bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcanal Endoscopic Versus Microscopic Tympanoplasty: Is There a Difference in Perforation Closure Rates?
Authors: Mitton Tanner , Kim Jenny , Killeen Daniel E. , Hunter Jacob B. , Isaacson Brandon , Kutz Joe Walter 
Published: August 2022

Objective:
To compare closure rates of endoscopic and microscopic tympanoplasty (MT) as influenced by perforation size, perforation location, and graft position.

Study Design:
Retrospective chart review.

Setting:
Tertiary university medical center.

Patients:
Adult patients who underwent tympanoplasty by a fellowship-trained neurotologist from January 2010 to December 2019, had at least 2 months of follow-up, and had a tympanic perforation with no cholesteatoma before surgery.

Interventions:
Transcanal endoscopic tympanoplasty (ET) or MT.

Main Outcome Measures:
The primary outcome is postoperative closure of the tympanic membrane perforation as assessed using otomicroscopy at the last follow-up appointment.

Results:
Two-hundred and eleven patients—98 in the transcanal ET group and 113 in the MT group—were identified. Tympanic membrane closure rates were not significantly different between the ET and MT groups (79.6% and 84.1% respectively; P = 0.473), and further multivariable analysis revealed that closure rates for ET relative to MT had an insignificant odds ratio (0.56; P = 0.144). Similar analyses also found no significant difference between the 2 methods in subsets of perforation size (small, large, subtotal/total), perforation location (anterior, posterior, inferior), and graft position (underlay, overlay).

Conclusions:
ET resulted in similar rates of postoperative closure rates compared with the microscopic technique.
Breast Cancer Recurrence after Smooth vs. Textured Implant-Based Breast Reconstruction: A Matched Cohort Study
Authors: Wu Zhen-Yu , Han Hyun Ho , Han Jing , Son Byung-Ho , Eom Jin Sup , Kim Sung-Bae , Gong Gyungyub , Kim Hak Hee , Ahn Sei-Hyun , Ko BeomSeok 
Published: August 2022

Background:
An increasing number of reports on breast implant-associated anaplastic large cell lymphoma have recently raised concerns about the potential influence of breast implants on carcinogenicity, particularly implants with a textured surface. We compared the recurrence outcomes between smooth and textured implant reconstructions for breast cancer.

Methods:
All patients who underwent immediate direct-to-implant (DTI)-based breast reconstruction for primary breast cancer between January 2010 and December 2016 were reviewed. A total of 590 patients were included. After propensity score 1:2 matching, 138 patients were included in the smooth implant group and 276 patients in the textured implant group. Locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates were compared between the groups.

Results:
After matching, the median follow-up periods were 62 months and 66 months for the smooth and textured groups, respectively. We observed no significant differences between the smooth and textured implant groups in terms of locoregional recurrence (10.9% vs. 11.6%; P = 0.827), distant metastasis (3.6% vs. 4.0%; P = 0.547), or first recurrence (12.3% vs. 13.4%; P = 0.757) rates. No significant differences were observed between the groups in five-year LRRFS (89.5% vs. 89.4%; P = 0.840), DFS (87.7% vs. 88.1%; P = 0.794), or DMFS (98.8% vs. 96.8%; P = 0.741) rates.

Conclusions:
No significant differences were observed between the smooth and textured implant groups in this matched cohort analysis of recurrence outcomes in patients with primary breast cancer who underwent immediate DTI reconstruction. Further larger-scale investigations are necessary to validate our results.
Complications Associated with Contralateral Prophylactic Mastectomy: A Systematic Review and Meta-Analysis
Authors: Murphy Alexander I , Asadourian Paul A , Mellia Joseph A , Rohde Christine H 
Published: August 2022

Background:
No prior systematic review and meta-analysis has aimed to answer the frequently-studied question: does a contralateral prophylactic mastectomy (CPM) increase complication risk for unilateral breast cancer patients undergoing unilateral mastectomy (UM)?

Methods:
A February 2021 search for studies on complications of UM+CPM identified 15 articles meeting inclusion criteria. Meta-analyses were conducted to compare complications of 1) diseased versus CPM breasts for UM+CPM patients and 2) patients undergoing UM+CPM versus UM alone when grouped by their different reconstructive methods. Outcomes included incidence of any complication and any severe complication requiring re-operation, re-admission, or delay in adjuvant therapy.

Results:
For all UM+CPM patients, the diseased breast was slightly more prone to complications versus the CPM breast (RR:1.24, CI:1.02-1.51). In studies that stratified by reconstructive method, incidence of complications was higher for UM+CPM versus UM alone for patients with no reconstruction (RR:2.03, CI:1.38-2.98), prosthetic-based reconstruction (RR:1.42, CI:1.13-1.80), and autologous reconstruction (RR:1.32, CI:1.09-1.61). Similar results were found by the only prospective trial on the topic, which showed the same for more severe complications. Other smaller retrospective studies that did not stratify by reconstructive method showed similar complications for UM+CPM versus UM alone (RR:1.06, CI:0.79-1.42). These groups had similar incidences of complication-related delay in adjuvant therapy, as demonstrated by one study.

Conclusions:
After UM+CPM, CPM breasts incur only slightly fewer complications. Stronger evidence supports more complications for UM+CPM than UM alone, although some studies report no difference. More work is needed to determine the effect of complications on timing of adjuvant therapy.
The Palpable Nodule After Autologous Fat Grafting: Distinguishing Benign Versus Malignant Lesions in a Breast Reconstruction Cohort
Authors: Fracol Megan , Allison Sophia , Chu Yuyang , Yu Yufan , Sood Rachita , Feld Lauren N. , Kim John Y.S. 
Published: August 2022

Background:
Nodule formation after autologous fat grafting (AFG) to the breast is the most common complication. In the reconstructive population, this generates significant patient anxiety and presents a diagnostic challenge. We characterized palpable nodule occurrence after AFG in breast reconstruction and compared benign versus malignant nodule characteristics.

Methods:
Chart review of the senior author’s experience with breast fat grafting was performed. Data extracted included demographics, intra-operative details, nodule data, radiographic characteristics and biopsy results. Logistic regression identified risk factors for nodule formation. Unpaired t-tests and Fisher’s exact tests compared characteristics of benign versus malignant nodules.

Results:
In total, 7 75 breasts were identified that underwent 1,158 fat grafting procedures, of which 67 (8.6%) developed palpable nodules. Sonographic characterization of nodules included presumed fat necrosis (38.2%), benign lesion (27.6%), presumed oil cysts (17.1%), indeterminate (8.9%) and concerning for malignancy (8.1%). Lesions concerning for malignancy were more often irregular (10.0% versus 0-2.9% of benign nodules) and more often larger than 0.8 cm in greatest dimension (80% versus 42.9%-61.8% of benign nodules). Six patients developed a palpable local recurrence. Malignant nodules tended to be larger (1.45 cm versus 0.70 cm, p=0.03), were more often vascular (50% versus 3.8%, p=0.03) and tended to occur later (17.5 months versus 10.0 months, p=0.60). Benign nodules occurred in the setting of larger fat graft volumes (64.2 cc versus 40.0 cc, p=0.008).

Conclusion:
This study provides the first comparison of radiographic and clinical characteristics between benign and malignant palpable nodules post-AFG in breast reconstruction.
“In Free Flap Autologous Breast Reconstruction Frailty Is a More Accurate Predictor of Postoperative Complications than Age, Body Mass Index, or ASA class: A Retrospective Cohort Analysis on the ACS-NSQIP Database.”
Authors: Joo Alex , Giatsidis Giorgio 
Published: August 2022

Background:
Free flap autologous breast reconstruction (f-ABR) improves quality of life in cancer survivors but has a 5-47% higher postoperative complication (PCs) rate in vulnerable patients, such as those with obesity or the elderly. Given the high (respectively: 43% and 16%) and rising prevalence of these conditions, operative risk prediction is critical to guide targeted care. Age, BMI, and ASA class have shown inaccuracies as predictive factors of PCs in f-ABR. Since frailty, a measure of vulnerability, was reported to be a reliable predictor of PCs in multiple other surgical fields, we hypothesized that it would be an accurate predictor of PCs also in f-ABR.

Methods:
Patients undergoing f-ABR (CPT: 19364) were identified using the ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program) database (01/2010-12/2018). Frailty was calculated using the validated modified Frailty Index (mFI). Rates of wound complications, bleeding episodes, readmissions, returns to operating room (ROR), and DVTs were compared across mFI score, BMI, age, and ASA class.

Results:
mFI ≥ 2 was associated with 22.22% (p <0.001) wound complications; 15.79% (p <0.001) bleeding episodes; 8.20% (p <0.001) readmissions; 17.19% (p <0.001) ROR; and 1.81% (p <0.05) DVTs. Higher BMI, age, and ASA class did not significantly correlate with increased rates in one or more PCs. Only a high mFI was consistently associated with significantly higher odds of complications in all complication types.

Conclusions:
As a reliable and accurate predictor of PCs in f-ABR, frailty could be used preoperatively to counsel patients and guide surgical care.
“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”
Authors: Muller-Sloof Emmy , de Laat Erik , Kenç Onur , Kumaş Ali , Vermeulen Hester , Hummelink Stefan , Ulrich Dietmar J.O. 
Published: August 2022

Background:
In breast reconstruction surgeries, surgical wound dehiscence is a serious complication which generates a significant burden on patients and healthcare systems. There are indications that postoperative treatment with closed incision negative pressure therapy (ciNPT) has been associated with reduced wound dehiscence rates. This randomized clinical trial examines the effect of ciNPT application on abdominal donor site surgical wound dehiscence in low- and high-risk patients undergoing a breast reconstruction with a deep internal epigastric perforator (DIEP) flap.

Methods:
Eighty eligible women, stratified as low- or high-risk patients, were included and were randomized for treatment with either ciNPT or adhesive strips (AS) by drawing sealed, opaque envelopes. All surgeons were kept blind for allocation. Primary outcomes were surgical wound dehiscence and surgical site infection at the abdominal donor site upon follow-up after 12 weeks. Secondary outcomes were seroma and hematoma formation. Five patients were excluded from the study due to non-sufficient exposure to the study treatment (n=4) or major protocol deviation (n=1).

Results:
A total of 75 women, low-risk (n=38) and high-risk (n=37), received either ciNPT (n=36) or AS (n=39). Patients’ demographics did not differ significantly. Donor-site surgical wound dehiscence occurred in 23 patients; the Absolute Risk Reduction was statistically significant (21.6%, 95% Confidence Interval [1.5-41.7]). No statistically significant differences were found in surgical site infection or secondary outcomes.

Conclusions:
In this randomized clinical trial, postoperative treatment with ciNPT decreased the incidence of surgical wound dehiscence at the abdominal donor site in low- and high-risk DIEP flap breast reconstruction patients.
Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens
Authors: Haddad Sara F. , Allaw Fatima , Kanj Souha S. 
Published: August 2022

Purpose of review
Antimicrobial overuse is a major health problem that contributes to antimicrobial resistance (AMR). Infections with Gram-negative bacilli (GNB) and multidrug-resistant organisms (MDRs) are associated with high morbidity and mortality, particularly in patients with underlying medical conditions.

Recent findings
Although many recent studies have been published about the novel antibiotics in treating infections including those due to MDR-GNB, the optimal duration of treatment (DOT) remains inconclusive. Recent observation has supported that short antibiotic therapy (SAT) decreases AMR and adverse effects. This narrative review provides an overview of the most recent published studies on the duration of therapy in the treatment of GNB infections, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), intra-abdominal infections (IAIs), bloodstream infections (BSIs) and urinary tract infections (UTIs), with a particular focus on MDR-GNB.

Summary
Studies showed different outcomes when comparing SAT to long antimicrobial therapy (LAT). No generalization can be made on all sites of infections and different GNBs. Further studies are needed to address the optimal DOT in MDR-GNB, as this group is underrepresented in recent studies.
Mycetoma, chromoblastomycosis and other deep fungal infections: diagnostic and treatment approach
Authors: Seas Carlos , Legua Pedro 
Published: August 2022

Purpose of review
to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections

Recent findings
Mycetoma and chromoblastomycosis are the only deep fungal infections incorporated in the list of neglected tropical diseases. These infections start in the skin but progress to deep tissues if not recognized early. A wide array of fungal pathogens are the causative agents. Molecular methods allow for early and accurate identification of the pathogens, but are unfortunately not available in endemic areas. Treatment options are mostly based upon clinical experience rather than on well-designed clinical trials

Summary
Deep fungal infections of the skin and soft tissues are rare conditions of wide world distribution but mostly reported from tropical countries. Urgent need for affordable and easily accessible molecular methods and well-conducted studies to allow for accurate diagnosis and to provide evidence to guide proper therapy are urgently needed.
Interobserver and Intraobserver Reliability in Sonoelastographic Assessment of Thyroid Nodules
Authors: Duman Emrah , Aslan Ahmet , Buz Ayşenur , Sancak Seda , Aslan Mine , Kabaalioglu Adnan , Fersahoglu Ayse Tuba , Okuroglu Nalan , Onur Ender 
Published: August 2022

Background
Thyroid ultrasonography is the first and perhaps most fundamental step for the radiological distinction of benign and malignant nodules. In this study, 2 radiologists reviewed the sonoelastographic and Doppler images of thyroid nodules and evaluated for the intraobserver and interobserver reliability.

Purpose
We aimed to determine confusing nodule identifiers and sonographic features differently defined by observers.

Methods
A total of 157 nodules in 91 patients (male/female, 72:19) with ages ranging from 18 to 72 years old were included in the study. Ultrasonographic images and video clips of the nodules were obtained and presented to 2 reviewers unaware of the cytopathology results. Two observers defined the characteristics of the nodules based on previously determined criteria. Then, intraobserver and interobserver correlation coefficients were calculated for each subcategory.

Results
In the grayscale ultrasonographic examination, varying degrees from low to high interobserver correlation coefficients were obtained for different subcategories (between κ = 0.359 and κ = 0.821). In color Doppler examination, we obtained medium correlation coefficients (κ = 0.493 and κ = 0.553). On the other hand, there was a high correlation coefficient in tissue compression elastography (κ = 0.617 and κ = 0.638).
According to our study results, elastographic pattern, shape of the nodule, presence of echogenic foci, and pathological lymph nodes are better predictors to determine the malignant potential of thyroid nodule with higher interobserver correlation. Therefore, these criteria may be used primarily for the evaluation of thyroid nodules. The intraobserver correlation coefficient was higher in the practitioner with longer experience, suggesting the importance of professional practice period on the decision-making process.
Extracellular Vesicles Isolated From Hypoxia-Preconditioned Adipose-Derived Stem Cells Promote Hypoxia-Inducible Factor 1α–Mediated Neovascularization of Random Skin Flap in Rats
Authors: Wu Shu , Hu Xuan , Wang Zhao-Hui , Zhu Yuan-Zheng , Wang Jiang-Wen , Nie Jia-Ying , Yang Juan-Min , Yi Yang-Yan 
Published: August 2022

Background
Random flaps are widely used for wound repair. However, flap necrosis is a serious complication leading to the failure of operation. Our previous study demonstrated a great proangiogenic potential of hypoxia-treated adipose-derived stem cells–extracellular vesicles (HT-ASC-EVs). Thus, we aim to evaluate the effect of HT-ASC-EVs in the survival and angiogenesis of random skin flap in rats.

Methods
Adipose-derived stem cells–extracellular vesicles were respectively isolated from adipose-derived stem cell culture medium of 3 donors via ultracentrifugation. The expression of hypoxia-inducible factor 1α (HIF-1α) and proangiogenic potential of HT-ASC-EVs and ASC-EVs were compared by co-culturing with human umbilical vein endothelial cells. Forty male Sprague-Dawley rats were randomly divided into 3 group (n = 10/group). A 9 × 3-cm random skin flap was separated from the underlying fascia with both sacral arteries sectioned on each rat. The survival and angiogenesis of flaps treated by ASC-EVs or HT-ASC-EVs were also compared. Laser Doppler flowmetry and immunohistochemistry were used to evaluate skin perfusion and angiogenesis of skin flaps on postoperative day 7.

Results
Hypoxia-treated adipose-derived stem cells–extracellular vesicles further improve the proliferation, migration, tube formation with upregulated HIF-1α, and VEGF expression of human umbilical vein endothelial cells in vitro, compared with ASC-EVs. In vivo, postoperatively injecting HT-ASC-EVs suppressed necrosis rate (29.1 ± 2.8% vs 59.2 ± 2.1%) and promoted the angiogenesis of skin flap including improved skin perfusion (803.2 ± 24.3 vs 556.3 ± 26.7 perfusion unit), increased number of CD31-positive cells, and upregulated expression of HIF-1α in vascular endothelium on postoperative day 7, compared with ASC-EVs.

Conclusions
Intradermal injecting HT-ASC-EVs improve the survival of random skin flap by promoting HIF-1α–mediated angiogenesis in rat model.
Coleadership in Maternity Teams, a Randomized, Counterbalanced, Crossover Trial in Simulation
Authors: Janssens Sarah , Clipperton Sharon , Simon Robert , Lowe Belinda , Griffin Alison , Beckmann Michael , Marshall Stuart 
Published: August 2022

Objective
This study aimed to measure the effect of a coleadership model on team performance compared with singular leadership model in simulated maternity emergencies.

Methods
A randomized, counterbalanced, crossover trial was performed at 2 tertiary maternity hospitals. Teams of obstetric physicians and nurse/midwives responded to 2 simulated maternity emergencies in either a singular or coleadership model. The primary outcome measure was teamwork rated with the Auckland Team Behavior tool. Secondary outcome measures included clinical performance (completion of critical tasks, time to critical intervention, documentation), self-rated teamwork (TEAM tool) and workload. Participants also answered a survey assessing their views on the coleadership model. Paired t tests and mixed-effects linear regression considering team as a random effect were used to estimate the unadjusted and adjusted associations between leadership model and the outcomes of interest.

Results
There was no difference between leadership models for the primary outcome of teamwork (5.3 vs. 5.3, P = 0.91). Clinical outcome measures and self-rated teamwork scores were also similar. Team leaders reported higher workload than other team members, but these were not different between the leadership models. Participants viewed coleadership positively despite no measured objective evidence of benefit.

Conclusions
A coleadership model did not lead to a difference in team performance within simulated maternity emergencies. Despite this, participants viewed coleadership positively.
A Novel Digital Algorithm for Identifying Liver Steatosis Using Smartphone-Captured Images
Authors: Xu Katherine , Raigani Siavash , Shih Angela , Baptista Sofia G. , Rosales Ivy , Parry Nicola M. , Shroff Stuti G. , Misdraji Joseph , Uygun Korkut , Yeh Heidi , Fairchild Katherine , Dageforde Leigh Anne 
Published: August 2022

Background.
Access to lifesaving liver transplantation is limited by a severe organ shortage. One factor contributing to the shortage is the high rate of discard in livers with histologic steatosis. Livers with <30% macrosteatosis are generally considered safe for transplant. However, histologic assessment of steatosis by a pathologist remains subjective and is often limited by image quality. Here, we address this bottleneck by creating an automated digital algorithm for calculating histologic steatosis using only images of liver biopsy histology obtained with a smartphone.

Methods.
Multiple images of frozen section liver histology slides were captured using a smartphone camera via the optical lens of a simple light microscope. Biopsy samples from 80 patients undergoing liver transplantation were included. An automated digital algorithm was designed to capture and count steatotic droplets in liver tissue while discounting areas of vascular lumen, white space, and processing artifacts. Pathologists of varying experience provided steatosis scores, and results were compared with the algorithm’s assessment. Interobserver agreement between pathologists was also assessed.

Results.
Interobserver agreement between all pathologists was very low but increased with specialist training in liver pathology. A significant linear relationship was found between steatosis estimates of the algorithm compared with expert liver pathologists, though the latter had consistently higher estimates.

Conclusions.
This study demonstrates proof of the concept that smartphone-captured images can be used in conjunction with a digital algorithm to measure steatosis. Integration of this technology into the transplant workflow may significantly improve organ utilization rates.
Hereditary motor neuropathies
Authors: Frasquet Marina , Sevilla Teresa 
Published: August 2022

Purpose of review
Distal hereditary motor neuropathies (dHMN) are a clinically and genetically diverse group of disorders that are characterized by length-dependent axonal degeneration of lower motor neurons. In this review, we will provide an overview of dHMN, and we will correlate the distinct clinical subtypes with their causative genes, focusing on the most recent advances in the field.

Recent findings
Despite the massive use of new-generation sequencing (NGS) and the discovery of new genes, only a third of dHMN patients receive a molecular diagnosis. Thanks to international cooperation between researchers, new genes have been implicated in dHMN, such as SORD and VWA1. Mutations in SORD are the most frequent cause of autosomal recessive forms of dHMN. As a result of these findings, the potential benefits of some pharmacological compounds are being studied in cell and animal models, mainly targeting axonal transport and metabolic pathways.

Summary
Despite the wide use of NGS, the diagnosis of dHMN remains a challenge. The low prevalence of dHMN makes international cooperation necessary in order to discover new genes and causal mechanisms. Genetic diagnosis of patients and identification of new pathomechanism are essential for the development of therapeutical clinical trials.