p 0.03. Additionally, median TAT for IOPTH values (preoperative, 0, 5, 10, and 15 minutes) decreased post-machine: time preoperative, 29 minutes (IQR 23 to 40) vs 18 minutes (IQR 17 to 23.5), p < 0.001; time 0, 33 minutes (IQR 27 to 39) vs 18.5 minutes (17.5 to 21), p < 0.001; time 5 minutes, 31 minutes (IQR 26 to 36) vs 20 minutes (IQR 18.5 to 21), p < 0.001; time 10 minutes, 32 minutes (IQR 27 to 39) vs 20 minutes (IQR 18.5 to 22.5), p < 0.001; and time 15 minutes, 30 minutes (IQR 26 to 36) vs 19 minutes (IQR 17 to 21), p < 0.001. Total costs pre- and post-machine were $4,442 and $4,111, respectively. With $331 cost reduction per operation and 127 operations per year, the IOPTH machine pays for itself in 3 years, or 378 surgeries, and saves $168,589 in the machine’s remaining 4-year life span.

CONCLUSIONS:
Operating room–based parathyroid hormone testing results in improved operating productivity by decreasing result TAT and operative time and reduces cost.
Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score–Matched and Coarsened-Exact–Matched Analysis of 1,100 Patients
Authors: Willems Edward , D’Hondt Mathieu , Kingham T Peter , Fuks David , Choi Gi-Hong , Syn Nicholas L , Sucandy Iswanto , Marino Marco V , Prieto Mikel , Chong Charing C , Lee Jae Hoon , Efanov Mikhail , Chiow Adrian K H , Choi Sung Hoon , Sutcliffe Robert P , Troisi Roberto I , Pratschke Johann , Cheung Tan-To , Wang Xiaoying , Tang Chung-Ngai , Liu Rong , Han Ho-Seong , Goh Brian K P ,   International Robotic and Laparoscopic Liver Resection Study Group Investigators
Published: September 2022

BACKGROUND:
The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy.

STUDY DESIGN:
This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact–matched analysis was performed.

RESULTS:
A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching.

CONCLUSIONS:
Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.
Expert Consensus for Key Features of Operative Reports of Ventral Hernia
Authors: Dhanani Naila H , Lyons Nicole B , Divino Celia M , Harris Hobart , Holihan Julie L , Hope William , Itani Kamal , Loor Michele M , Martindale Robert , Prabhu Ajita , Reinke Caroline , Roth J Scott , Towfigh Shirin , Liang Mike K 
Published: September 2022

BACKGROUND:
Operative reports are important documents; however, standards for critical elements of operative reports are general and often vague. Hernia surgery is one of the most common procedures performed by general surgeons, so the aim of this project was to develop a Delphi consensus on critical elements of a ventral hernia repair operative report.

STUDY DESIGN:
The Delphi method was used to establish consensus on key features of operative reports for ventral hernia repair. An expert panel was selected and questionnaires were distributed. The first round of voting was open-ended to allow participants to recommend what details should be included. For the second round the questionnaire was distributed with the items that did not have unanimous responses along with free text comments from the first round.

RESULTS:
Eighteen surgeons were approached, of which 11 completed both rounds. Twenty items were on the initial questionnaire, of which 11 had 100% agreement. Of the remaining 9 items, after the second questionnaire an additional 7 reached consensus.

CONCLUSION:
Ventral hernia repairs are a common and challenging problem and often require reoperations. Surgeons frequently refer to previous operative notes to guide future procedures, which requires detailed and comprehensive operative reports. This Delphi consensus was able to identify key components needed for an operative report describing ventral hernia repair.
Developmental instability of CA1 pyramidal cells in Dravet Syndrome
Authors: Jones Steffan P. , O’Neill Nathanael , Muggeo Sharon , Colasante Gaia , Kullmann Dimitri M. , Lignani Gabriele 
Published: September 2022

AbstractDravet Syndrome (DS) is mostly caused by heterozygous loss-of-function mutations in the voltage-gated sodium channel SCN1A (Nav1.1), thought to result in severe epilepsy and neurodevelopmental impairment due to reduced interneuron excitability. Recent studies in mouse models suggest that an “interneuronopathy” alone does not completely explain all the cellular and network impairments seen in DS. Here, we investigated the development of the intrinsic, synaptic, and network properties of CA1 pyramidal cells in a DS model prior to the appearance of overt seizures. We report that CA1 pyramidal cell development is disrupted by loss of Scn1a, and propose that this is explained by a period of reduced intrinsic excitability in early postnatal life, during which Scn1a is normally expressed in hippocampal pyramidal cells. We also use a novel ex vivo model of homeostatic plasticity to show an instability in homeostatic response during DS epileptogenesis. This study provides evidence for an important role of Scn1a haploinsufficiency in pyramidal cells in the pathophysiology of DS.
Learning Continuous Potentials from smFRET
Authors: Bryan J. Shepard , Pressé Steve 
Published: September 2022

ABSTRACTPotential energy landscapes are useful models in describing events such as protein folding and binding. While single molecule fluorescence resonance energy transfer (smFRET) experiments encode information on continuous potentials for the system probed, including rarely visited barriers between putative potential minima, this information is rarely decoded from the data. This is because existing analysis methods often model smFRET output assuming, from the onset, that the system probed evolves in a discretized state-space to be analyzed within a Hidden Markov Model (HMM) paradigm. By contrast, here we infer continuous potentials from smFRET data without discretely approximating the state-space. We do so by operating within a Bayesian nonparametric paradigm by placing priors on the family of all possible potential curves. As our inference accounts for a number of required experimental features raising computational cost (such as incorporating discrete photon shot noise), the framework leverages a Structured-Kernel-Interpolation Gaussian Process prior to help curtail computational cost. We show that our Structured-Kernel-Interpolation Priors for Potential Energy Reconstruction from smFRET (SKIPPER-FRET) analysis accurately infers the potential energy landscape from a smFRET binding experiment. We then illustrate advantages of SKIPPER-FRET over standard HMM approaches by providing information, such as barrier heights and friction coefficients, otherwise inaccessible to HMMs.SIGNIFICANCEWe introduce SKIPPER-FRET, a tool for inferring continuous potential energy landscapes, including barrier heights, from single molecule smFRET data. We benchmark on synthetic and experimental data.
SPRAY-INDUCED GENE SILENCING IDENTIFIES PATHOGEN PROCESSES CONTRIBUTING TO POWDERY MILDEW PROLIFERATION
Authors: McRae Amanda G. , Taneja Jyoti , Yee Kathleen , Shi Xinyi , Haridas Sajeet , LaButti Kurt , Singan Vasanth , Grigoriev Igor V. , Wildermuth Mary C. 
Published: September 2022

SUMMARYSpray-induced gene silencing (SIGS) is an emerging tool for crop pest protection. It utilizes exogenously applied double stranded RNA to specifically reduce pest target gene expression using endogenous RNA interference machinery. Powdery mildews, widespread obligate biotrophic fungi infect agricultural crops including wheat, barley, cucurbits, grapevine, and ornamentals such as roses. In this study, SIGS methods were developed and optimized for powdery mildews using the known azole-fungicide target CYP51 and the Golovinomyces orontii-Arabidopsis thaliana pathosystem. Additional screening resulted in the identification of conserved gene targets and processes important to powdery mildew proliferation: apoptosis-antagonizing transcription factor in essential cellular metabolism and stress response; lipase a, lipase 1, and acetyl-CoA oxidase in lipid catabolism; 9-cis-epoxycarotenoid dioxygenase, xanthoxin dehydrogenase, and a putative abscisic acid G-protein coupled receptor predicted to function in manipulation of the plant hormone abscisic acid; and the secreted effector EC2. Powdery mildew is the dominant disease impacting grapes and extensive powdery mildew resistance to applied fungicides has been reported. Therefore, we developed SIGS for the Erysiphe necator-Vitis vinifera system and tested six successful targets identified using the G. orontii-A. thaliana system. For all targets tested, a similar reduction in powdery mildew disease was observed between systems. This indicates screening of broadly conserved targets in the G. orontii-A. thaliana pathosystem identifies targets and processes for the successful control of other powdery mildews. The flexibility, specificity, reduced environmental and health risks, and rapid transition from the bench to the field make SIGS an exciting prospect for commercial powdery mildew control.