bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Systematic Review and Meta-analysis of Techniques for Management of Postoperative Lymphatic Leaks After Groin Surgery
Authors: Song Siyou , Parmeshwar Nisha , Steiner Gabriela , Kim Esther A. 
Published: June 2022

Purpose
Plastic surgeons are often consulted to manage postoperative groin lymphatic leaks that may lead to serious sequelae if not promptly treated. Because there are no standardized guidelines for best treatment practices, this systematic review and meta-analysis evaluates the outcomes of multiple management modalities to ultimately guide decision making for surgeons.

Methods
Literature surrounding lymphatic leaks in the groin was reviewed from PubMED, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2000, to December 1, 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inciting procedure, postoperative lymphatic complication, used management, and days to resolution were recorded. Pairwise comparisons using the Wilcoxon rank sum test with Bonferroni continuity correction were used to determine which treatment modalities differed significantly and accounted for multiple hypothesis testing.

Results
A total of 1468 total studies were initially found, which narrowed to 267 unique articles after duplicates were removed. Twelve articles ultimately met the inclusion criteria and were included in the data analysis. There were 264 groin complications, of which 217 were initially treated with conservative management, 81 with a minimally invasive procedure, and 125 with surgery. More than 95% of all cases had an inciting procedure of a vascular nature.
For vascular surgery–induced lymphatic leak treated by minimally invasive and surgical techniques, a significantly higher number of cases resolved compared with those treated conservatively (100% and 96.7% compared with 29.5%, respectively, P < 0.05). However, there were no significant differences in the proportion that resolved between the minimally invasive and surgical cases (P = 0.11). Vascular cases that were only managed with surgery had significantly shorter days to resolution compared with cases that first attempted conservative management (P < 0.001).

Conclusions
Both minimally invasive and surgical options have increased odds of resolution and lower failure rates compared with conservative management alone. The odds of resolution were higher when treated with more invasive procedures compared with conservative-only management, but the mean days to resolution was longer. This meta-analysis depicts successful resolution with procedural management and supports an initial trial of minimally invasive techniques.
Microsurgical Anterolateral Thigh Flap for Reconstruction of Extremity Soft Tissue Defects in Pediatric Patients
Authors: Shi Yan , Xu Yongqing , Zhu Yueliang , Yang Xi , Wang Teng , Cui Yi , Zhang Xulin , He Xiaoqing 
Published: June 2022

Background
The anterolateral thigh flap is one of the most widely used flaps because it has the advantages of less damage to the donor site, no sacrifice of main blood vessels, and abundant soft tissue. However, the application of anterolateral thigh flap in children is relatively rare because of small blood vessels and rapid physiological changes. The aim of this study was to explore the effectiveness and characteristics of free anterolateral thigh flaps for the reconstruction of extremity soft tissue defects in pediatric patients.

Patients and Methods
This study included 26 pediatric patients, with an average age of 6.7 years (range, 2–13 years). There were 5 cases of upper limb defects and 21 cases of lower limb defects, all of which were accompanied by exposed bones or tendons. The causes of defects included traffic injury in 9 cases, mechanical injury in 7 cases, collision injury in 4 cases, spoke injury in 3 cases, cicatricial contracture in 2 cases, and fibroma in 1 case. All defects were reconstructed with free anterolateral thigh flaps.

Results
Twenty-six anterolateral thigh flaps were harvested, including 15 fasciocutaneous flaps and 11 musculocutaneous flaps. The mean size of the flap was 73.4 cm2 (range, 4 × 3 to 24 × 8 cm). The donor sites were sutured directly in 19 cases and underwent split-thickness skin grafting in 7 cases. There were 3 cases of vascular crisis, 3 cases of flap edge necrosis, 3 cases of infection, 1 case of pressure ulcer, and 1 case of dehiscence after surgery. Eleven patients had scar hyperplasia in the donor site. A total of 34 reoperations were performed, including 14 flap debulking, 7 debridement, 4 skin graft, 3 vascular crisis re-exploration, and 6 other procedures.

Conclusions
Free anterolateral thigh flap was a safe and reliable option for reconstructing soft tissue defects of extremities in pediatric patients. Notably, the incidence of scar hyperplasia in the donor site and the possibility of reoperation in pediatric patients were higher than those in adult patients.
A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States
Authors: Hughes Alexa J. , Samson Thomas D. , Henry Cathy R. , Johnson Timothy Shane 
Published: June 2022

Background
The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs.

Methods
A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex.

Results
Eighty-two integrated plastic surgery residencies were analyzed. Fifteen PDs (18.3%) were female. Fifty-six (68%) PDs completed general surgery residencies, whereas 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained, whereas only 46 (68%) male PDs pursued additional training after residency (P = 0.02). Research output among male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared with women with an average of 27.5 publications (P = 0.008) and an H-index of 8.7 (P = 0.02). When comparing male to female PDs, there was no difference between age at PD appointment (P = 0.15), or in the amount of time between completion of plastic surgery training to PD appointment (P = 0.29). Male PDs were older (52.2) compared with female PDs (46.5) (P = 0.02). Male PDs served longer terms (4.98 years) than female PDs (2.87 years) (P = 0.003).

Conclusions
The majority of integrated plastic surgery PDs are men with a Doctor of Medicine degree who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although women make up only 18.3% of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the United States. As more women train in plastic surgery, it is possible that the percentage of women serving academic leadership roles will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.
The Standardized Inclusive Numeric Academic Index
Authors: Margulies Ilana G. , Sayegh Farah , Li Hanzhou , Paine Kaitlyn M. , Zoghbi Yasmina , Warburton Andrew , Ibelli Taylor J. , Taub Peter J. 
Published: June 2022

Purpose
Academic productivity is a poorly defined metric that is commonly used to determine faculty career advancement. While various indices incorporate scholarly activity, no specific index assimilates the perceived importance of a variety of academic accomplishments a physician may make. Herein, the development and validation of an algorithm to generate an academic productivity score based on surveying physicians nationwide are described.

Methods
From 2016 to 2018, an online cross-sectional survey was distributed to faculty members at an academic institution and plastic surgeons from different academic levels nationwide. Respondents were presented with randomized, binary comparisons of 42 different achievements of an academic physician and asked to choose the more important achievement. Descriptive statistics of demographics and “win rates” of each achievement were reported and an algorithm for academic productivity scoring was designed. To validate the proposed index, 30 curricula vitae of academic surgeons were anonymized and ranked in order of increasing academic achievement by 6 volunteers. Interrater reliability was assessed by Krippendorff α (α ≥ 0.800).

Results
Survey respondents completed an average of 116 (SD, 97.6) comparisons each, generating a total of 14,736 ranked comparisons. Of the 42 variables, the highest win rates were attained by being the dean of a medical school (0.90) and editor of a medical journal (0.88). The lowest win rates were attained by industry spokesperson (0.1) and members of the local medical society (0.1). Initial validity evidence found the interrater reliability for the 6 rankers to have a Krippendorff α value of 0.843. The interrater reliability between the average rater ranking and the algorithm-generated ranking had a Krippendorff α value of 0.925.

Conclusions
The present study demonstrates that the standardized inclusive numeric academic index may be used as a valid, comprehensive measure of academic productivity. Future studies should assess its application across different medical specialties.
The Social Vulnerability Index and Long-term Outcomes After Traumatic Injury
Authors: Herrera-Escobar Juan P. , Uribe-Leitz Tarsicio , Wang Joyce , Orlas Claudia P. , Moheb Mohamad El , Lamarre Taylor E. , Ahmad Niha , Hau Ka Man , Jarman Molly , Levy-Carrick Nomi C. , Sanchez Sabrina E. , Kaafarani Haytham M. A. , Salim Ali , Nehra Deepika 
Published: June 2022

Objective:
The aim of this study was to evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury.

Background:
The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors.

Methods:
Moderate-severely injured adult patients treated at 1 of 3 level–1 trauma centers were prospectively followed 6 to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle 2 quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury.

Results:
A total of 3153 patients were included [54% male, mean age 61.6 (SD = 21.6)]. The median overall SVI percentile rank was 35th (IQR: 16th–65th). compared to low SVI patients, high SVI patients were more likely to have new functional limitations [odds ratio (OR), 1.51; 95% confidence interval (CI), 1.19–1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40–2.89), and to screen positive for post-traumatic stress disorder (OR, 1.56; 95% CI, 1.12–2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes.

Conclusions:
The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.
Visual Field Defect Patterns Associated With Lesions of the Retrochiasmal Visual Pathway
Authors: Cho Juno , Liao Eric , Trobe Jonathan D. 
Published: June 2022

Background:
Perimetry is widely used in the localization of retrochiasmal visual pathway lesions. Although macular sparing, homonymous paracentral scotomas, and quadrantanopias are regarded as features of posterior retrochiasmal visual pathway lesions, incongruous hemianopia is regarded as a hallmark of anterior lesions. Recent studies have questioned the specificity of these defect patterns.

Methods:
Retrospective record review conducted in a single, academic, medical center using an electronic search engine with the terms ““homonymous hemianopia,” “optic tract,” “temporal lobectomy,” “visual field defect,” and “MRI.” Patients were included if they had reliable, automated, static visual fields, high-quality reviewable MRI scans, and pertinent lesions. MRI lesions were assigned to 1 of 6 retrochiasmal visual pathway segments by the study neuroradiologist. Two study authors independently reviewed the visual fields and designated 10 different defect patterns.

Results:
From an original cohort of 256 cases, only 83 had MRI-defined lesions that were limited to particular retrochiasmal segments and had visual field defect patterns that allegedly permitted localization to those particular segments. The 5 contralateral nerve fiber bundle defects were exclusive to optic tract tumors with rostral extension. Pie-in-the-sky defects were exclusive to Meyer loop lesions. Among 22 fields with macular sparing, 86% arose from the visual cortex or posterior optic radiations. Among 31 fields with homonymous quadrantanopias, 77% arose from Meyer loop, visual cortex, or posterior optic radiations. Among 13 fields with homonymous paracentral scotomas, 69% arose from visual cortex or posterior optic radiations. Optic tract lesions accounted for 70% of incongruous hemianopias but that pattern occurred uncommonly.

Conclusion:
In correlating discrete MRI-defined retrochiasmal lesions with visual field defect patterns identified on static perimetry, this study showed that macular sparing, homonymous paracentral scotomas, and quadrantanopias localized to the visual cortex and posterior optic radiations segments but not exclusively. It has differed from an earlier study in showing that incongruous hemianopias occur predominantly from optic tract lesions.
Accuracy of Visual Fields in Localizing MRI Lesions in Posterior Cerebral Artery Infarction
Authors: Cho Juno , Liao Eric , Trobe Jonathan D. 
Published: June 2022

Background:
The representation of the visual field in visual cortex was established over a century ago by correlating perimetric defects with the estimated location of war wounds. The availability of high-definition MRI offers the possibility of more precise correlation.

Methods:
Homonymous hemianopias disclosed on automated visual fields (HVFs) were drawn from an electronic medical record search from 2009 to 2020 at the Michigan Medicine, a tertiary care academic medical center. The patterns of the visual field defects (VFDs) were interpreted by a consensus of 2 authors. The VFDs were correlated with the location of MRI lesions in 92 patients with posterior cerebral artery (PCA) domain ischemic strokes, as determined by the neuroradiologist author, who was masked as to the VFDs.

Results:
Among the 77 VFDs confined to 1 hemifield, 74 (96%) correctly predicted the side of the visual cortex lesion. In 3 cases, the MRI lesion in the opposite cerebral hemisphere was not foretold. Among the 15 VFDs present in both hemifields, 5 (33.3%) overestimated the MRI lesions, which were evident in only 1 hemisphere. Among the 30 VFDs confined to 1 quadrant, 29 (97%) correctly predicted the lesioned visual cortex quadrant. However, 14 VFDs failed to predict MRI lesions present in both superior and inferior visual cortex quadrants on the same side. Those unpredicted lesions mostly had subtle or indistinct signal abnormalities or were confined to anterior visual cortex, an area that is inaccessible with the HVF test protocol used in this study.

Conclusion:
In this study of PCA ischemic stroke, VFDs limited to 1 hemifield were accurate in locating the side and quadrant of the MRI visual cortex lesions. However, the quadrantic VFDs sometimes failed to predict that the lesions involved both the superior and inferior quadrants on the same side, largely because those lesions had subtle imaging features that defied accurate radiologic assessment or were out of the reach of the visual field test protocol.
Minimum Technical Requirements for Performing Ambulatory EEG
Authors: Tatum William O. , Halford Jonathan J. , Olejniczak Piotr , Selioutski Olga , Grigg-Damberger Madeleine M. , Gloss David , Acharya Jayant , Schuele Stephan , Sinha Saurabh R. , Tsuchida Tammy , Drislane Frank W. 
Published: June 2022

Summary:
Ambulatory EEG (AEEG) devices offer portable, multichannel, digital EEG recording with or without video in the patient's natural environment. The technology applied for AEEG recording is like the technology for routine EEG and inpatient long-term video-EEG monitoring but designed to be compact and wearable. Computer-based AEEG technology is well-suited to digital recording, signal processing, and visual display. However, acquiring interpretable EEG outside of the hospital setting presents its own technical challenges. Published guidelines have established technical standards for performing routine EEG and inpatient video-EEG monitoring, but technical standards for AEEG are lacking. Therefore, this guideline provides minimal technical standards for the performance of AEEG which are essential to ensure the quality of studies for clinical and research practice. We expect these minimum standards to evolve over time with improved performance and advances in the technology.
Democratizing Flexible Endoscopy Training: Noninferiority Randomized Trial Comparing a Box-Trainer vs a Virtual Reality Simulator to Prepare for the Fundamental of Endoscopic Surgery Exam
Authors: Mascagni Pietro , Spota Andrea , Pizzicannella Margherita , Laracca Giovanni Guglielmo , Svendrovski Anton , Fiorillo Claudio , Lim Sun Gyo , Oudkerk Pool Marinka , Dallemagne Bernard , Marescaux Jacques , Swanstrom Lee , Shlomovitz Eran , Perretta Silvana 
Published: June 2022

BACKGROUND:
A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs).

STUDY DESIGN:
In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT—the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees’ feedback.

RESULTS:
Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 ± 14.29 vs 25.58 ± 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 ± 237.56 vs 322.68 ± 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 ± 1.20 vs 4.81 ± 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001).

CONCLUSIONS:
Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training.
Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm
Authors: Zelga Piotr , Hernandez-Barco Yasmin G , Qadan Motaz , Ferrone Cristina R , Kambadakone Avinash , Horick Nora , Jah Asif , Warshaw Andrew L , Lillemoe Keith D , Balakrishnan Anita , Fernández-del Castillo Carlos 
Published: June 2022

BACKGROUND:
The 2017 revised International Association of Pancreatology guidelines for management of intraductal papillary mucinous neoplasm (IPMN) describe worrisome features (WF) and high-risk stigmata (HRS), recommending resection in the latter and further work-up and close surveillance for patients with WF. The effect of multiple WF on the likelihood of malignancy has not been evaluated.

STUDY DESIGN:
Eight hundred ten patients who underwent pancreatic resection for IPMN in 2 tertiary referral centers were identified from prospective institutional databases. Patients were retrospectively categorized into subgroups according to the number of WF or HRS and presence of malignancy, defined as high-grade dysplasia (HGD) or invasive cancer on final pathology

RESULTS:
Three hundred seventy-nine (47%) patients had HRS, 370 (46%) had 1 or more WF, and 61 patients (7%) had neither. Malignancy was present in 70% (n = 267) of patients with HRS and in 30% (n = 127) of those with WF. Only 3 of 61 patients without WF/HRS had malignancy, and all only in the form of HGD. The risk of malignancy increased in a stepwise fashion with the number of WF, to 22%, 34%, and 59% with 1, 2, and 3 WF, respectively (p = 0.001), and reached 100% in patients with 4 or more WF. Although the relative risks differed for particular WF, the areas under the curve were not statistically different.

CONCLUSION:
We confirm that presence of HRS in IPMN is associated with a very high likelihood of malignancy. The presence of a single WF has a malignancy risk of 22%, and additional WF increase this risk significantly. When 3 or more WF are present, the risk is similar to that of HRS.
Five-Year Analysis of the MBSAQIP Database: Are We Getting Better?
Authors: Clapp Benjamin , Janik Michal R , El Badaoui Joseph , Dodoo Christopher , Portela Ray , Kellogg Todd , Ghanem Omar M 
Published: June 2022

BACKGROUND:
The MBSAQIP has been used to evaluate risk and create risk models. Previous studies have determined what complications matter most.

STUDY DESIGN:
This study was a registry-based analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between January 1, 2015, and December 31, 2019, at centers participating in MBSAQIP. Cases were identified using Current Procedural Terminology. Patients less than 18 years old were excluded. A chi-square test was used to assess differences in the prevalence of complications and effects across years. Using a multivariable Poisson regression model with a link log and robust estimation, prevalence ratio estimates and 95% CI were obtained.

RESULTS:
A total of 690,770 observations met the inclusion criteria. Mean (SD) age was 44.5 (±12.0) years, and mean (SD) BMI was 45.2 kg/m2 (±7.9). SG cases accounted for 73.45% of all observations. There was a significant relative reduction in readmissions, end-organ dysfunction, and all-cause mortality from 2015 to 2019 in the SG subgroup. There were also noticeable reductions in 30-day readmission, ICU admission, and end-organ dysfunction in the RYGB subgroup. For complications, bleeding, postoperative pneumonia, and stroke were significantly decreased in the RYGB subgroup, but only bleeding was significantly decreased in the SG subgroup during the 5-year study period.

CONCLUSIONS:
There has been a continuous improvement in several (but not all) outcomes through the years that the MBSAQIP has been collecting data. Different outcomes were reduced between the SG and RYGB subgroups, and the decrease in all-cause mortality was only noted in the SG subgroup.