bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Functioning in Adolescents with Idiopathic Scoliosis
Authors: Alamrani Samia , Rushton Alison B. , Gardner Adrian , Bini Elena , Falla Deborah , Heneghan Nicola R.
Published: January 2021

Study Design.

A systematic review.

Objective.

To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS).

Summary of Background Data.

The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice.

Methods.

A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS; using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach.

Results.

Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence).

Conclusion.

Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in individuals with AIS.

Level of Evidence: 2
Significant Sleep Dysregulation in a Toddler With Developmental Delay
Authors: Stein Martin T. , Owens Judith , Abbott Myles
Published: January 2021

CASE:

Derrick's parents made an appointment with a new pediatrician for a second opinion about disordered sleep. Now 22-months old, he was evaluated at 18 months of age for developmental delay when he was found to have “a regulatory disorder associated with delays in language and motor development, hypotonia and significant sleep problems.” The parents are now most concerned about his sleeping pattern. Prolonged sleep onset and frequent night awaking occur each night since 6-months of age. These problems are more severe in the past few months when he awakes screaming and cannot be settled. The awakening episodes occur 2 to 4 times each night when “he screams and thrashes his body for up to an hour.” Daytime tantrums increased. After the parents read a book about sleep in young children, they provided a calm atmosphere at bedtime including a dark room and singing a quiet lullaby. When these changes did not alter sleep, they purchased a vibrating mattress which was also unsuccessful.

Derrick was born full term after an uncomplicated prenatal and perinatal course. He sat at 10 months, crawled at 12 months, and walked at 18 months. He currently drinks from a sippy cup and he can use a utensil to eat. He has few words saying only “no” and “mama” in the past month. Imitation of some words occurred recently. He has responded to simple directions in the past 2 months. Derrick passed the newborn audiology screen. He does not have difficulty swallowing and he does not drool. He plays with many different toys and he plays in parallel with his older brother who also experienced delays in motor and language development. His brother is now doing very well in school. There is no family history of cognitive delay, seizure disorder, cerebral palsy, early developmental delay (other than the brother) or a significant sleep problem.

Physical examination:

head circumference, length and weight (75th percentile). He had mild generalized hypotonia, mild weakness, 2+ symmetrical deep tendon reflexes, and absence of ankle clonus. His gait was slightly wide based, steady, and without a limp. Neither ataxia nor drooling was observed. He was easily engaged in play with the examiner without evidence of irritability. The remainder of the examination was normal.
Can a Pediatrician Effectively Treat a 9-Year-Old Obese Girl?
Authors: Rhee Kyung (Kay) , Boutelle Kerri , McKenna Matthew , Stein Martin T.
Published: January 2021

CASE:

Maria is a 9-year-old Latina girl who was followed up by her pediatrician since birth with normal developmental milestones, good school achievement, and without significant medical problems. She was not in the pediatric office for the past 3 years. At the age of 9 years, she presented for a health supervision visit. Her pediatrician looked at her growth chart-90 pounds (95th percentile) and height 52 inches (50th percentile)-that confirmed a clinical impression of obesity on physical examination. Her body mass index was 23.4 (>95th percentile for age).

During 10 years in primary care pediatric practice, the pediatrician typically prescribed a management plan for obese school-aged and adolescent patients that started with parent and child education about potential health problems associated with obesity followed by a recommendation to decrease the caloric intake and encourage active exercise each day. She then arranged for follow-up visits to monitor weight and adherence to the management plan. However, a moment of self-refection suggested that most of her patients did not follow her advice in a sustained way. Obesity persisted in most cases. The pediatrician wondered if there was an alternative-better yet, evidence-based—approach to pediatric obesity that might provide a better outcome.
Sudden Onset of Refusal to Eat on Waking After a Nightmare in a 6-Year-Old Girl
Authors: Zaccagnino Maria , Gahagan Sheila , Spencer Andrea , Jellinek Michael , Stein Martin T.
Published: January 2021

CASE:

Bridgette is a 6-year-old girl, who presented with sudden onset of refusal to eat or drink. The only precipitating event was a nightmare the previous night. She described a dream in which her mother and maternal aunt, dressed as witches, and father and maternal uncle, appearing as bats, wanted to kill her by making her eat and drink from a cauldron. Bridgette stated, “I can't eat anymore, I'm afraid of dying.” Bridgette's eating pattern and behavior were described as previously normal. Motor, social, and language milestones were also normal. Her parents reported that she occasionally refused nonpreferred foods, and they believed that her food intake had decreased at age 4 years. She was a full-term infant without perinatal problems and breast fed until 8 months. Her medical history was significant for strabismus surgery, before 6 months. Her mental health history revealed mildly depressed mood and irritability related to teasing at school after her strabismus surgery. Her parents described her as “always looking for attention.” Her teachers reported that she had normal intelligenceand described her behavior as shy, slightly withdrawn, and distrustful. Social history revealed an only child of married parents without marital or work-related problems. Bridgette went to her maternal grandmother's home after school and during school holidays.

Her parents pleaded with her to eat, but she refused. She was evaluated at urgent care where her physical examination was described as normal. Her body mass index was above the 97th percentile (3 SD above the mean). The parents were described as fearful and despairing. Laboratory tests included a complete blood count with differential, an electroencephalogram, and a computed tomography scan, all of which were normal. Intravenous fluids were administered on the day of presentation and the following day. She continued to refuse to eat or drink, and after 2 days, she was hospitalized for nasogastric tube feeding.
An Ethical Conflict Between Parents and Clinician in a Child with a Language Delay
Authors: Gupta Vidya Bhushan , Brosco Jeffrey P. , Patel Nidhip , Braddock Adam , Stein Martin T.
Published: January 2021

CASE: A developmental-behavioral pediatrician evaluated a 2-year-old child for developmental delays. He determined that the child had mild expressive language delays; the child had an intelligible vocabulary of 20 words and at least 20 other words that he said unclearly. He said a few contracted 2-word phrases, such as “gimme” and “its ok.” He was shy and generally clung to his parents who spoke softly and very little. His development in all other domains was normal. Hearing evaluation and the neurological examination were normal.

The pediatrician provided suggestions to the parents in order to stimulate language and scheduled a follow-up appointment in 3 months. The parents asked him to refer the child for early intervention and write a letter to the US Immigration and Naturalization Service. They asked that the letter state that the child had a disabling condition and returning the child and his family to their country of origin would cause permanent harm to the child. The parents then gave the pediatrician a draft of a letter that had been prepared by an immigration lawyer.

The physician explained to the parents that the child had a mild expressive language delay and that he would like to see the child again in 3 months before deciding on early intervention. He advised them to obtain a copy of his medical note from the medical records department. The parents insisted that he write the letter and got upset and called him “heartless” when the physician refused to write the letter.
Reconstruction of Severe Palm Injury with Sensate Medial Plantar Artery Flap and Nerve Grafting
Authors: Padovano William M. , Hill Elspeth J. R. , Felder John M.
Published: January 2021

A 28-year-old, healthy man presented with an abrasion injury of the left palm, including a full-thickness glabrous skin defect, an open injury of the carpal tunnel with 50% transection of the median nerve, and a multilevel traction/avulsion injury of the thenar motor branch. He underwent repair with a free medial plantar artery flap, nerve transfer of the palmar cutaneous nerve to the medial plantar cutaneous nerve, grafting of the median nerve, and direct neurotization of the thenar muscles via an end-to-side nerve graft from the median nerve. At 8 months postoperative, both donor and recipient areas had healed completely, and the patient had regained meaningful 2-point discrimination of the palm and fingers, achieved innervation of the thenar muscles, and returned to work as a cook.
Subtotal Mandible Reconstruction with a Free Fibula Flap and No Skin Incisions
Authors: Lim Soobin , Mulloy Clairissa D. , Stern-Buchbinder Zachary , St. Hilaire Hugo , Stalder Mark W.
Published: January 2021

Resection of large mandibular tumors followed by primary reconstruction using free tissue transfer is typically accomplished using transcutaneous cervical incisions, which provide access for ablation as well as inset of the osseous free flap. This approach offers wide exposure; however, it subjects the patient to potential facial scarring, marginal mandibular nerve injury, lip deformity/incompetence, formation of orocutaneous fistulae, as well as functional impairments to speech, mastication, and deglutition. To reduce morbidity and to preserve aesthetics, a transoral approach can be used in cases that do not require a neck dissection. This technique can be coupled with transoral dissection of the facial vessels for intraoral microanastomoses to avoid extraoral incisions altogether. We present a case of a large 17.2 cm subtotal mandibulectomy and 3-segment fibular free flap reconstruction using virtual surgical planning, with patient-specific cutting guides and reconstruction plate performed entirely transorally without any skin incisions. Although technically challenging, this is a safe and effective technique for large segmental mandibular defects, which provides superior cosmetic and functional outcomes.
Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction
Authors: Diaz-Abele Julian , Padalko Adam , Dalke Kimberly , Brichacek Michal , Buchel Edward W.
Published: January 2021

Background:

Acellular dermal matrix (ADM) in direct-to-implant breast cancer reconstruction is the standard of care due to superior cosmetic results and decreased capsular contracture, but can be cost prohibitive. Although more economical, using patient’s own dermis (“Autoderm”) instead of ADM has undescribed sterility. Sterility is essential, as bacterial contamination may cause infection and capsular contraction. This study aimed to determine the sterility and optimal decontamination protocol of Autoderm.

Methods:

A prospective controlled study of 140 samples from 20 DIEP (deep inferior epigastric perforator) breast cancer reconstruction patients was performed. Seven de-epithelialized dermal samples (2 × 1 cm) per patient were collected from excess abdominal tissue (6 decontamination protocols and one control). Samples were submerged in povidone-iodine, chlorhexidine, or cefazolin/tobramycin/bacitracin for 15 minutes; half of the samples were agitated (150 rpm) for 15 minutes, and half were not. The control was normal saline without agitation. The solution was removed, and the tissue was sent for aerobic colony count cultures. Patient’s demographic data and complications were also collected.

Results:

Of 140 samples, 3 of 20 non-agitated povidone-iodine and 1 of 20 control samples had aerobic bacterial growth. All of the other 100 samples from 5 experimental groups (povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation) had no aerobic bacterial growth.

Conclusions:

This study suggests povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation are effective at sterilizing de-epithelialized dermis, whereas povidone-iodine without agitation and saline are ineffective. Autoderm with the appropriate decontamination protocol may be a potential sterile alternative to ADM.
Education during Surgical Outreach Trips in Vietnam: A Qualitative Study of Surgeon Learners
Authors: Billig Jessica I. , Nasser Jacob S. , Chung William H. J. , Huynh Kristine A. , Chung Kevin C.
Published: January 2021

Background:

Visiting educator trips teach surgical care in low-resource settings to develop sustainable global surgery. Surgery has been integral in these volunteer activities, but it is unknown whether surgeon learners receive suitable education during these trips. We sought to describe the educational experiences of surgeon learners during a visiting educator trip to better understand the perceptions of surgical outreach education.

Methods:

We conducted semistructured interviews of 18 surgeon learners participating in a visiting educator trip to 2 hospitals in Thai Nguyen, Vietnam. Each interview was conducted in Vietnamese, translated into English, and transcribed. Narratives were content coded using thematic analyses.

Results:

We identified 3 main themes. First, participants noted the value in surgical outreach and believed that these trips provided a thorough understanding of surgical care from patient evaluation to complications management. Second, participants described key barriers to education. Participants desired to focus on “learning one topic in depth” rather than learning in breadth. Furthermore, they described the paucity of translated resources, a lack of English proficiency, and rudimentary translator services. Finally, participants provided substantive guidance in improving surgical outreach education, specifically regarding the limited nature of current international partnerships to foster long-term, sustainable relationships.

Conclusions:

Although Vietnamese surgeon learners felt that visiting educator trips were beneficial, they recognized important areas for improvement. The language barrier was a major impediment to effective learning with materials and lectures commonly provided in English, highlighting the need for improved language concordance. Additionally, participants desired continued relationships with the visiting surgeons to build long-term collaboration.
Open-label Venous Leg Ulcer Pilot Study Using a Novel Autolologous Homologous Skin Construct
Authors: Armstrong David G. , Orgill Dennis P. , Galiano Robert D. , Glat Paul M. , Carter Marissa J. , Zelen Charles M.
Published: January 2021

Background:

Venous leg ulcers (VLUs) are often refractory to compression therapy, and their prevalence is increasing. An autologous homologous skin construct (AHSC) that uses the endogenous regenerative capacity of healthy skin has been developed to treat cutaneous defects, with a single application. The ability of AHSC to close VLUs with a single treatment was evaluated in an open-label, single-arm feasibility study to test the hypothesis that AHSC treatment will result in wound closure by providing healthy autologous tissue to the wound bed.

Methods:

Ten VLUs were treated with a single application of AHSC. A 1.5 cm2 full-thickness skin harvest from the proximal calf was collected and sent to a Food and Drug Administration–registered facility, where it was processed into AHSC and returned to the provider within 48 hours. AHSC was spread evenly across the wound and dressed with silicone. The primary endpoint was wound closure rate at 12 weeks. Wound closure was followed with 3-dimensional planimetry, and closure was confirmed by a panel of plastic surgeons. Additional endpoints followed for 12 weeks included graft take, harvest site closure, adverse event rate, complications, and patient-reported pain.

Results:

All 10 VLUs demonstrated successful graft take as evidenced by graft persisting in wound and harvest site closure. Eight VLUs exhibited complete closure within 12 weeks. One VLU that failed to heal with a prior split thickness skin graft closed within 13.5 weeks with AHSC. The mean time of closure was 34 days (95% confidence interval, 14–53). Pain improved by closure confirmation visit. There was 1 serious adverse event unrelated to the product or procedure.

Conclusion:

This pilot study demonstrated that AHSC may be a viable single-application topical intervention for VLUs and warrants further investigation in larger, controlled studies.
Synchronous Abdominal Wall and Small-bowel Transplantation: A 1-year Follow-up
Authors: Atia Andrew , Hollins Andrew , Erdmann Ralph F. , Shammas Ronnie , Sudan Debra L. , Mithani Suhail K. , Ravindra Kadiyala V. , Erdmann Detlev
Published: January 2021

Abdominal wall–vascularized composite allotransplantation (AW-VCA) has evolved as a technically feasible but challenging option in the rare event of abdominal wall reconstruction in patients whose abdomen cannot be closed by applying conventional methods. The authors conducted the first synchronous child-to-adult recipient AW-VCA using an arteriovenous loop technique. This article presents a 1-year follow-up of the patient’s postoperative course. Frequent skin biopsies were performed in accordance with Duke Institutional Review Board protocol, with 3 episodes of rejection treated with high-dose steroids and Thymoglobulin (Genzyme Corp, Cambridge, Mass.). The patient developed an opportunistic fungal brain abscess secondary to immunosuppression, which led to temporary upper extremity weakness. Future considerations for AW-VCA include a modified surgical technique involving utilization of donor vein graft for arteriovenous loop formation. In addition, reduction in postoperative biopsy schedule and changes in immunosuppression regimen may lead to improved outcomes and prevent unnecessary high-dose immunosuppression.
The Impact of Coronavirus Disease 2019 on Plastic Surgery Training: The Resident Perspective
Authors: Kapila Ayush K. , Schettino Michela , Farid Yasser , Ortiz Socorro , Hamdi Moustapha
Published: January 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic has led to marked changes in surgical training, including that of plastic surgery residents. We performed a survey to gain an insight into the self-reported current and future impact of COVID-19 on plastic surgery residents.

Methods:

A 20-point questionnaire was designed by a panel of surgical trainees and trainers, which was filled in by Belgian plastic surgery residents and their international network of peers between 19 and 26 April 2020—week 6 of stringent Belgian lockdown measures. Questions covered the impact of COVID-19 on surgical activity, surgical training, and the future of training.

Results:

Thirty-five of 38 plastic surgery residents in Belgium filled in the questionnaire, as did 51 of their international peers from 9 other countries. Decreased surgical activity of >75% was reported by 86% of Belgian trainees and by 73% of international colleagues. All consultations were stopped for 26% of Belgian trainees and 37% of international peers. Forty-six percents of Belgian trainees and 27% of international peers were reassigned to different departments. Eighty-five percent of all trainees felt surgical training had suffered, yet 54% of Belgian residents and 39% of international peers felt training should not be prolonged. Anxiety regarding the pandemic was present in 54% of Belgian residents and 69% of international colleagues.

Conclusions:

This is the first report, expressing the voice of a representative group of plastic surgery residents, showing a significant impact of COVID-19 on training and activity. A joint effort is needed to provide continued forms of education by virtual education and skills-based learning.
A Reversed Inset Toe PIPJ Vascularized Joint Transfer for Finger PIPJ Composite Defect Reconstruction
Authors: Lin Yu-Te , Loh Charles Yuen Yung
Published: January 2021

Background:

Free vascularized joint transfers (VJT) are indicated for reconstruction of a composite defect of the finger joints. When the bone defect involves the proximal interphalangeal joint (PIPJ) and the full length of the middle phalanx, using the toe PIPJ with a shorter middle phalanx to reconstruct such a defect will be difficult. In this article, we describe an unusual application to repair the composite defect with a reversed inset of the toe PIPJ, where the proximal phalanx of the toe is placed distally and vice versa.

Methods:

We describe a new technique to repair the composite defect with a reversed inset of the toe PIPJ. A 33-year-old woman sustained a crush injury to the left, middle, and ring finger, having fallen off her moped in a road traffic incident. A vascularized PIPJ from the second toe along with a hemipulp (1 × 4 cm) from the great toe transfer was performed with a reverse inset.

Results:

With intensive physiotherapy and surgical tenolysis, a range of motion of 20–80 degrees at the new PIPJ was achievable. The joint motion was stable, and the radiograms of the finger demonstrated no visible joint degeneration. She reported the use of the finger, which improved overall hand function.

Conclusion:

Reverse inset of toe PIPJs is possible in simultaneous reconstruction of damaged finger PIPJs and building up of bony length distally.
Power-assisted Liposuction and a Single Incision Pull-through Technique for Top Surgery: A Case Report
Authors: Bitoiu Brendon A. , McKee Daniel E.
Published: January 2021

Various treatment approaches exist for female-to-male subcutaneous mastectomy, also known as “top surgery.” The most commonly performed techniques for patients with decreased volume of breast tissue, no ptosis, and good skin elasticity continue to involve areolar or periareolar incision. Here, we report a case of a 17-year-old patient who underwent top surgery performed through power-assisted liposuction and a non-areolar single-incision “pull-through” technique. Operative management included initial liposuction for contouring of adipose tissue. Surgical subcision of excess breast tissue adherent to the subdermal plane was then performed and removed with a grasp-and-pull motion using the pull-through technique. We obtained a favorable result with low scar burden, preserved nipple sensation, and no nipple contracture. No complications were reported. This procedure is limited for patients with small breast size (A cup, <100 grams of glandular tissue per side), minimal to no ptosis, appropriate nipple size and position, soft fibroglandular tissue, and good skin elasticity.
Facial Transplantation in a Nationalized Health System: The Canadian Experience
Authors: Lorquet Etienne , Govshievich Alexander , Chollet André , Tremblay Dominique M. , Borsuk Daniel E.
Published: January 2021

Background:

Facial transplantation (FT) is recognized as the ultimate reconstruction for severely disfigured patients. The substantial cost of these procedures in a nationalized health system has not been extensively published. The first Canadian FT performed in May 2018 was a great opportunity to address this subject and evaluate the viability of such a program.

Methods:

A detailed patient chart review was performed and a cost per unit approach was used to estimate the procedure cost. The preoperative, operative, and the postoperative periods up to 1-year after the surgery were analyzed. Financial support from private sponsors and Hospital Fund donations were considered. The literature on international FT and national solid organ transplantation was reviewed.

Results:

The overall 1-year cost was estimated at $440,224 (2018 CAD). The costs are explained by a long hospital length of stay, costly immunosuppressive therapy, and high immunosuppression-related complications. Those findings are consistent with international FT literature. The societal impact of the surgery was minimized with a $36,921 (2018 CAD) grant obtained from an external contributor. Interestingly, the hospital foundation sustained a 794% increase in donations ($1,787,148; 2019 CAD) the year following the surgery.

Conclusion:

Our experience confirmed that the combination of private funding, with positive goodwill and hospital donations, is a workable model for innovative surgery in the setting of a nationalized health system with financial restrictions.
Proceed with Caution: Mouse Deep Digit Flexor Tendon Injury Model
Authors: Titan Ashley L. , Fahy Evan , Chen Kellen , Foster Deshka S. , Bennett-Kennett Ross , Dauskardt Reinhold H. , Gurtner Geoffrey C. , Chang James , Fox Paige M. , Longaker Michael T.
Published: January 2021

Background:

The purpose of this study was to determine the feasibility of using mouse models for translational study of flexor tendon repair and reconstruction.

Methods:

Quantitative data detailing the gross anatomy, biomechanical characteristics, and microscopic structure of the deep digit flexor tendon (DDF) of the mouse hindpaw were obtained. Histological characterization of the DDF and the anatomy of the digit in the mouse hindpaw are detailed. Biomechanical testing determined the load-to-failure, stress, elastic modulus, and the site of tendon failure.

Results:

In gross anatomy, the origins and insertions of the mouse deep digit flexor tendon are similar to those of the human digit, surrounded by a synovial sheath that is only 1- to 2-cells thick. A neurovascular network runs on each side of the digit outside the synovial sheath, but does not clearly penetrate it. The thickness of the DDF is 0.14 ± 0.03 mm and the width is 0.3 ± 0.03 mm. The thickness of the DDF is less than that of 9-0 nylon needle. The mean failure force of the deep flexor tendon was 2.79 ± 0.53N.

Conclusions:

The gross anatomy of the mouse hindpaw digit is similar to that of the human digit except for key differences seen in the synovial sheath and vascular supply. The dimensions of the mouse DDF make it challenging to create a clinically translatable repair model using currently available surgical techniques. Despite the similarities between the human and mouse anatomy, and the powerful basic science tools available in murine models, mice are an unreliable model for assessing flexor tendon injury and repair.
Fat Grafting Subjectively Improves Facial Skin Elasticity and Hand Function of Scleroderma Patients
Authors: Strong Amy L. , Adidharma Widya , Brown Owen H. , Cederna Paul S.
Published: January 2021

Systemic scleroderma is a chronic connective tissue disease characterized by internal organ and skin fibrosis. Unfortunately, there is a lack of efficacious treatments for cutaneous manifestations, and alternative interventions should be considered. Fat grafting has gained significant attention due to its regenerative properties and success in improving skin quality and volume deficits in fibrotic diseases. While some studies have investigated the efficacy of autologous fat grafting, we utilized the Coleman method for harvesting and processing to determine the efficacy of fat grafting to improve skin fibrosis in the hands and face of scleroderma patients without excess processing of adipose tissue. Patients with a diagnosis of scleroderma who underwent fat grafting between March 2015 and March 2019 at the University of Michigan were included. Ten female patients were identified that met inclusion criteria. The mean age at the time of surgery was 48.7 (± 17.6) years. An average of 53.2 (± 15.5) ml of fat was injected into the hands and 26.1 (± 16.4) ml into the face. Patients were treated with 1–4 rounds of grafting depending on the initial severity of skin fibrosis and volume deficiency. Fat grafting subjectively and qualitatively improved perioral skin quality, facial animation, hand range of motion, and hand pain for patients with systemic scleroderma. No complications were identified. Additional studies are necessary to determine the ideal volume, timing of treatments, and type of fat to optimize the efficacy of autologous fat grafting for the treatment of systemic scleroderma.
A Review of Multiple Venous Malformations of the Upper Limb: Classification, Genetics, and Pathogenesis
Authors: Al-Qattan Mohammad M.
Published: January 2021

Venous (cavernous) malformations are commonly seen in the upper limb. There is no consensus in the literature regarding the classification of venous malformations. Patients may be viewed as 2 clinical entities: patients with single or multiple lesions. Single venous malformations are sporadic and nonsyndromic, whereas the presence of multiple malformations indicates the presence of either an inherited or an overgrowth (noninherited) disorder. In this article, the author reviews multiple venous malformations of the upper limb, offers a novel classification, and describes their clinical entities along with their genetics and pathogenesis. These clinical entities will also be described by categorizing the cases as per the clinical presentation. Furthermore, the number of cases seen by the author (during an experience of 28 years of practice in Saudi Arabia) in each category will be reviewed to give the reader an overall view of the frequency of presentation of each category to the hand/plastic surgery clinic. Clinically, patients may present in 4 different presentations depending on the distribution of the lesions: the late-onset malformations confined to the upper limb; malformations involving the limbs/face/trunk with no mucosal lesions; widespread malformations of the skin, oral mucosa, and the intestine; and venous malformations presenting as a well-known syndrome. The author has seen a total of 84 patients, and the most 2 common presentations were late-onset type (n = 26) and malformations involving the limbs/face/trunk with no mucosal lesions (n = 36). This is the most comprehensive review of multiple venous malformations of the upper limb.
Using percutaneous parapedicle screw vertebroplasty to treat transpedicle screw loosening
Authors: Wang Kai-Chun , Yang Deng-Ho , Chang Ku-I , Hsu Wei-Tzu , Chang Chih-Yen , Wang Chien-Ying , Yang Yi-Ping , Chien Chian-Shiu , Yang Meng-Yin , Shen Chiung-Chyi
Published: January 2021

Background:

Pedicle screw loosening (PSL) is a postsurgical complication of spinal fusion surgery that can result in morbidity. The aim of this study was to evaluate the efficacy and safety of percutaneous parapedicle screw vertebroplasty (PPSV) for pain reduction and motility improvement in patients with PSL.

Methods:

The postsurgical solid inter-body fusion with inter-body bone mass formation of 32 patients who underwent lumbar-sacrum spinal fusion surgery was confirmed with plain films and CT scans. Each patient had one or two screws with symptomatic PSL and was treated with PPSV. All the patients were then followed up for 12 to 24 months. The visual analog scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were used to evaluate each patient before the operation, after the operation, and during the follow-up period.

Results:

A total of 32 patients with a total of 47 screws with PSL were treated with PPSV and experienced different results in terms of pain reduction (with the mean VAS score dropping from 7.97 ± 0.74 to 2.34 ± 1.59, p < 0.001) and motility improvement (with the mean RMDQ score dropping from 16.75 ± 1.84 to 7.21 ± 4.08, p < 0.001). The motility improvement was significantly correlated with pain reduction (r = 0.42, p = 0.018), with the mean follow-up period being 19.3 ± 6.2 months (range: 8-36 months). However, five patients who experienced moderate improvements had eventually received a revision operation after undergoing PPSV.

Conclusion:

The PPSV procedure is effective and safe for the reduction of pain and improvement of life quality in patients with PSL. It can thus be considered as a possible option for the revision of spinal fusion surgery.
Angioplasty and stenting for symptomatic stenosis of the left subclavian artery complicated with aortic dissection
Authors: Huang Chun-Chao , Huang Wei-Ming , Jhou Zong-Yi , Chen Jung-Hsuan , Chen Shu-Ting , Lin Hui-Chen , Huang Chung-Yao , Chen Chia-Hung , Luo Chao-Bao , Chang Feng-Chi
Published: January 2021

Background:

Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection.

Methods:

Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients.

Results:

Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%–95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7–118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency.

Conclusion:

Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection.
Short-term effect of atropine on higher-order aberrations in myopic children
Authors: Kuo Yih-Shiuan , Yen May-Yung , Lin Pei-Yu
Published: January 2021

Background:

This study aimed to investigate the short-term effect of cycloplegia on higher-order aberrations (HOAs) in school-age myopic children who received 0.25% atropine for cycloplegic refraction.

Methods:

We performed a retrospective chart review of 24 myopic children between the ages of 5 and 15 years, who had received one topical drop of 0.25% atropine for three consecutive nights before undergoing cycloplegic refraction. Auto-refraction, visual acuity, and HOAs measured with the iTrace aberrometer were compared before and after atropine use. To account for the effect of cycloplegia, the amount of HOAs under matching scanning sizes was compared.

Results:

There were statistically significant differences in the spherical equivalent, with a hyperopic shift after atropine use (p < 0.001). Corrected visual acuity and spherical aberrations showed no significant change under the respective pupil and scanning sizes before and after atropine use. Under identical scanning sizes, there was a significant change in total spherical aberration (from 0.03 to 0.06 μm, p = 0.044) and internal spherical aberration (from −0.10 to −0.05 μm, p = 0.049) after atropine use. Differences in corneal spherical aberration were insignificant.

Conclusion:

The positive shift of spherical aberration induced by the inhibition of accommodation in myopic children may have a possible effect against myopic progression. Future studies can focus on the long-term effect on HOAs and impact on visual quality with lower concentrations of atropine.
Gastroenteropancreatic neuroendocrine tumor registry study in China
Authors: Cong Lin , Wu Wenming , Lou Wenhui , Wang Jinwan , Gu Feng , Qian Jiaming , Xu Jianming , Bi Feng , Cai Sanjun , Tang Chengwei , He Yulong , Zhong Jie , Zhao Yupei
Published: January 2021

Objectives:

The aim of this multicenter, prospective, registry study was to summarize the epidemiology of Chinese patients with locally advanced and end-stage gastroenteropancreatic neuroendocrine tumors (GEP-NETs) as well as the diagnostic methods and treatment strategies used for these patients.

Methods:

GEP-NET patients from 11 departments of 8 hospitals in China were prospectively enrolled for a pre-defined period (June 30, 2011 to May 29, 2012). The patients’ demographic, pathological, and treatment data were recorded, analyzed, and released on June 29, 2015.

Results:

Seventy-nine eligible patients were enrolled, and most of these patients were classified according to the World Health Organization 2010 classifications. The most common primary tumor site was the pancreas. The liver was the most common site of metastases, followed by the lymph nodes. The majority of the patients underwent surgical interventions. Patients also received local treatment, medication, or chemotherapy.

Conclusion:

The pancreas was the most common primary tumor site of locally advanced and end-stage GEP-NETs. Surgical interventions are currently the most common treatment strategy.
Obesity and genetics
Authors: Golden Angela , Kessler Christine
Published: January 2021

Genetics is now known to play a substantial role in the predisposition to obesity and may contribute up to 70% risk for the disease. Over a hundred genes and gene variants related to excess weight have been discovered. Yet, genetic obesity risk does not always translate into actual obesity development, suggesting complex interactions between genetic, behavioral, and environmental influences and resulting epigenetic changes. Rare but serious forms of monogenic obesity typically appear in early childhood. Polygenic obesity is most common and demonstrates strong interplay between genes and the obesogenic environment. This review provides an overview of genetic causes of obesity, potential mechanisms of epigenetic changes, and environmental influences that should diminish obesity bias and offer hope for more effective obesity prevention and intervention strategies.
Linguistic Validation and Cross-Cultural Adaptation of the Post–COVID-19 Functional Status Scale for the Chilean Population
Authors: Lorca Luz Alejandra , Torres-Castro Rodrigo , Ribeiro Ivana Leao , Benavente Paulina , Pizarro Marta , San Cristobal Belgica , Ugarte Javiera , Laura Cristobal , Huanchicay Camila , Mamani Alexandra
Published: January 2021

Background

Patients with COVID-19 can present functional status and disability alterations in the medium- and long-term. On the international level, a multicentered study is being carried out to validate the Post–COVID-19 Functional Status scale for different nations, thus allowing visualizing the needs for a multidisciplinary approach and planning intervention plans. The objective of this study was to perform a linguistic validation and cross-cultural adaptation of the Post–COVID-19 Functional Status scale for people infected with COVID-19 for the Chilean population.

Methods

A cross-sectional study of scale validation was carried out. The study was performed in two phases: (1) forward-translation, reverse-translation and (2) apparent cross-validity adaptation. For the apparent validity analysis, 29 individuals who had been hospitalized in Hospital del Salvador with a COVID-19 infection diagnosis and at the time of the interview were in their homes participated.

Results

In phase 1 forward-translation, an item required semantical changes. The reverse-translation versions were similar, and the most relevant doubts were resolved in a consensus meeting. In phase 2, the pilot study confirmed adequate understanding and scale applicability.

Conclusions

Using a systematic and rigorous methodology allowed obtaining a Spanish version of the Post–COVID-19 Functional Status scale for Chile, which is conceptually and linguistically equivalent to the original instrument and adequate to assess the functional status of people infected with COVID-19.
Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations
Authors: Edwards Robert R. , Dworkin Robert H. , Turk Dennis C. , Angst Martin S. , Dionne Raymond , Freeman Roy , Hansson Per , Haroutounian Simon , Arendt-Nielsen Lars , Attal Nadine , Baron Ralf , Brell Joanna , Bujanover Shay , Burke Laurie B. , Carr Daniel , Chappell Amy S. , Cowan Penney , Etropolski Mila , Fillingim Roger B. , Gewandter Jennifer S. , Katz Nathaniel P. , Kopecky Ernest A. , Markman John D. , Nomikos George , Porter Linda , Rappaport Bob A. , Rice Andrew S.C. , Scavone Joseph M. , Scholz Joachim , Simon Lee S. , Smith Shannon M. , Tobias Jeffrey , Tockarshewsky Tina , Veasley Christine , Versavel Mark , Wasan Ajay D. , Wen Warren , Yarnitsky David
Published: January 2021

There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for “precision medicine” or personalized pain therapeutics (ie, empirically based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain and the success rates for putative analgesic drugs in phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.
Examination of the Wrist
Authors: Reavey Patrick L. , Hammert Warren C.
Published: January 2021

Learning Objectives:

After reading this article and reviewing the supplemental videos, the participant should be able to: 1. Identify common wrist conditions that may be encountered on evaluation. 2. Describe provocative maneuvers used to confirm a diagnosis of wrist disorder. 3. Develop a systematic approach to examination of the wrist. 4. Determine appropriate diagnostic maneuvers for radial, central, and ulnar wrist pain.

The wrist is a complex structure, and providers caring for hand and upper extremity conditions need to have an understanding of the wrist examination and provocative maneuvers for conditions that are encountered. Fractures, tendonitis, arthritis, and instabilities are all commonly encountered, and the provider should have an idea of the diagnosis based on clinical examination and use imaging as needed to confirm or stage a diagnosis.
Five Wrist Operations That Give the Best Results
Authors: Maldonado Andres A. , Pulos Nicholas , Rhee Peter C. , Shin Alexander Y.
Published: January 2021

Learning Objectives:

After reading this article and viewing the videos, the participant should be able to: 1. Recognize the following five wrist operations as consistent options for different wrist injuries: carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis. 2. Know the state-of-the-art of these five procedures. 3. State the indications of each operation. 4. List the surgical steps of these five procedures.

The wrist is a complex joint that concentrates different types of tissues (e.g., bone, cartilage, ligaments, nerves, vessels) and a broad different spectrum of diseases. Treatment of wrist injuries has improved during recent years, mainly because of improvement in strategy, techniques, microsurgical equipment, understanding anatomy and improvements in technology. In this article, we present the five operations (i.e., carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis) that have consistently given good outcomes in patients suffering from different wrist injuries/maladies.