bluuebunny/crossref_metadata_2025 huggingface dataset:
Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: A case report
Authors: Taheri Zahra , Babaee Taher , Hajiaghaei Behnam , Mohammadi Hassan Reza
Published: April 2021

Case Description:

This is a report of a 2.5-month-old infant with bilateral lambdoid and sagittal synostosis who underwent minimally invasive suturectomy followed by cranial remolding orthosis (CRO).

Objectives:

To evaluate the result of minimally invasive suturectomy followed by CRO treatment in an infant with bilateral lambdoid and sagittal synostosis.

Study Design:

This is a case report.

Treatment:

We fabricated the orthosis based on a computer-aided design and with computer-aided manufacturing technology. Cranial remolding orthosis compliance was measured subjectively. The child's parents were asked to complete a survey using visual analog scales to assess their satisfaction of their child's head appearance, problems with donning/doffing the orthosis, and feedback received from other people.

Outcomes:

At the time of fitting, the posterior skull hemisphere volume was 389.4 cm3. The values of cephalic index and cranial vault asymmetry index (CVAI) were 81% and 5%, respectively. After 6 months of CRO treatment, the cephalic index and CVAI were 83% and 1.5%, respectively. Moreover, the posterior skull hemisphere volume was 589.2 cm3. Average compliance with CRO wear was 88%. According to the parental questionnaire results, pressure sores occurred 0% of the time, displacement occurred 15% of the time, contact dermatitis occurred 10% of the time, problems with donning/doffing of the orthosis occurred 27% of the time, difficulties in breastfeeding occurred 30% of the time, negative feedback from other people upset them 55% of the time, and they were 100% satisfied with treatment.

Conclusions:

After 6 months of using CRO, the CVAI and skull volume improved and reached their normal proportions. Our results may help ongoing research and clinical care regarding the role of postoperative CRO treatment in patients with complex synostosis.
Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension
Authors: Seth Mayank , Beisheim Emma Haldane , Spencer Maximilian Tobias , Horne John Robert , Sarlo Frank Bernard , Sions Jaclyn Megan
Published: April 2021

Background:

Improper suspension between the residual limb and prosthesis can result in pistoning, which may compromise skin integrity and reduce overall user comfort. In addition to objective measures of limb pistoning, user perspective may provide insight into suspension system effectiveness.

Objectives:

The primary objective of this analysis was to explore differences in self-reported measures among adults with transtibial amputation (TTA) using pinlock vs suction suspension systems.

Study Design:

This is a secondary analysis of cross-sectional data.

Methods:

Participants (n = 48) were included if they (1) were ≥18 years of age, (2) were community-dwelling, (3) had a unilateral TTA of ≥6 months, and (4) were prescribed a prosthesis with either pinlock or suction suspension. Participants completed self-reported measures evaluating socket comfort (Socket Comfort Score [SCS]), prosthesis-enabled mobility (Prosthesis Evaluation Questionnaire—Mobility Section [PEQ-MS]; Locomotor Capabilities Index [LCI]), and balance-confidence (Activities-Specific Balance Confidence Scale [ABC]).

Results:

Participants using suction suspension reported significantly higher SCS as compared with participants using pinlock suspension (P ≤ .001). No differences were observed between groups for PEQ-MS, LCI, and/or ABC.

Conclusions:

Individuals with TTA using suction suspension may report greater socket comfort than peers using pinlock suspension, but prosthesis-enabled mobility and balance-confidence may be similar. Future research is warranted to confirm these preliminary findings using a prospective, crossover study design that controls for all suspected factors that might influence socket comfort.
Locomotor activities of individuals with lower-limb amputation
Authors: Srisuwan Bantoon , Klute Glenn K.
Published: April 2021

Background:

Ambulatory individuals with lower-limb amputation perform a variety of locomotor activities, but the step count distribution of these activities is unknown.

Objective:

To describe a novel method for activity monitoring and to use it to count steps taken while walking straight ahead on level ground, turning right and left, up and down stairs, and up and down ramps.

Study Design:

This is an observational study.

Methods:

A portable instrument to record leg motion was placed on or inside the prosthetic pylon of 10 individuals with unilateral transtibial amputations. Participants first walked a defined course in a hospital environment to train and validate a machine learning algorithm for classifying locomotor activity. Participants were then free to pursue their usual activities while data were continuously collected over 1-2 d.

Results:

Overall classification accuracy was 97.5% ± 1.5%. When participants were free to walk about their home, work, and community environments, 82.8% of all steps were in a straight line, 9.0% were turning steps, 4.8% were steps on stairs, and 3.6% were steps on ramps.

Conclusion:

A novel activity monitoring method accurately classified the locomotion activities of individuals with lower-limb amputation. Nearly 1 in 5 of all steps taken involved turning or walking on stairs and ramps.
Effect of transfemoral prosthetic socket interface design on gait, balance, mobility, and preference: A randomized clinical trial
Authors: Kahle Jason T. , Miro Rebecca M. , Ho Loi T. , Porter Michael R. , Lura Derek J. , Carey Stephanie L. , Lunseth Paul , Swanson Ann E. , Highsmith M. Jason
Published: April 2021

Background:

There are alternative transfemoral (TF) socket interface designs that have not been compared with the standard of care, ischial ramus containment (IRC). The interface directly affects performance.

Objectives:

To compare 3 TF interface designs, IRC, dynamic socket (DS), and subischial (Sub-I), regarding gait, balance, mobility, and preference. The authors hypothesized that these more active users may experience gait, mobility, and preference benefits from the less intrusive DS and Sub-I interface designs.

Study Design:

Single-blind, repeated-measures, 3-period randomized controlled crossover clinical trial.

Methods:

People with unilateral TF amputation with 1 year or longer prosthesis use experience, independent community ambulatory status, 18 to 60 years of age, of any race or ethnicity, with a body mass of 45 to 125 kg, and with a self-reported ability to walk for 20 minutes continuously were included in the study. Each participant was fit in all 3 interface designs.

Results:

Thirteen participants completed the clinical trial. Velocity, cadence, mobility, and balance were not statistically different between the 3 socket conditions. The DS demonstrated significantly greater symmetry in swing, stance, single support percentage, and toe angle compared with IRC and Sub-I. Sixty days after study completion, 7 participants changed interfaces, trending away from IRC.

Conclusions:

Large differences were not observed. Small differences in spatiotemporal gait measures combined with patient preference may make a meaningful difference to individual patients and should be considered.
Structural determinants of HIV/STI prevalence, HIV/STI/sexual and reproductive health access, and condom use among immigrant sex workers globally
Authors: McBride Bronwyn , Shannon Kate , Strathdee Steffanie A. , Goldenberg Shira M.
Published: April 2021

Objective:

Given stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/sexually transmitted infection (STI) prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally.

Methods:

Systematic search of peer-reviewed studies published in English (2009–2019). Eligible studies reported HIV/STI, access to HIV/STI/SRH services, and/or condom use outcomes and/or lived experiences among ISWs. Quantitative and qualitative data were synthesized using a structural determinants framework.

Results:

Of 425 studies screened, 29 studies from 15 countries were included. HIV prevalence ranged from 0.3 to 13.6% and varied across settings, with highest prevalence among undocumented ISWs in a high-income country (Portugal). Precarious immigration status was a structural factor associated with poorer HIV/STI outcomes, whereas qualitative narratives showed ISWs’ lived experiences as strongly shaped by policing and stigma. Despite disparities, in some settings, HIV and STI prevalence were lower and odds of condom use with clients were higher among ISWs relative to non-im/migrant sex workers. This review identified a paucity of research on SRH and male and gender-diverse ISWs. Across legislative settings, criminalization of SW and im/migrant status, policing, and migration-related marginalization were prominent structural barriers to ISWs’ HIV/STI/SRH access.

Conclusion:

This review identified important inequities and variation in HIV/STI prevalence among ISWs globally. Our findings highlight impacts of the intersections of migration and criminalization, and suggest a need to reform criminalized sex work laws; address punitive policing and immigration enforcement; enable safer indoor work environments; and expand community-based interventions towards promoting HIV/STI/SRH access and health equity among ISWs.
HIV, hepatitis C virus and risk of new-onset left ventricular dysfunction in women
Authors: Shitole Sanyog G. , Lazar Jason M. , Hanna David B. , Kim Ryung S. , Anastos Kathryn , Garcia Mario J. , Tien Phyllis C. , Lima João A.C. , Kaplan Robert C. , Kizer Jorge R.
Published: April 2021

Background:

HIV and HCV have each been linked with cardiac dysfunction. Studies of HIV have often lacked appropriate controls and primarily involved men, whereas data for HCV are sparse.

Methods:

We performed repeat echocardiography over a median interval of 12 years in participants from the Women's Interagency HIV Study in order to evaluate the relationships of HIV and HCV with incident left ventricular (LV) dysfunction (systolic or diastolic).

Results:

Of the 311 women included (age 39 ± 9), 70% were HIV-positive and 20% HCV-positive. Forty three participants (13.8%) developed LV dysfunction, of which 79.1% was diastolic. Compared with participants with neither infection, the group with HIV--HCV coinfection showed a significantly increased risk of incident LV dysfunction after adjustment for risk factors [RR = 2.96 (95% CI = 1.05–8.31)], but associations for the HCV monoinfected and HIV monoinfected groups were not statistically significant [RR = 2.54 (0.83–7.73) and RR = 1.66 (0.65–4.25), respectively]. Comparison of HCV-positive and HCV-negative women showed a significantly increased risk independent of covariates [RR = 1.96 (1.02–3.77)] but this was not the case for HIV-positive vs. HIV-negative women [RR = 1.43 (0.76–2.69)]. There was no evidence of HCV-by-HIV interaction. A more restrictive definition of LV diastolic dysfunction led to fewer incident cases, but a similar, though nonsignificant, risk estimate for HCV.

Conclusion:

Among mostly middle-aged women, HCV but not HIV infection was associated with a pronounced risk of incident LV dysfunction. Although the influence of residual confounding cannot be excluded, these findings bolster the potential benefits that could be realized by adopting recent recommendations for expanding HCV screening and treatment.
Risk for incident diabetes is greater in prediabetic men with HIV than without HIV
Authors: Slama Laurence , Barrett Benjamin W. , Abraham Alison G. , Palella Frank J. , Kingsley Lawrence , Viard Jean Paul , Lake Jordan E. , Brown Todd T.
Published: April 2021

Background:

Diabetes mellitus is a major comorbidity in people with HIV (PWH). Hyperglycemia below diabetic range defines prediabetes (prediabetes mellitus). We compared the progression from prediabetes mellitus to diabetes mellitus in PWH and people without HIV (PWOH).

Methods:

Fasting glucose was measured semiannually in the MACS since 1999. Men with prediabetes mellitus (fasting glucose between 100 and 125 mg/dl, confirmed within a year by fasting glucose in the prediabetes mellitus range or HbA1c between 5.7 and 6.4%) were included. The first visit with prediabetes mellitus was the baseline visit. Incident diabetes mellitus was defined as fasting glucose at least 126 mg/dl, confirmed at a subsequent visit, or self-reported diabetes mellitus, or use of anti-diabetes mellitus medication. We used binomial transition models to compare the progression from prediabetes mellitus to diabetes mellitus by HIV serostatus, adjusted for age, number of previous prediabetes mellitus to diabetes mellitus transitions, ethnicity, BMI, family history of diabetes mellitus, and hepatitis C virus (HCV) infection.

Results:

Between 1999 and 2019, 1584 men (793 PWH; 791 PWOH) with prediabetes mellitus were included. At baseline, PWH were younger (48 vs. 51 years, P < 0.01), had lower BMI (26 vs. 27), were more frequently nonwhite (47 vs. 30%), and HCV-infected as per last measure (8 vs. 4%) than PWOH (all P < 0.01). Over a median 12-year follow-up, 23% of participants developed diabetes mellitus. In adjusted analyses, the risk for incident diabetes mellitus was 40% (95% CI: 0--80%) higher among PWH than PWOH (P = 0.04).

Conclusion:

Among men with prediabetes mellitus, PWH had an increased risk of incident diabetes mellitus adjusted for competing risk factors, warranting the evaluation of diabetes mellitus prevention strategies.
The Most Common Relationship of a Midface Fracture in Maxillofacial Trauma Study
Authors: Ahmad Wan Muhamad Amir W. , Noor Nor Farid Mohd , Shaari Ramizu , Nawi Mohamad Arif Awang , Ghazali Farah Muna Mohamad , Aleng Nor Azlida , Rohim Rabiatul Adawiyah Abdul , Alam Mohammad Khursheed
Published: April 2021

Oral and maxillofacial fractures are the most common injuries among multiple trauma. About 5% to 10% of trauma patients having facial fractures. The objectives of this case study are to focus the most common mid-face fractures types’ and to determine the relationship of the midface fracture in maxillofacial trauma among the patient who attended the outpatient clinic in a Hospital Universiti Sains Malaysia. In this research paper, an advanced statistical tool was chosen through the multilayer perceptron neural network methodology (MLPNN). Multilayer perceptron neural network methodology was applied to determine the most associated predictor important toward maxillary bone injury. Through the predictor important classification analysis, the relationship of each bone will be determined, and sorting according to their contribution. After sorting the most associated predictor important toward maxillary bone injury, the validation process will be applied through the value of training, testing, and validation. The input variables of MLPNN were zygomatic complex fracture, orbital wall fracture, nasal bone fracture, frontal bone fracture, and zygomatic arch fracture. The performance of MLPNN having high accuracy with 82.2%. As a conclusion, the zygomatic complex fracture is the most common fracture trauma among the patient, having the most important association toward maxillary bone fracture. This finding has the highest potential for further statistical modeling for education purposes and the decision-maker among the surgeon.
Epidemiological Profile and Clinical Stage at Presentation of Eyelid Malignancies in a Multi-Ethnic Country
Authors: Dias Maurílio Roriz , Osaki Midori H. , Ferreira Carlos Alberto A. , Conti Marina L. , Cho Sabrina , Nicolau Zaira , Osaki Tammy H.
Published: April 2021

Eyelid malignancies are frequently seen in clinical practice. There is a lack of studies that have assessed the features of these lesions in mixed population countries. The epidemiologic profile, clinical stage at presentation, management, and outcomes of patients with eyelid malignancies were assessed, in order to better understand the features of these lesions in a multi-ethnic country. The medical records of patients who underwent eyelid tumor excision in a tertiary service in Brazil, from 2014 to 2019 were retrospectively reviewed. It was recorded for each patient: age, gender, time of onset, location, diagnosis, management, and follow-up. The medical records of 298 patients who presented with eyelid tumors were evaluated and 67 (22.4%) were malignant. The mean age of patients with malignancies was 52.93 years and 50% were male. Basal cell carcinoma was the most prevalent (61.2%), followed by squamous cell carcinoma (SCC) (29.9%) and sebaceous gland carcinoma (3%). The average time it took from appearance to surgical treatment was 3 years; the lower eyelid was the most affected for both basal cell carcinoma and SCC; 70% of SCCs were locally invasive at presentation and metastasis occurred in 15%. Basal cell carcinoma was the most common eyelid malignancy observed, however, its frequency was lower when compared to other western countries. The advanced stage at presentation may reflect the lack of education of the population to seek early care, and the lack of specialized tertiary centers in remote areas, resulting in delayed diagnosis.
Use of Dorsal Nasal Flap in Combination With Nasolabial Perforator Propeller Flap for Reconstruction of Nasal Skin Defects of Medium to Large Size; A Simpler Alternative to Frontal Flap
Authors: Demiröz Anil , Yildiz Tuğba Feryal , Öner Mehmet Beşir , Ercan Alp , Karatan Berrak , Kömürcü Hasan
Published: April 2021

Nasal reconstruction is one of the most challenging procedures in plastic surgery. To get optimal aesthetic and functional results, the surgeon should know all the options well. Forehead flap is the gold standard technique for closure of medium to large defects of the nose. Although it provides a very good color and texture match, it may become a difficult option in patients with poor condition. The aim of this study was to define a simpler technique for nasal reconstruction using combined local flaps.

Twelve patients, operated using a dorsal nasal flap combined with a nasolabial perforator propeller flap, were presented in the study. Properties of the patients, defect size and locations, and complications were evaluated.

The mean size of the reconstructed defects was 10.1 cm2. No flap loss was observed. Venous congestion was the most common complication and resolved spontaneously in all cases. Two cases had partial distal necrosis, which also healed spontaneously.

Closure was achieved successfully in all cases with a medium to large nasal defect using a combined dorsal nasal flap and nasolabial perforator propeller flap. This method can be used as an alternative to forehead flap.
Double Eyelid Blepharoplasty With Palpebral Margin Incision in Asian Eyelids
Authors: Yang Xuan , Gu Zichun , Li Hua , Wang Zhengcai , Cai Jiaqin , Ma Jingjing
Published: April 2021

Background:

Double eyelid surgery is the most common plastic surgery in Asian women. The traditional full-incision method is widely used but leaves scars in the upper eyelid creases that are obvious when the eyes are closed, especially in Asians. Although the buried-suture method leaves no scars on the eyelids, it cannot be used to remove excess tissues or correct ptosis, which are common in Asian eyelids. Therefore, a palpebral margin incision technique has been developed. The aims of this study are to popularize this technology by presenting our clinical results of the palpebral margin incision technique and sharing our experience in details.

Methods:

This technique consists of 3 distinctive aspects:

Results:

This technique was performed in 112 Asian female patients, including 101 with a skin excision and 11 with no skin excision. The follow-up period was 1 year. Most (98.2%) of the patients gave good evaluations, reporting perfect curves of the upper eyelid folds and bilateral symmetry. No significant complications or apparent scarring occurred in any patients.

Conclusions:

The palpebral margin incision technique has even broader indications than the traditional full-incision method and overcomes the disadvantages of traditional full-incision methods such as visible scars when the eyes are closed and damage to the vasoganglion and lymphatic capillary net, resulting in severe swelling. This method is suitable for patients of any age with any type of eyelid and can achieve a natural and stably lasting double eyelid and more desired cosmetic effect.
Pediatric Facial Fractures in South Australia: Epidemiology, Clinical Characteristics, and Outcomes
Authors: Diab Jason , Flapper Walter J. , Grave Benjamin , Anderson Peter J. , Moore Mark H.
Published: April 2021

Introduction:

Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia.

Methods:

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study.

Results:

A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P < 0.05). Boys were 2.3 times more likely to have a sport-related facial fracture than girls. Early adolescence were 5.2 times more likely to have an orbitozygomatic fracture than children of early childhood (P < 0.05). Age, associated injuries, and sport-related facial fractures were independently associated with increased length of stay (P < 0.001).

Conclusions:

There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.
Quadrant Excision of Benign Lesions: A Prospective Outcome Study of Pediatric Patients
Authors: Sepehripour Sarvnaz , Lloyd Mark S.
Published: April 2021

Serial excision is a commonly used technique for the excision of large lesions. The procedure in children is challenging due to different skin quality and unpredictable scar patterns compared to adults. Quadrant excision is a modification of serial excision. The authors report quadrant excisions in 3 pediatric cases with facial congenital melanocytic naevi in aesthetically challenging areas. Based on our results we recommend the use of this technique in similar cases.
The Surgical Treatment of Robin Sequence: Neonatal Mandibular Distraction Osteogenesis in the Unfavorable Patient
Authors: Shen Chen , Wang Maxime M. , Eisemann Bradley T. , Rodriguez Alcibiades J. , Rickert Scott M. , Flores Roberto L.
Published: April 2021

Introduction:

Neonates with severe Pierre Robin sequence (PRS) can be treated by mandibular distraction osteogenesis (MDO), tongue-lip adhesion, or tracheostomy; however, there is an active debate regarding the indications of MDO in this patient population. Published algorithms identify tracheomalacia, bronchomalacia, laryngomalacia, hypotonic syndromes, and central sleep apnea as contraindications for MDO and indications for tracheostomy, but these comorbidities may exist along a spectrum of severity. The authors propose that appropriately selected neonates with PRS who concurrently express 1 or more of these traditional contraindications may be successfully treated with MDO.

Methods:

The authors performed a 5-year retrospective chart review of all neonates who underwent MDO for treatment of severe PRS. All patients expressed a comorbidity previously identified as an indication for tracheostomy. Pre- and postoperative characteristics were recorded. Apnea/hypopnea index (AHI) before and after MDO were compared using 2-tailed repeated measures t-test.

Results:

The authors identified 12 patients with severe PRS and conditions associated with contraindications to MDO: 9 (75.0%) patients had laryngomalacia, 6 (50.0%) patients had tracheomalacia, 2 (16.6%) patients had bronchomalacia, 1 (8.3%) patient had central sleep apnea, and 3 (25.0%) patients had hypotonia. Five (41.7%) patients underwent concurrent gastrostomy tube placement due to feeding insufficiency. Average birthweight was 3.0 kg. Average pre-op AHI was 34.8. Average post-op AHI was 7.3. All patients successfully underwent MDO with avoidance of tracheostomy.

Conclusions:

By employing an interdisciplinary evaluation of patient candidacy, MDO can safely and effectively treat upper airway obstruction and avoid tracheostomy in higher-risk neonatal patients with traditional indications for tracheostomy.
Using 3D Printing and Mirror Image Modeling in Orbital Floor Reconstruction
Authors: Akiki Ronald K. , Jehle Charles C. , Crozier Joseph , Woo Albert S.
Published: April 2021

Three-dimensional (3D) modeling and printing technologies are increasingly utilized as tools to assist in complex craniofacial reconstructions. Herein, the authors report the intraoperative use of sterilized 3D models printed in-house to mold a custom resorbable implant in the case of a pediatric patient with a unilateral complex orbital fracture. The imaging was processed with open-source software. Two patient-specific orbital models were 3D-printed (Fig. 2): a life-size print of the patient's preoperative CT scan and a left orbit reconstructed to resemble its uninjured state using mirrored-imaging of the uninjured side. This construct ultimately served as a sterilized template to mold a resorbable implant intraoperatively. Post-operatively, the patient experienced no complications. At the 18-month follow-up, the patient had done well without diplopia, headaches or visual problems. The authors report a case of a successful orbit reconstruction assisted by mirrored-image computer modeling and patient-specific 3D printing.
Ultrasound Diagnosis of Prenatal Cleft Lip: How Does Its Accuracy Affect the Family?
Authors: Sasson Daniel C. , Rokni Alex M. , Shah Nikhil D. , Yuksel Selcen S. , Park Eugene , Gosain Arun K.
Published: April 2021

Factors impacting the accuracy of ultrasound (US) diagnosis of cleft lip (CL) and its subsequent effect on parents are not well understood. Our objectives were to evaluate how the type of CL (complete versus incomplete) and associated cleft palate affect the accuracy of CL's prenatal diagnosis and to evaluate differences between parents’ perception of prenatal US in cases of true-positive versus false-negative results. The authors performed a retrospective review of all patients who underwent repair for nonsyndromic CL following prenatal US. Patients were stratified by type of CL and associated cleft palate. Parents were called to determine if their child's CL was diagnosed via US and their perception of the results. Forty-seven children with complete and 40 with incomplete CL responded to phone calls. The presence of a complete CL (P = 0.001) and an associated cleft palate (P = 0.014) were independently associated with an increased likelihood of prenatal diagnosis. Parents who received a true-positive prenatal diagnosis of CL were more satisfied than those who received a false-negative diagnosis (P = 0.0063). True-positives perceived knowing of their child's diagnosis in advance to be more helpful than false-negatives believed it would have been. These results afford an improved context to interpret US studies and help physicians provide more informed prenatal counseling.
The Silicone Turkish Delight for Dorsal Augmentation in Rhinoplasty
Authors: Richardson Sunil , Khandeparker Rakshit Vijay Sinai , Dhara Vasantha , Diwaker Meghali
Published: April 2021

Rhinoplasties are the most challenging facial aesthetic procedures with the majority of the cases requiring dorsal augmentation either in the form of autogenous or alloplastic materials. Although autogenous grafts are the gold standard, these grafts have their innate issues such as donor site morbidity, occasional displacement, resorption, tendency to warp or develop sharp edges over time with increased perceptibility and clinical visibility of the graft with time. These issues were addressed by Erol in 2000 who advocated the use of finely diced autologous cartilage wrapped in a monolayer of surgical and termed it Turkish delight. This technique has been extensively modified by surgeons across the world with an attempt to forgo the use of autogenous grafts preventing donor site morbidity and replacing it with alloplastic materials. Silicon's inert nature, resorption resistance, absence of a secondary surgical site and economical value make it a widely utilized allograft augmentation option in Asian countries. The authors hereby present a modification of the original Turkish delight technique by utilizing diced silicone pieces amalgamated with 1 to 2 ml of autologous blood and wrapped in monolayer of surgicel (oxidized cellulose). The technique produced clinically stable results in 27 patients who were followed up for a period of 24 to 60 months (average 30 months). Improved pliability, negated risk of graft extrusion with no donor site morbidity are the key advantages of this technique over conventional autologous grafts and silicon block augmentation techniques. These results point towards the viability of the technique for performing dorsal augmentation in rhinoplasty.
A Comparative Assessment of Scars Resulting From Skin Grafts in Facial Defects
Authors: Seo Du-Heon , Shin Jin Yong , Roh Si-Gyun , Chang Suk Choo , Lee Nae-Ho
Published: April 2021

Purpose:

The authors compared facial scars after split-thickness skin grafts (STSGs) performed with a dermal substitute or after full-thickness skin grafts (FTSGs) in facial defect.

Materials and Methods:

The medical records of patients who had undergone FTSG or STSG with dermal substitute after skin cancer surgery between March 2016 and December 2018 were retrospectively reviewed. The scars resulting from skin grafts were assessed using the patient and observer scar assessment scales (PSAS and OSAS) in our clinic after a minimum of 6 months postoperatively.

Results:

Of the 50 study subjects, 35 patients (FTSG group) received FTSG only and 15 patients (STSG group) received STSG with the dermal substitute. The total scores of PSAS and OSAS were significantly lower in the FTSG group and it is suggested that both patients and observers thought that better scar outcomes were achieved when FTSGs were used. However, for defects smaller than 1.8 cm2 and defects located in the periorbital area, there was no statistically significant difference in the scores of PSAS and OSAS in the 2 groups. Interestingly, for defects located in the periorbital area, although there was no significant difference, PSAS and OSAS scores were lower in the STSG group than in the FTSG group. In other word, scar outcomes in the STSG group were better.

Conclusions:

Although there was no significant difference, unlike what we usually know, our result shows that STSG with dermal substitute tended to produce comparable or rather better results than FTSG under some conditions.
Not Just Bystanders: A Qualitative Study on the Vicarious Effects of Surgical Training on the Wellness of Support Persons for Trainees
Authors: Evans Julie , Kemp Michael T. , Rivard Samantha J. , Sharma Sriganesh B. , Williams Aaron M. , Coleman Dawn , Dimick Justin , Sandhu Gurjit
Published: April 2021

Objective:

To obtain insights into the effects of surgical training on the well-being of support persons.

Summary Background Data:

Surgical trainee wellness is a critical priority among surgical educators and leaders. The impact of surgical training on the wellness of loved ones who support trainees has not been previously studied.

Methods:

This qualitative study employs semi-structured interviews of 32 support persons of surgical trainees at a single tertiary care center with multiple surgical specialty training programs. Interviews focused on perceptions about supporting a surgical trainee. Transcripts underwent thematic analysis with semantic and conceptual coding. Key themes regarding the effects that caring for a trainee has on support persons are reported.

Results:

Three key themes were identified: (1) Sacrifices—support persons report significant tangible and intangible sacrifices, (2) Delaying life—life is placed on hold to prioritize training, and (3) A disconnect—there is a disconnect and a lack of recognition of support person needs that require greater awareness and targeted interventions.

Conclusions:

The impact of surgical training can extend beyond trainees and can affect the wellness of their support persons who endure the effects of training alongside trainees. Programs should be aware of these effects and develop meaningful strategies to aid trainees and their support persons.
Randomized Controlled Trial Comparing the Short-term Outcomes of Enhanced Recovery After Surgery and Conventional Care in Laparoscopic Distal Gastrectomy (GISSG1901)
Authors: Tian Yulong , Cao Shougen , Liu Xiaodong , Li Leping , He Qingsi , Jiang Lixin , Wang Xinjian , Chu Xianqun , Wang Hao , Xia Lijian , Ding Yinlu , Mao Weizheng , Hui Xizeng , Shi Yiran , Zhang Huanhu , Niu Zhaojian , Li Zequn , Jiang Haitao , Kehlet Henrik , Zhou Yanbing
Published: April 2021

Objective:

This study aimed to compare the effects of ERAS and conventional programs on short-term outcomes after LDG.

Summary of Background Data:

Currently, the ERAS program is broadly applied in surgical areas. Although several benefits of LDG with the ERAS program have been covered, high-level evidence is still limited, specifically in advanced gastric cancer.

Methods:

The present study was designed as a randomized, multicenter, unblinded trial. The enrollment criteria included histologically confirmed cT2-4aN0-3M0 gastric adenocarcinoma. Postoperative complications, mortality, readmission, medical costs, recovery, and laboratory outcomes were compared between the ERAS and conventional groups.

Results:

Between April 2019 and May 2020, 400 consecutive patients who met the enrollment criteria were enrolled. They were randomly allocated to either the ERAS group (n = 200) or the conventional group (n = 200). After excluding patients who did not undergo surgery or gastrectomy, 370 patients were analyzed. The patient demographic characteristics were not different between the 2 groups. The conventional group had a significantly longer allowed day of discharge and postoperative hospital stay (6.96 vs 5.83 days, P < 0.001; 8.85 vs 7.27 days, P < 0.001); a longer time to first flatus, liquid intake and ambulation (3.37 vs 2.52 days, P < 0.001; 3.09 vs 1.13 days, P < 0.001; 2.85 vs 1.38 days, P < 0.001, respectively); and higher medical costs (6826 vs 6328 $, P = 0.027) than the ERAS group. Additionally, patients in the ERAS group were more likely to initiate adjuvant chemotherapy earlier (29 vs 32 days, P = 0.035). There was no significant difference in postoperative complications or in the mortality or readmission rates. Regarding laboratory outcomes, the procalcitonin and C-reactive protein levels on postoperative day 3 were significantly lower and the hemoglobin levels on postoperative day 5 were significantly higher in the ERAS group than in the conventional group.

Conclusion:

The ERAS program provides a faster recovery, a shorter postoperative hospitalization length, and lower medical costs after LDG without increasing complication and readmission rates. Moreover, enhanced recovery in the ERAS group enables early initiation of adjuvant chemotherapy.
Utilization of Laparoscopic Choledochoscopy During Bile Duct Exploration and Evaluation of the Wiper Blade Maneuver for Transcystic Intrahepatic Access
Authors: Nassar Ahmad H.M. , Gough Vivienne , Ng Hwei J. , Katbeh Tarek , Khan Khurram
Published: April 2021

Objective:

This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy.

Summary of Background Data:

Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic exploration.

Methods:

The indications, techniques, and operative and postoperative data on choledochoscopy collected prospectively during transcystic and choledo- chotomy explorations were analyzed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochoscopes.

Results:

Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during 1320 bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilized more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts, and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. Twenty retained stones (2.1%) were encountered but no choledochoscopy related complications.

Conclusions:

Choledochoscopy should always be performed during a chol- edochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilized in over 50% of explorations, increasing their rate of success. When attempted, the transcystic WBM achieves intrahepatic access in 70%-80%. It should be part of the training curriculum.
Native American Caregivers' Developmental Priorities for Young Children
Authors: Ferris Kyliah Petrita , Guiberson Mark , Bush Erin J.
Published: April 2021

Native American tribes and families are highly pluralistic in their ideologies, beliefs, traditions, and values. Very little research has described the parenting and child-rearing beliefs of Native American caregivers. The purpose of this study was to gain an understanding of Native American caregivers' developmental priorities and preferences regarding their young children's development. Participants included 21 Native American caregivers from a reservation in the Mountain West region of the United States. Ethnographic interviewing techniques described by C. E. Westby (1990) were used to collect caregiver perspectives. Through the use of a naturalistic inquiry paradigm, the process of template analysis was used to organize concepts and identify central themes and subthemes regarding caregivers' priorities and preferences for their children's development. The following 4 themes were identified: (a) supporting Native culture and language preservation, (b) teaching preacademic skills, (c) acquiring social and emotional competence, and (d) teaching self-care and independence. Clinical implications based on these themes and subthemes are discussed in the context of intervention with young Native American children and their families.
Culturally Responsive Language and Literacy Instruction With Native American Children
Authors: Gillispie Matthew
Published: April 2021

Many American Indian education leaders advocate for the need to combine evidence-based reading instruction with cultural-based educational practices. In the broader education literature, education philosophers propose analogous models such as culturally responsive teaching to meet the educational realities of diverse students. Culturally Responsive Early Literacy Instruction (CRELI) was a project funded by the U.S. Office of Special Education Programs to train graduate scholars in speech–language pathology to work with American Indian/Alaska Native communities. The grant scholars and staff of CRELI worked with two early childhood education centers for American Indian preschoolers and developed curriculum units that featured culturally relevant storybooks as thematic centerpieces and activities to facilitate early language and literacy development. This clinical tutorial summarizes this work, broader components of culturally responsive teaching, and attributes of language-focused literacy curriculum and differentiated instruction, followed by a sample curriculum unit to demonstrate application of culturally responsive teaching concepts.
Production of Narratives by At-Risk American Indian Children in the Midwest
Authors: McConnell Grace E. , Loeb Diane
Published: April 2021

The narratives of two groups of 28 American Indian children attending a Midwestern Bureau of Indian Affairs school (16 with a mean age of 5;10 years, and 12 with a mean age of 7;8 years) were examined in three contexts: retell, fictional with sequence pictures, and fictional with one picture. The narratives were examined in terms of microstructure (e.g., total number of utterances, total number of words, total number of communication units, and mean length of utterance in words and morphemes), macrostructure, and evaluative elements, which are used by speakers to link events, comment on events and characters, and inform the listener on how to interpret the story. Differences among story task contexts also were evaluated. The narratives of American Indian students differed between age groups and across tasks. The older children produced narratives with longer mean length of utterances in morphemes and more evaluative elements. The older children also produced more end-at-high-point stories, whereas the younger children produced more chronological narratives. Both age groups responded with longer and more complex narratives when generating fictional stories with visual support. Clinical implications are provided for adjusting narrative assessment tasks to be more culturally appropriate for children by modifying the task demands, increasing the role of the listener, and adding cultural relevance to stories.
Cardiac MicroRNA Expression Profile After Experimental Brain Death Is Associated With Myocardial Dysfunction and Can Be Modulated by Hypertonic Saline
Authors: Ferreira Ludmila Rodrigues Pinto , Correia Cristiano Jesus , Zanoni Fernando Luiz , Carvalho-Silva Ana Carolina , Zaniratto Ricardo , da Silva Cândido Darlan , Almeida Rafael Ribeiro , Breithaupt-Faloppa Ana Cristina , Cunha-Neto Edecio , Moreira Luiz Felipe P.
Published: April 2021

Background.

Brain death (BD) is associated with systemic inflammatory compromise, which might affect the quality of the transplanted organs. This study investigated the expression profile of cardiac microRNAs (miRNAs) after BD, and their relationship with the observed decline in myocardial function and with the changes induced by hypertonic saline solution (HSS) treatment.

Methods.

Wistar rats were assigned to sham-operation (SHAM) or submitted to BD with and without the administration of HSS. Cardiac function was assessed for 6 h with left ventricular (LV) pressure-volume analysis. We screened 641 rodent miRNAs to identify differentially expressed miRNAs in the heart, and computational and functional analyses were performed to compare the differentially expressed miRNAs and find their putative targets and their related enriched canonical pathways.

Results.

An enhanced expression in canonical pathways related to inflammation and myocardial apoptosis was observed in BD induced group, with 2 miRNAs, miR-30a-3p, and miR-467f, correlating with the level of LV dysfunction observed after BD. Conversely, HSS treated after BD and SHAM groups showed similar enriched pathways related to the maintenance of heart homeostasis regulation, in agreement with the observation that both groups did not have significant changes in LV function.

Conclusions.

These findings highlight the potential of miRNAs as biomarkers for assessing damage in BD donor hearts and to monitor the changes induced by therapeutic measures like HSS, opening a perspective to improve graft quality and to better understand the pathophysiology of BD. The possible relation of BD-induced miRNA’s on early and late cardiac allograft function must be investigated.
Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims
Authors: Lentine Krista L. , Lam Ngan N. , Caliskan Yasar , Xiao Huiling , Axelrod David A. , Costa Salvatore P. , Levine Deborah J. , Runo James R. , Te Helen S. , Rangaswami Janani , Dadhania Darshana M. , Schnitzler Mark A. , Kasiske Bertram L. , Villines Todd C.
Published: April 2021

Background.

The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described.

Methods.

We linked US transplant registry data with Medicare claims (2006–2016) to investigate P-HTN diagnoses among Medicare-insured KTx recipients (N = 35 512) using billing claims. Cox regression was applied to identify independent correlates and outcomes of P-HTN (adjusted hazard ratio [aHR] 95%LCLaHR95%UCL) and to examine P-HTN diagnoses as time-dependent mortality predictors.

Results.

Overall, 8.2% of recipients had a diagnostic code for P-HTN within 2 y preceding transplant. By 3 y posttransplant, P-HTN was diagnosed in 10.310.6%11.0 of the study cohort. After adjustment, posttransplant P-HTN was more likely in KTx recipients who were older (age ≥60 versus 18–30 y a HR, 1.912.403.01) or female (aHR, 1.151.241.34), who had pretransplant P-HTN (aHR, 4.384.795.24), coronary artery disease (aHR, 1.051.151.27), valvular heart disease (aHR, 1.221.321.43), peripheral vascular disease (aHR, 1.051.181.33), chronic pulmonary disease (aHR, 1.201.311.43), obstructive sleep apnea (aHR, 1.151.281.43), longer dialysis duration, pretransplant hemodialysis (aHR, 1.171.371.59), or who underwent transplant in the more recent era (2012–2016 versus 2006–2011: aHR, 1.291.391.51). Posttransplant P-HTN was associated with >2.5-fold increased risk of mortality (aHR, 2.572.843.14) and all-cause graft failure (aHR, 2.422.642.88) within 3 y posttransplant. Outcome associations of newly diagnosed posttransplant P-HTN were similar.

Conclusions.

Posttransplant P-HTN is diagnosed in 1 in 10 KTx recipients and is associated with an increased risk of death and graft failure. Future research is needed to refine diagnostic, classification, and management strategies to improve outcomes in KTx recipients who develop P-HTN.