bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Acting Injection and Implant Preferences and Trade-Offs for HIV Prevention Among South African Male Youth
Authors: Montgomery Elizabeth T. , Browne Erica N. , Atujuna Millicent , Boeri Marco , Mansfield Carol , Sindelo Siyaxolisa , Hartmann Miriam , Ndwayana Sheily , Bekker Linda-Gail , Minnis Alexandra M.
Published: February 2021

Background:

Long-acting pre-exposure prophylaxis (LA-PrEP) formulated as implants and injections are promising prevention method strategies offering simplicity, discretion, and long dose duration. Men are important end users of LA-PrEP, and early assessment of their preferences could enhance downstream male engagement in HIV prevention.

Methods:

A discrete-choice experiment survey was conducted with 406 men, aged 18–24, in Cape Town, South Africa, to assess preferences for 5 LA-PrEP attributes with 2–4 pictorially-depicted levels: delivery form, duration, insertion location, soreness, and delivery facility. Latent class analysis was used to explore heterogeneity of preferences and estimate preference shares.

Results:

The median age was 21 (interquartile range 19–22), and 47% were men who have sex with men. Duration was the most important product attribute. Latent class analysis identified 3 classes: “duration-dominant decision makers” (46%) were the largest class, defined by significant preference for a longer duration product. “Comprehensive decision makers” (36%) had preferences shaped equally by multiple attributes and preferred implants. “Injection-dominant decision makers” (18%) had strong preference for injections (vs. implant) and were significantly more likely to be men who have sex with men. When estimating shares for a 2-month injection in the buttocks with mild soreness (HPTN regimen) vs. a 6-month implant (to arm) with moderate soreness (current target), 95% of “injection-dominant decision makers” would choose injections, whereas 79% and 63% of “duration-dominant decision makers” and “comprehensive decision makers” would choose implant.

Conclusions:

Young South African men indicated acceptability for LA-PrEP. Preferences were shaped mainly by duration, suggesting a sizeable market for implants, and underscoring the importance of product choice. Further research into men's acceptability of LA PrEP strategies to achieve engagement in these HIV prevention tools constitutes a priority.
Cost Savings in Urology Operating Rooms by Editing Surgeon Preference Cards
Authors: Pesigan Precy , Chen Henry , Bajaj Arjun A. , Gill Harcharan S.
Published: February 2021

Background and Objectives:

Operating room costs contribute significantly to the overall expenditure for inpatient care. We evaluated a simple way to reduce urology operating room costs by limiting the loss from unused disposable items.

Methods:

Baseline data were collected on opened and unused disposable items. Surgeons were asked to edit their preference cards and mark optional surgical items that would only be opened if requested.

Results:

The cost of unused disposable items during the first 4 weeks in 3 operating rooms averaged $410/week. Costs after implementing the intervention declined to an average of $30/week. This yielded $380/week in savings, equating to a 92% reduction in waste, and a potential savings of $19 760 annually in the 2 urology operating rooms alone.

Conclusion:

Since the urology department represents only 10% of the main operating rooms at our institution, if other operating rooms implemented similar cost saving methods the hospital could potentially accrue significant savings.
Multiple Myeloma Presenting as Disseminated Osteoblastic Lesions With Intense 18F-FDG Uptake on PET/CT
Authors: Wang Yueqi , Fan Qiuping , Su Minggang
Published: February 2021

A 42-year-old woman presented with numbness and weakness in the lower limbs. The radiograph, MRI, and 99mTc-MDP bone scintigraphy revealed multiple bone lesions. The lesions were sclerotic on radiograph. Subsequent 18F-FDG PET/CT showed the lesions were disseminated and had intense 18F-FDG uptake. Monoclonal lambda plasmacytoma was confirmed after CT-guided biopsy of the third lumbar vertebral lesion. The laboratory data also showed a monoclonal immunoglobulin G lambda protein in serum and urine immunofixation. The patient was diagnosed as multiple myeloma finally. Multiple myeloma should be in the differential diagnosis scope of multiple osteoblastic lesions with intense 18F-FDG uptake on PET/CT.
Immunoglobulin G4–Related Sclerosing Cholangitis Revealed by 68Ga-FAPI PET/MR
Authors: Qin Chunxia , Yang Ling , Ruan Weiwei , Shao Fuqiang , Lan Xiaoli
Published: February 2021

A 60-year-old woman with surgically confirmed immunoglobulin G4–related sclerosing cholangitis underwent 18F-FDG PET/CT due to significantly elevated serum CA-19-9 level, which revealed a hypermetabolic lesion in the residual liver. 68Ga-FAPI PET/MR was performed to further evaluate whether the FDG-avid lesion is a malignant tumor. Astonishingly, diffuse intense radioactivity was revealed throughout the liver, suggesting involvement of active immunoglobulin G4–related sclerosing cholangitis, but nonfocal elevated 68Ga-FAPI accumulation in the FDG-avid lesion indicated postoperative change. From this case, we speculated that FAPI imaging could be used for evaluation of chronic liver disease because fibroblast activation protein has a profibrogenic role in chronic liver injury.
Cardiac Transthyretin Amyloidosis
Authors: Roteta Unceta Barrenechea Ana , Aibar Arregui Miguel Angel , Nogueira Souto Daniel , Melero Polo Jorge , Moreno Gázquez Inmaculada , Tardin Cardoso Leticia , Saker Diffalah Yasmina , Andrés Gracia Alejandro
Published: February 2021

Purpose

Amyloidosis is a heterogeneous group of diseases caused by abnormal extracellular deposition of insoluble proteins and can involve myocardium. One of the causes of myocardial involvement is TTR amyloidosis. Our objective has been to evaluate the situation of cardiac amyloidosis (CA) in our center and the role of nuclear medicine, and to review the state of the art of nuclear medicine in this entity.

Patients and Methods

We have evaluated retrospectively 186 patients with clinical suspicion of CA and analyzed the clinical characteristics, free light chains and immunofixation in serum and/or urine, and the most relevant biomarkers associated with transthyretin CA (C-ATTR) of these patients and compared them with the results of the 99mTc-DPD scintigraphy.

Results

We have verified the growing bibliographic evidence concerning C-ATTR. A total of 51 scintigraphies (27.4%) were positive, 2 (1.1%) indeterminate and 133 (71.5%) negative according to the Perugini score. ATTR was diagnosed in 22 (11.8%; 77.3% males; mean age, 79.4 years). Of these, 12 (75% men; 82.3 years) were ATTRwt (wild-type or age-associated) patients, 2 (50% men; 52 years) experienced ATTRv (variant or hereditary), and 8 (87.5% men; 82.3 years) were not classified because of the absence genetic test. The origin of amyloidosis could not be determined in 31 (16.7%; 80.7% males; 84.5 years). In 29 of them (93.6%), it was because there was no study of free light chains or immunofixation.

Conclusions

Nuclear medicine is playing an increasing role in the diagnosis and classification of CA. However, the monitoring of these is still patchy.
Squamous Cell Carcinoma Mimicking Neck Paraganglioma on 68Ga-DOTATATE PET/CT
Authors: Civan Caner , Isik Emine Goknur , Has Simsek Duygu , Sen Comert , Unal Seher Nilgun
Published: February 2021

Somatostatin receptor (SSTR) imaging with 68Ga-labeled somatostatin analogs has been used for many tumors with high SSTR expression. Increased uptake mostly depends on the SSTR status of tumors; however, false-positive uptake can be demonstrated in benign diseases or other malignancies because of the increased SSTR expression. We present a case of a 50-year-old man with increased SSTR activity on cervical lesion located in internal jugular chain in 68Ga-DOTATATE PET/CT, which was performed for suspicion of paraganglioma. Biopsy revealed lymph node metastasis of squamous cell carcinoma other than paraganglioma. 18F-FDG PET/CT showed primary malignancy on larynx and lymph node metastasis, which were correlated surgically.
18F-FDG PET/CT Detection of a Popliteal Mycotic Aneurysm Complicating Staphylococcus aureus Bacteremia
Authors: El Yaagoubi Yacine , Prunier-Aesch Caroline , Chetanneau Alain , Philippe Laurent , Bleuet François , Menard Eric , Doll Gérard
Published: February 2021

A 75-year-old man presented with Staphylococcus aureus bacteremia, fever, and right posterior knee pain. Venous Doppler ultrasound of the lower extremity showed an isolated right calf muscle vein thrombosis, without any sign of deep vein thrombosis. 18F-FDG PET/CT revealed an intense focal uptake on the right popliteal artery, suggesting a mycotic aneurysm (MA). Lower limb CT angiography confirmed an MA of the right popliteal artery. The patient underwent surgical procedure with excision of the MA, whose cultures grew methicillin-sensitive S. aureus. Our case highlights the importance of including lower limbs in 18F-FDG PET/CT acquisition in case of suspicion of septic emboli.
Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Breast Reconstruction
Authors: Hermiz Steven J.R. , Lauzon Steve , Brown Geoffrey , Herrera Fernando A.
Published: February 2021

Introduction

Frailty can be quantified using an index score to effectively predict surgical outcomes and complications. The modified frailty index (mFI) score includes 5 patient-specific medical history comorbidities including diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease/pneumonia, and nonindependent functional status. The purpose of our study was to apply the 5-item mFI score to predict and minimize complications in patients undergoing breast reconstruction.

Methods

The National Surgical Quality Improvement Program was queried for all patients undergoing primary breast reconstruction from 2016 to 2018. Patients were divided based on timing of reconstruction and type of reconstruction: immediate or delayed, and implant based or autologous based. A validated modified fragility score was applied to all patients. Patients were stratified by mFI scores of 0 (no comorbidities), 1 (1 comorbidity), and 2+ (2 or more comorbidities). Patient demographics and 30-day complications rates were recorded.

Results

A total of 22,700 patients were identified. There were 10,673 patients who underwent immediate breast reconstruction, and 12,027 patients who underwent delayed breast reconstruction. A total of 14,159 patients underwent implant-based, and 8541 underwent autologous-based reconstruction. A total of 16,627 patients had an mFI score of 0, 4923 had a mFI score of 1, and 1150 had a mFI score of 2+. Compared with patients with an mFI score of 0, patients with an mFI score of 2 or greater were more likely to develop a postoperative complication (7.2 vs 12.3; P < 0.0001). Patients undergoing immediate reconstruction were more likely to develop a postoperative complications for every mFI category. The most common complications were wound and hematologic related.

Conclusion

Patients with higher mFI scores are likely to have an increase in postoperative complications after breast reconstruction. Increasing body mass index increases postoperative complications independent of frailty index scores. Patients with increasing frailty index scores undergoing immediate breast reconstruction have a significantly higher risk of postoperative complications compared with delayed reconstruction.

Patients with increasing frailty index scores undergoing autologous breast reconstruction have a significantly higher risk of postoperative complications compared with implant-based reconstruction. High frailty index scores are associated with a higher risk of postoperative complications, reoperation rates, and readmission rates. Patients with higher mFI scores may benefit from a delayed implant-based reconstruction.
Comparison of Lateral Tooth Volume and Morphology Between Buccally and Palatally Localised Unilateral Impacted Maxillary Canine Cases on Cone-Beam Computed Tomography
Authors: Karacin Gizem , Şenişik Neslihan Ebru , Yildirim Derya
Published: February 2021

The aim of this study was to compare the lateral tooth volume and morphology differences between buccally and palatally localized unilateral impacted maxillary canine (IMC) patients with volumetric and linear measurements on cone-beam computed tomography (CBCT) records. CBCT records of 48 individuals with 24-buccally and 24-palatally localized unilateral IMCs were included to the study. The patients comprised 34 females, 14 males, with a mean age of 17.71 (±SD 6.63 years). This split-mouth, retrospective case-control, study consisted of buccally and palatally IMC group, and each group was categorized into 2 sub-groups as impacted and erupted side. Lateral tooth volume, tooth length, mesiodistal-buccolingual crown widths, mesiodistal- buccolingual root widths at cemento–enamel junction (CEJ), at 4 mm apical to CEJ, at 8 mm apical to CEJ, mesiodistal crown-root angle, arch perimeter measurements were performed on CBCT images. The data were analyzed by factorial design repeated measures ANOVA. Bonferroni test was used for post-hoc analysis. The total volume, mesiodistal - buccolingual crown widths, buccolingual root width of lateral incisor at CEJ were statistically smaller in palatally IMC group. The lateral incisor's length, and arch perimeter were statistically shorter, mesiodistal, buccolingual root widths at 8 mm apical to CEJ, and crown-root angle of the lateral were narrower on impacted side than erupted side. The volume and crown widths of lateral incisor are effective in sagittal localization of IMC. The shorter length, narrower apical root morphology and mesially inclined crown-root angle of lateral incisor are noteworthy on impacted sides, regardless of sagittal position of IMC.
Analysis of Gull in Flight Appearance and Related Parameters Following Le Fort I Osteotomy
Authors: Suzen Muazzez , Dilaver Emrah , Uckan Sina
Published: February 2021

The present study aimed to investigate how “Gull in Flight” appearance and alar-columellar relationship change following maxillary surgery. Thirty-three patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Measurements which were angle of columella triangle, alar-rim angle, columella lobular angle, and distance of points forming “Gull in Flight” appearance were evaluated on pre and postoperative frontal and lateral photos of patients. Data was submitted to statistical analysis and significance level was determined as 0.05. Following Le Fort I surgery, distance of points forming “Gull in Flight” appearance with respect to canthus was decreased significantly (P < 0.05). Positions of these points to each other were not changed (P > 0.05). Every 1 mm maxillary impaction led to 0.58 mm reduction in y3 (the distance from the point that illustrates Gull's body) (P = 0.032). There was a decrease in angle of columella triangle, alar-rim angle and increase in columella lobular angle. However, these changes were not found significant (P > 0.05). Angle of columella triangle was increased 2.51 degree for every 1 mm maxillary advancement (P = 0.028). In conclusion, maxillary surgery had an impact on nasal region from frontal view. However, “Gull in Flight” appearance which is one of the aesthetic parameters in nose was not changed following maxillary surgery.
Primary Palatal Surgery in Nonsyndromic Cleft Palate Children and Velopharyngeal Insufficiency Correction Outcomes
Authors: Carvajal Álvarez Drina C. , Palomares-Aguilera Mirta M. , Meneses Geldres María B. , Villarroel Giugliano Carlos
Published: February 2021

Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery. The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higher presentation in Soft Cleft Palate and Hard and Soft Cleft Palate. Twenty-seven patients (19%) had surgical indication for VPI correction, and 20 of them received VPI surgery, before school age. Cleft type and gender were significantly associated with VPI surgery indication rate. Postsurgery, 80% presented normal resonance. Nasal emission improved in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.
Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review
Authors: Chicco Maria , Huang Tony Chieh-Ting , Cheng Hsu-Tang
Published: February 2021

Objective:

The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors.

Methods:

The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population.

Results:

Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference.

Conclusions:

The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
Autologous Craniofacial Fat Grafting in the Irradiated Field
Authors: Gormley Jessica , Copeland Andrea E. , Augustine Haley , McRae Mark
Published: February 2021

Autologous fat grafting has been used as a reconstructive modality following the treatment of head and neck malignancy. However, it has been criticized for poor graft retention and unpredictable results, which may be further compromised by prior radiation therapy. This systematic review will consolidate the literature on autologous fat grafting in the previously irradiated craniofacial region and report its effects on aesthetic and functional outcomes, volume resorption, and postoperative complications. A computerized search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. Sixty patients from six studies were included. Mean age was 46.06 years (range 13–73) and 37.5% were female. All studies used the Coleman technique fat grafting or a modified version. A total of 94.9% of patients had significant improvement in aesthetic outcomes and 86.1% in the study specific functional outcomes. Mean graft volume resorption was 41% (range 20%–62%) and there were three (5%) postoperative complications. Autologous fat grafting is increasingly being used to optimize aesthetic outcome following head and neck reconstruction, even in the presence of prior radiation treatment. Although the literature to date is encouraging, the heterogeneity in patient population, intervention, outcome measures, and time horizon limit our ability to draw conclusions about the success of craniofacial fat grafting in the irradiated field. Future research should include a large comparative study as well as a protocol for standardizing outcome measures in this population.
A Mathematical Model to Predict Human Microcephaly
Authors: Damar Cagri , Dogan Ilkay
Published: February 2021

Background:

Microcephaly (MiC) is defined as head circumference (HC) dimensions smaller than the normal standards.

Objective:

To detect MiC with a mathematical formula.

Materials and Methods:

The 0 to 5 years head HC percentile data for girls and boys reported by the World Health Organization were used. To assess early childhood, these growth standards are available on its website for international use. Mathematical formulas best estimating the 3rd percentile curves were defined using basic regression analysis methods.

Results:

The mathematical models obtained as a result of logarithmic regression analysis with the highest coefficient of determination values (R
2 = 0.991 for girls; R
2 = 0.991 for boys) were identified as the best model. The formulas of HC = 34.025 + 3.283 ∗ ln (age as months), and HC = 35.475 + 3.14 ∗ ln (age as months) were determined for girls and boys, respectively. A limitation of these formulas is that they do not provide the HC at birth (ln (0) = undetermined).

Conclusion:

Microcephaly can be estimated using the mathematical formulas with a calculator without using percentile scales, mobile applications, software, or the Internet.
Nasal and Oral Subunits Reconstruction of Localized Scleroderma Deformities
Authors: Xiao Haitao , Deng Ke , Wang Huaisheng , Xu Xuewen
Published: February 2021

Localized scleroderma is a rare soft tissue disorder characterized by a thickening of the skin from excessive collagen deposits. For patients with face involved, soft tissue depression and atrophy could cause serious facial contour deformity and adversely affect the patients’ quality of social life. However, localized scleroderma cases with delicate facial aesthetic subunits defects were rarely reported to be surgically reconstructed. In this study, we present 2 patients with nasal subunits and oral subunit deformities caused by localized scleroderma respectively. The first patient with a right-side alar defect and nasal dorsum depression, forehead depression and eyebrow depression were treated through a 2-stage surgical approach, with microvascular preauricular and helical rim flap and dermofat graft transplantation. The lower lip and mandible defects of the second patient were reconstructed with a combination of submental flap and fat grafting. The transplanted dermofat graft, fat graft, the microvascular free flap, and the submental flap survived completely and maintained adequate tissue volume and facial contour during the follow-up time of 2 years. Both patients were satisfied with the overall aesthetic results. This clinical report supports the use of microsurgical flap and tissue grafts on the treatment of localized scleroderma (LS) caused facial aesthetic subunits deformities.
Combination of Dermal fat Grafting and Frontalis Suspension Using Polytetrafluoroethylene Sheet for Blepharoptosis With a Deep Sulcus
Authors: Kokubo Kenichi , Katori Nobutada , Hayashi Kengo , Fujii Akiko , Koike Tomoyuki , Kawabata Tomotaka , Maegawa Jiro
Published: February 2021

The frontalis suspension procedure is a common surgical method for patients with severe blepharoptosis. While frontalis suspension is a very effective method, the transplant material may be visualized after surgery in patients with a deep sulcus and severe blepharoptosis. To prevent this complication, we performed a combination of dermal fat grafting and frontalis suspension using a polytetrafluoroethylene sheet in 5 patients (6 eyelids). We followed-up the patients for at least 6 months postoperatively (mean: 6.8 months) and observed no transplant material visualization or occurrence of infection. The mean pre- and postoperative margin reflex distance-1 was –3.75 (–5 to –2) and 2.10 (1–3), respectively. Bulky upper eyelids were observed 6 months postoperatively in 1 patient (2 eyelids). None of the patients underwent reoperation. In conclusion, the combination of frontalis suspension using a polytetrafluoroethylene sheet and dermal fat grafting for severe blepharoptosis and a deep upper eyelid sulcus was effective in preventing visualization of the transplant material.
An Update on Facial Skin Rejuvenation Effectiveness of Mesotherapy EBM V
Authors: Atiyeh Bishara S. , Abou Ghanem Odette
Published: February 2021

Although it appears to be a simple, easy, and financially attractive therapeutic modality, skin rejuvenation mesotherapy is a controversial cosmetic procedure and proof of its efficacy is still lacking. The authors have published a review about this therapeutic modality more than a decade ago. Few clinical studies evaluating its efficacy and safety were available then without any conclusive scientific evidence about its efficacy; nevertheless, mesotherapy has continued to be performed at a relatively high financial cost to patients by many nonmedical and medical professionals for antiaging purposes. The authors have published a review about this therapeutic modality more than a decade ago. The current review is an update aimed at identifying any evidence about the scientific validity and efficacy of this approach that has emerged since then. No clinical valuable new data and new information has been identified. As by American Society of Plastic Surgeons (ASPS) policy statement updated and approved in 2019, mesotherapy for skin rejuvenation is currently not Food and Drug Administration approved. Until more conclusive data is available, skin rejuvenation mesotherapy cannot be recommended for routine skin rejuvenation clinical application.
Characteristics of the Sphenoid Bone in Crouzon Syndrome
Authors: Lü Yang , Gui Lai , Teng Li , Jin Xiaolei , Niu Feng , Song Tao
Published: February 2021

Background:

The goal of this study is to analyze the safety of reconstructive surgeries for Crouzon syndrome, and to understand the deformities and complications related to the surgical procedure.

Methods:

Thirty-nine subjects underwent preoperative computed tomographic scans were included (Crouzon, n = 19; controls, n = 20) in this study. Craniofacial cephalometric measurements were analyzed by Materialise software.

Results:

The overall average distance from the pterygoid junction to the coronal plane in the patients with Crouzon syndrome was 21.34 mm (standard deviation [SD] 5.13), which was deeper than that in the controls by 35% (P = 0.000).

The overall average distances between the left and right foramen ovale and pterion on the sphenoid bone in the subjects were 64.93 mm (SD 7.56) and 67.83 mm (SD 8.57), which were increased by 13% (P = 0.001) and 14% (P = 0.001) compared with those in the controls.

The overall distances between the most inferior point of the left and right lateral pterygoid plate and the medial pterygoid plate in the subjects were 51.09 mm (SD 6.68) and 51.51 mm (SD 10.98), which was not statically different from the controls (P = 0.887, P = 0.991, respectively).

Conclusions:

This study characterized the surgically relevant anatomy of the sphenoidal bone. The pterygomaxillary junction is located in the posterior of the skull. Though there are some anatomical differences due to age, it is well known that the cranial cavity of the sphenoid side is likely to be enlarged in Crouzon syndrome, which may contribute to the other complications of the disease.
Cleft Care Packages and the Impact on Postoperative Care Following a Primary Cleft Lip Repair
Authors: Roy Michelle G. , Davies Lesley A. , Guillen Diana E. , Sequitin Jeromie D. , Buchanan Edward P. , Maricevich Renata S. , Truong Tuan A. , Monson Laura A.
Published: February 2021

Objective:

To provide caregivers with all the resources needed to care for a surgical site following a primary cleft lip repair and evaluate its efficacy on postoperative care.

Setting/Participants:

Caregivers of infants ages 3 to 6 months with a cleft lip and/or palate undergoing a primary repair at the Texas Children's Hospital.

Methods:

Packages were given to caregivers at discharge following repair. Packages included instructions and supplies needed for surgical site care. At discharge an advanced practice provider obtained informed consent and a questionnaire that established baseline knowledge of surgical site care. Following the questionnaire, the advanced practice provider demonstrated how to care for the site using the package provided. Assessment of scar healing, nasal stent compliance, and ease of care was evaluated at postoperative follow up.

Results:

Thirty-two families were enrolled in this study. Our data supports that caregivers who are provided resources to care for the site had increased comfort level, preparedness, and compliance rates following a primary cleft lip repair. Eighty-four percent of respondents strongly agreed that the package provided aided in preparedness for site care with 100% of respondents recommending the resources to future families undergoing a cleft lip repair.

Conclusions:

Caregivers feel comfortable and equipped with their ability to care for their child's repaired cleft lip when given the appropriate instructions and supplies. In addition, they would recommend the packages to future families following a repair. Empowering families to be proactive in postoperative care will potentially lead to better outcomes in cleft care.
The Ophthalmopetrosal Sinus of Hyrtl: The Evidence of A Rare Variant
Authors: Mincă Dragoş-Ionuţ , Rusu Mugurel Constantin
Published: February 2021

Hyrtl [Wien Med Wochenschr. 1862;19:291-292] reported firstly the ophtalmopetrosal sinus (OPS) running from the superior orbital fissure and emptying either in the transverse sinus, or in its junction with the superior petrosal sinus. Since then, this anatomic variant was mostly referred and poorly studied. Neither Hyrtl, nor other authors brought any evidence of such OPS. It is hereby reported and proofed such an OPT which was found at dissection. It drained ophthalmic veins and coursed posteriorly, first on the greater wing (alar segment), then on the temporal bone (temporal segment, on the petrosquamous fissure), emptying in the transverse sinus. A lateral type of the superior petrosal sinus connected the OPS and the transverse sinus. The OPS courses on the middle fossa floor, lateral to the Meckel's cavum, foramen ovale, foramen spinosum, and fallopian hiatus. It is a rare thus unexpected finding during specific approaches of the middle fossa floor.
Sphenotemporal and Fronto-Orbital Dysmorphology in Unilateral Coronal Synostosis Using Geometric Morphometric Curve-Based Analysis
Authors: Rutland John W. , Delman Bradley N. , Bellaire Christopher P. , Napoli James G. , Villavisanis Dillan F. , Margulies Ilana G. , Goel Pedram , Urata Mark M. , Taub Peter J.
Published: February 2021

Background:

Geometric morphometric analysis with Procrustes superimposition is a commonly used method to characterize and study complex dysmorphology. The present study employs an advanced Procrustes-based approach to studying craniofacial dysmorphology in unilateral coronal synostosis and quantitatively describe bony patterns in this disorder, in order to better understand the associated fronto-orbital and sphenotemporal deformities.

Methods:

Forty-one unilateral coronal synostosis (UCS) patients and 41 age- and sex-matched controls underwent high-resolution computed tomography imaging. Thirty-one anatomical landmarks were labeled on each imaging set. Landmarks were used to calculate angle, lengths, and define fronto-orbital and sphenotemporal anatomical curves. A validated geometric morphometric workflow was used to perform a Procrustes superimposition to register landmarks into a common space and perform a principal components analysis.

Results:

Supraorbital bar curvature was significantly increased ipsilateral to the fused suture and decreased contralateral,P < 0.0001 for both sides. The sagittal sphenotemporal curve also showed ipsilateral increase in curvature (P < 0.0001) but there was no effect on the contralateral side (P > 0.05).

Conclusions:

Geometric morphometric analysis revealed significant dysmorphology between UCS patients and controls. These results suggest bilateral changes in fronto-orbital curvature and ipsilateral changes in sagittal sphenotemporal curvature, which may be useful in further characterizing the dynamic craniofacial changes in UCS.
Original Design of the Limberg Flap: An Opposite Triangular Flap
Authors: Hwang Kun
Published: February 2021

The aim of this study was to identify the original design of the Limberg flap.

Publications by the original author, Limberg, and his original designs of the so-called “Limberg flap” were searched in PubMed. These included his original monograph written in Russian (Mathematical Principles of Local Plastic Procedures on the Surface of the Human Body, 1946), the first English paper (“Design of Local Flaps,” 1966), and English translation of his book by Wolfe (1984).

Three figures that may be the prototypes of the Limberg flap were found in the 1946 Russian monograph. One figure involved designing unilaterally active opposite triangular flaps, placed on a lateral incision on the edge of the defect. Another was closure of a defect of the nasal dorsum with a cheek flap with opposite triangular flaps with lateral incision angles of 30° and 105°. The third depicted closure of the lateral section of a fusiform defect using adjacent opposite triangular patches. In 1966 English chapter, he described the rotation of a triangular flap for the closure of a rhomboid defect. Two standing cones and a lying cone are still formed and should be sited where the tissues are lax enough to compensate. In 1984 English translation, the “unilaterally active opposite triangular flaps” and “rotation of a triangular flap in the closure of a rhomboid defect,” were translated as “convergent triangular flaps” and “convergent triangular flaps” respectively.

Limberg first called original design of the flap “opposite triangular flap,” and later “local triangular flap” for closing rhomboid skin defects.
A Surgical Management for Severe Rhinophyma With Five-Blade Scratcher
Authors: Wang Dong-Ming , He Xu-Feng , He Xiang , Zhang Hui-Min
Published: February 2021

Rhinophyma, the final stage of acne rosacea, severely influences the patient's appearance and can only be treated by surgical methods. This case reports a simple, safe, effective, and economical surgical method-five-blade scratcher. After the surgical treatment, the overall nasal contour of the patient, a male with severe rosacea, was restored without scar formation. Thus, this surgical method reported in this case is feasible and easy to operate, and worthy of clinical promotion.
Spatial Analysis of the Temporomandibular Joint and Condyle Following Mandibular Distraction in Robin Sequence
Authors: Pourtaheri Navid , Chandler Ludmila , Singh Anusha , Maniskas Seija , Wilson Alexander T. , Sun Alexander Haosi , Steinbacher Derek M.
Published: February 2021

To comprehensively assess changes in temporomandibular joint and mandibular condyle morphology in Robin sequence (RS) patients undergoing mandibular distraction osteogenesis (MDO). A retrospective analysis of pediatric patients with RS and functional temporomandibular joints who underwent MDO by a single surgeon was performed. Preoperative and postoperative computed tomography (CT) scans were morphometrically analyzed three-dimensional in 3-matic and Mimics (Materialise). Comparative analysis was performed using Wilcoxon signed-rank tests. Fourteen RS patients were included (28 condyles, 56 CT scans), 78% male and 22% females. The mean age at surgery was 9.4 weeks (range 1.6–46.7 weeks). The average age at initial CT was 5.3 days (range 0–11 days). The mean time interval for CT scan before MDO and after hardware removal were 8.8 ± 6.4 days and 11.2 ± 25.8 days, respectively. Rotatory changes of the condyle revealed a significantly decreased horizontal angle following MDO (–7.55°, 95% confidence interval –11.13° to –3.41°; P < 0.001). Anteroposteriorly, the angle between condylar process and ramus (incline) increased significantly (14.14°, 95% confidence interval 10.71°–19.59°; P < 0.001). Intragroup analysis revealed no difference between left versus right condylar position measurements. The condyle itself increased in size and length and the intercondylion distance increased post-MDO. There were no complications and all patients achieved relief of airway obstruction without tracheostomy. Morphologic and positional changes of the mandibular condyle following MDO in RS patients parallel changes that occur during normal development in non-RS patients. As a result, MDO may facilitate normal condylar morphology and function in RS patients.
Fan-Shaped Thin Fat Pedicles for Tear Trough Correction Through a Layer-Level Fixation: A Modified Transconjunctival Blepharoplasty
Authors: Cheng Liying , Sun Xiaoming , Ye Lingxiao , Chen Lu , Zhang Liucheng , Mao Xiyuan , Jin Rong , Zhang Lu , Zhang Yuguang , Zhang Ying
Published: February 2021

Fat repositioning is an effective way to treat tear trough deformity (TTD) in Asians. Recent techniques mainly focused on the fixation technique, whereas how to precisely shape and individually quantify the fat pedicle has been ignored. This article introduced an individualized, targeted, and tension-free technique to fabricate a fan-shaped thin septum fat pedicle for repositioning. Furthermore, a layer-level fixation method was advocated to provide sufficient, continuous, uninterrupted filling of the TTD. From January 1, 2009, to December 31, 2018, 492 patients underwent this procedure. Through a transconjunctival incision, a continuous fan-shaped, tension-free, customized septum fat pedicle was precisely designed to match the TTD anatomy. The pedicle could either be elongated, or thickened, or debulked, or translocated, to meet the patients’ individual needs. At the same time, a layer-level fat pedicle fixation technique was applied to fully interrupt the TTD. The mean operation time was 60 ± 9.3 minutes. All patients demonstrated a significant improvement with elimination of both eye bags and TTD. High satisfaction was noted among the patients. No obvious resorption of the fat pedicles was observed, and the lower lid contour improvements were durable. One infection occurred after 3 days of surgery, and was resolved by removal of the suture followed by topical application of iodine and oral antibiotics for 3 to 5 days. No other complications were observed. Precisely repositioning transconjunctival fat using a layer-level fixation technique with a fan-shaped thin fat pedicle under a subperiosteal plane is an effective, lasting, and safe approach for individually treating TTD.
Treatment of Facial Fractures at Safety-Net Hospitals: A National Analysis of Inpatient Burden and Cost
Authors: Musavi Leila S. , Chin Patrick , Pfaff Miles , Fadavi Darya , Aliu Oluseyi , Yang Robin
Published: February 2021

Purpose:

Safety-net hospitals (SNHs) are vital in the care of trauma populations, but little is known about the burden of facial trauma presenting to SNHs. The authors sought to characterize the presentation and treatment of facial fractures across SNHs and determine the association between SNH care and healthcare utilization in patients undergoing fracture repair.

Methods:

Adult patients presenting with a facial fracture as their primary admitting diagnosis from the year 2012 to 2015 were identified in the National Inpatient Sample. The “safety-net burden” of each hospital was defined based on the proportion of Medicaid and self-pay discharges. Patient factors analyzed were sex, race, age, income level, insurance status, fracture location, and comorbidities. Hospital factors analyzed were safety-net burden, teaching status, geographic region, bed size, and ownership status. The main outcomes were length of stay (LOS), hospital costs, time to repair, and postoperative complications.

Results:

Of 78,730 patients, 27,080 (34.4%) were treated at SNHs and 24,844 (31.6%) were treated at non-SNHs. Compared to non-SNHs, patients treated at SNHs were more likely to undergo operative repair at SNHs (65.8% versus 53.9%, P < 0.001). Overall mean LOS was comparable between non-SNH and SNH (3.43 versus 3.38 days, P = 0.611), as was mean hospital cost ($15,487 versus $15,169, P = 0.434). On multivariate linear regression, safety-net status was not a predictor of increased LOS, cost, or complications. However, safety-net status was significantly associated with lower odds of undergoing repair within 48 hours of admission (odds ratio 0.783, 95% confidence interval = 0.680–0.900, P = 0.001).

Conclusions:

Safety-net hospitals are able to treat facial trauma patients with greater injury burden and lower socioeconomic resources without increased healthcare utilization. Healthcare reform must address the financial challenges that endanger these institutions to ensure timely treatment of all patients.
Air-Evacuation-Relevant Hypobaria Following Traumatic Brain Injury Plus Hemorrhagic Shock in Rats Increases Mortality and Injury to the Gut, Lungs, and Kidneys
Authors: Proctor Julie L. , Medina Juliana , Rangghran Parisa , Tamrakar Pratistha , Miller Catriona , Puche Adam , Quan Wei , Coksaygan Turhan , Drachenberg Cinthia B. , Rosenthal Robert E. , Stein Deborah M. , Kozar Rosemary , Wu Feng , Fiskum Gary
Published: February 2021

Rats exposed to hypobaria equivalent to what occurs during aeromedical evacuation within a few days after isolated traumatic brain injury exhibit greater neurologic injury than those remaining at sea level. Moreover, administration of excessive supplemental O2 during hypobaria further exacerbates brain injury. This study tested the hypothesis that exposure of rats to hypobaria following controlled cortical impact (CCI)-induced brain injury plus mild hemorrhagic shock worsens multiple organ inflammation and associated mortality. In this study, at 24 h after CCI plus hemorrhagic shock, rats were exposed to either normobaria (sea level) or hypobaria (=8,000 ft altitude) for 6 h under normoxic or hyperoxic conditions. Injured rats exhibited mortality ranging from 30% for those maintained under normobaria and normoxia to 60% for those exposed to 6 h under hypobaric and hyperoxia. Lung histopathology and neutrophil infiltration at 2 days postinjury were exacerbated by hypobaria and hyperoxia. Gut and kidney inflammation at 30 days postinjury were also worsened by hypobaric hyperoxia. In conclusion, exposure of rats after brain injury and hemorrhagic shock to hypobaria or hyperoxia results in increased mortality. Based on gut, lung, and kidney histopathology at 2 to 30 days postinjury, increased mortality is consistent with multi-organ inflammation. These findings support epidemiological studies indicating that increasing aircraft cabin pressures to 4,000 ft altitude (compared with standard 8,000 ft) and limiting excessive oxygen administration will decrease critical complications during and following aeromedical transport.
The Addition of High-Technology Into the Stop the Bleed Program Among School Personnel Improves Short-Term Skill Application, Not Long-Term Retention
Authors: Jafri Farrukh N. , Dadario Nicholas B. , Kumar Anshul , Silverstein Samantha R. , Quintero Frank , Larsen Erik A. , Fasciglione Kimberly , Mirante Doreen , Ellsworth Kelly , Amicucci Bernadette , Ricca Joseph
Published: February 2021

Introduction

The Stop the Bleed (STB) program trains the general public on identifying and treating life-threatening bleeding. Data on efficacy and retention of skills taught through this program are limited, with the role of high-technology modalities to augment the program, such as simulation and feedback devices, untested.

Methods

A convenience sample of 66 school personnel participated in an open-label observational study from January to August 2019. The control group received the standard bleeding control course, while the intervention group received the bleeding control course with addition of a simulation and a feedback device for wound packing. Assessment was performed by STB instructors using performance metrics from prior studies as well as a feedback device. Retention testing was performed 2 to 8 months after intervention. The study was approved by the hospital's institutional review board.

Results

The intervention group performed better than the control group on correct tourniquet application [90.3% vs. 71.0%; odds ratio (OR) = 11.28; P = 0.015; 95% confidence interval (CI) = 1.86 to 104.67] wound packing scores (59.5% vs. 29.6%; OR = 0.33; P = 0.007; 95% CI = 9.36 to 56.00) and were more likely to assess their safety (OR = 5.49; P = 0.034; 95% CI = 1.28 to 27.66), and reported higher comfort scores on stepping into an emergency scenario (OR = 11.19; P = 0.004; 95% CI = 2.51 to 63.11), wound packing (OR = 5.16; P = 0.025; 95% CI = 1.35 to 22.46), and using a tourniquet (OR = 11.41; P = 0.003; 95% CI = 2.57 to 67.59). Thirty-one participants (46.9%) were assessed again at retention 2 to 8 months later where scores for tourniquet placement and wound packing were not significantly different in the two groups.

Conclusions

Augmenting STB with simulation and feedback improved both self-reported comfort level and skill set of participants, but the retention of skills was poor in both groups.
Clinical Significance of a Circulating Tumor Cell-based Classifier in Stage IB Lung Adenocarcinoma
Authors: Ren Lijuan , Zhong Xiaoming , Liu Wei , Xu Di , Lei Yiyan , Zhou Jianwen , Jiang Wenting , He Qiong , Sun Yu , Ke Zunfu
Published: February 2021

Objective:

To investigate the effectiveness of a CTC-based classifier in stratifying stage IB LUAD.

Summary of Background Data:

Stage IB LUADs have an approximately 70% 5-year survival rate. The clinical application of ACT is controversial due to inconsistent results in a series of trials and few useful guide biomarkers. Thus, there is a pressing need for robust biomarkers to stratify stage IB patients to define which group would most likely benefit from ACT. Methods: Two hundred twelve stage IB LUAD patients were enrolled and were divided into 3 independent cohorts. The aptamer-modified NanoVelcro system was used to enrich the CTCs.

Results:

A cutoff of <4 or >4 CTCs as the optimal prognostic threshold for stage IB LUAD was generated to stratify the patients in a 70-patient cohort into low-risk and high-risk groups. Patients with ≥ 4 CTCs in the training cohort had shorter progression-free survival (P < 0.0001) and overall survival (P < 0.0001) than patients with <4 CTCs. CTC number remained the strongest predictor of progression-free survival and overall survival even in a multivariate analysis including other clinicopathological parameters. Furthermore, a nomogram based on the CTC count was developed to predict the 3-year and 5-year survival in the training cohort and performed well in the other 2 validation cohorts (C-index: 0.862, 0.853, and 0.877).

Conclusion:

The presence of >4 CTCs can define a high-risk subgroup, providing a new strategy to make optimal clinical decisions for stage IB LUAD.