bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacting Care and Treatment of the Burn Patient Conversion to Electronic Documentation
Authors: Hampe Holly M. , Keeling Terri , Fontana Michelle , Balcik Debbie
Published: November 2016

Improving patient care through enhanced electronic communication among health care providers is aimed at reducing the number of medication and medical errors. The American Reinvestment and Recovery Act (ARRA) was signed into law in 2009, supporting the federal government's commitment to the improvement of health care quality, safety, and efficiency through requirements to implement an electronic health record by October 2015 or hospitals and eligible providers potentially realizing penalties or reduced reimbursement rates. In addition to ARRA, Congress presented another initiative to further advance the delivery of high-quality health care, the Health Information Technology for Economic and Clinical Health Act (HITECH), leading to the authorization of $27 billion to encourage health care providers to achieve meaningful use of the electronic health record. However, the conversion of the paper medical records to an electronic version has been challenging, particularly in specialty departments. The burn unit of a tertiary hospital located in the Pittsburgh area experienced such challenges. A project plan, developed in 2009 prior to the electronic medical record going live, involved a multidisciplinary team, consisting of providers, nurses, and information system builders who came together to determine how to capture the totality of the burn unit documentation. The goal of the project was to develop an electronic documentation tool and provide a system to accurately and efficiently evaluate documentation compliance with the staff. The Lund Browder documentation tool, used with the paper medical record, was the selected tool for the electronic conversion. This tool has been regarded by most health care organizations as being the most accurate in measuring the extent and degree of the burn. With the paper documentation tool, the staff was, on average, 74% compliant with the Lund Browder tool. The electronic version and availability of the tool increased compliance to 100% in the fourth quarter of 2015.
Rib Fracture Protocol Advancing the Care of the Elderly Patient
Authors: Leininger Susan
Published: November 2016

This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture.
The Hospital Course of a Successfully Treated Patient with Respiratory Failure
Authors: Callister T. Brian
Published: November 2016

The successful treatment of a patient with acute respiratory failure is a complex undertaking that requires clinical competence, evidence-based interventions, seamless coordination of care transitions, and transparent open communication among all members of the health care team. Many of the processes of care in these critically ill patients are reassuringly consistent across services, across hospitals, across health systems, and even across the country. Although the clinical course of such complicated patients can be extremely unpredictable, we are fortunate that the professional, technical, and psychosocial aspects of care for these patients can be relatively orderly, evidence-based, and transparent.
Case Study
Authors: Mowry Matthew
Published: November 2016

Trauma during pregnancy is the leading cause of non–obstetric-related maternal and fetal death. This article summarizes obstetric physiology and outlines the assessment and treatment of traumatic injuries of the pregnant patient. A case is presented in which a pregnant woman with blunt abdominal trauma was managed efficiently in a trauma center within a hospital that does not have in-house obstetric services.
Educating Providers in Return-to-Play Suggested Guidelines Postconcussion
Authors: Bires Angela Macci , Leonard Amanda L. , Thurber Brandon
Published: November 2016

As the awareness of concussions increases, it is imperative to be able to evaluate, diagnose, and treat concussed individuals properly to prevent further complications or death. The primary purpose of this study was to compare a provider's current awareness and comfort level as it relates to the return-to-play guidelines for concussions. A secondary aim was to evaluate current protocols that are in use and determine whether they coincide with the suggested guidelines. An educational intervention was implemented to assess the knowledge and confidence of health care providers. The study design was a quantitative, convenient sample, pretest/posttest questionnaire. The questionnaire was administered to participants who were nurse practitioners prior to an educational PowerPoint presentation. At 8 weeks, the posttest was administered. Approximately 19% of individuals were not aware of a graded return-to-play protocols. The findings suggest that the educational intervention increased their confidence levels in making a diagnosis of a concussion, in assessing danger signs, and in understanding when to refer to a specialist. Additional supporting evidence from this study indicates that the educational intervention allowed the participants to achieve a greater comfort level in finding appropriate resources for them and their patients.
Preparing Critical Care and Medical-Surgical Nurses to Open a New Hospital
Authors: Comeau Odette Y. , Armendariz-Batiste Josette , Baer Jennifer Grant
Published: November 2016

Building a new hospital is an exciting time. However significant planning is required to prepare staff to assume care of patients in an environment with new workflow changes and new equipment. The challenges of this advanced preparation are compounded when the opening of the new hospital includes the planned move of the inpatient census of patients from an existing hospital to the new hospital. Goals and objectives on the move day include patient and staff safety, with a seamless transition to the new environment. This article describes the experiences and strategies used by an adult inpatient department to successfully open a new hospital.
The Association Between Out-of-Pocket Costs and Adherence to Adjuvant Endocrine Therapy Among Newly Diagnosed Breast Cancer Patients
Authors: Farias Albert J. , Hansen Ryan N. , Zeliadt Steven B. , Ornelas India J. , Li Christopher I. , Thompson Beti
Published: November 2016

Objective:

To determine how out-of-pocket costs for adjuvant endocrine therapy (AET) medication affects adherence among newly diagnosed breast cancer survivors with private health insurance who initiate therapy.

Materials and Methods:

We examined medical and pharmacy claims for the 1-year period after initiating AET using the Truven Health Analytics MarketScan database. Adherence was defined as ≥80% proportion of days covered. Mean out-of-pocket costs for AET fill were measured as the sum of copayments, coinsurance, and deductibles and adjusted to 30-day amounts. Using a multivariable logistic regression model we calculated adjusted risk ratios controlling for age, comorbidities, type of surgery, use of chemotherapy and/or radiation therapy, average out-of-pocket costs for other services, and pharmacy use characteristics.

Results:

Of the 6863 women 64 years and younger who were diagnosed with breast cancer and initiated AET, 73.9% were adherent (proportion of days covered≥80%). A total of 19% of patients had <$5 monthly out-of-pocket costs for AET, 30% had $5 to $9.99, 17% had $10 to $14.99, 10% had $15 to $19.99, and 25% had $20 or greater. Patients with out-of-pocket costs for AET between $10 and $14.99, $15 and $19.99, and >$20 were 6% to 8% less likely to be adherent compared with patients paying <$5.00, after controlling for covariates (P<0.05). Out-of-pocket costs for inpatient, outpatient, and other pharmacy services were not associated with adherence.

Conclusions:

A substantial proportion of privately insured patients are nonadherent to AET and out-of-pocket costs for AET medication are significantly associated with a greater likelihood of nonadherence.
Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus
Authors: Behnia-Willison Fariba , Pour Nina Reza , Mohamadi Behrang , Willison Nadia , Rock Madeleine , Holten Ian W. , O’Shea Robert , Miller Joseph
Published: November 2016

Background:

Lichen sclerosus (LS) is an inflammatory dermatosis with autoimmune pathogenesis. Although relatively common, its true incidence is unknown and likely underestimated. LS is usually anogenital, but in around 10% of patients, it can present as extragenital lesions. Continuous administration of topical corticosteroids is the mainstay of medical treatment. Other treatments are available but are only occasionally prescribed along with or instead of topical steroids. Injection of platelet-rich plasma (PRP) into affected areas has been reported to result in the regeneration of normal skin. In this study, we aimed to evaluate the safety, symptom resolution, and objective improvement in patients with autoimmune condition like genital LS after treatment with PRP.

Methods:

Over a 2-year period at FBW Gynaecology Plus, we had a total of 28 patients with confirmed LS on biopsy, unresponsive to topical steroid treatment. After acquiring informed consent, patients’ own blood was centrifuged on site and injected under local anesthesia to the external genitalia.

Results:

Almost all of our patients showed clinical improvement in the size of their lesions, and in 8 cases, lesions totally disappeared after treatment with PRP. Symptoms disappeared in 15 of the 28 patients after treatment, with no need for further steroid therapy in 23 patients. Thirteen women experienced partial symptom relief.

Conclusions:

Based on our limited findings, we hypothesize that PRP presents a potential alternative to topical steroids for treatment of vulvovaginal autoimmune conditions such as LS. A larger pilot and/or randomized controlled trial study is required to evaluate this finding further.
Median Nerve Trifurcation
Authors: Lonie Sarah , Niumsawatt Vachara , Rozen Warren M.
Published: November 2016

Median nerve trifurcation in the carpal tunnel has only rarely been described and never reported to be found at surgery. We present the first such case, highlighting a median nerve trifurcation found at carpal tunnel release. Consideration of amendment of the Lanz classification should be made to account for such cases, and surgeons should be aware of possible anatomical variations to avoid iatrogenic injury.
Flexor Tendon Repair Postoperative Rehabilitation: The Saint John Protocol
Authors: Higgins Amanda , Lalonde Donald H.
Published: November 2016

The Saint John Protocol describes a rehabilitation program of up to half a fist of protected true active finger flexion beginning 3 to 5 days after flexor tendon repair. We no longer use full fist place and hold. We illustrate with film and text the reasons for these changes.
Abdominal Wall Reconstruction Using Retrorectus Self-adhering Mesh: A Novel Approach
Authors: Khansa Ibrahim , Janis Jeffrey E.
Published: November 2016

Background:

In abdominal wall reconstruction, the retrorectus plane offers an ideal location for mesh placement. Mesh fixation in this plane is often achieved using transfascial sutures, which risks entrapping intercostal nerves and causing significant pain, and takes time to place. A novel alternative is the use of sutureless self-adhering mesh. Although the use of this mesh in inguinal hernias has been well described, studies on its use in abdominal wall reconstruction are lacking.

Methods:

Consecutive patients who underwent ventral hernia repair with retrorectus mesh were reviewed. This included patients who received transfascially sutured mesh and those who received sutureless self-adhering mesh. All patients were followed up for at least 12 months. The amount of narcotics required by each patient postoperatively was calculated. Surgical-site occurrences (SSOs) and hernia recurrence and bulge were measured.

Results:

Twenty-six patients underwent abdominal wall reconstruction with retrorectus mesh. This included 12 patients with transfascially sutured mesh and 14 patients with self-adhering mesh. Mean follow-up was 600 days. Baseline characteristics were similar between the 2 groups. Patients receiving self-adhering mesh required significantly less narcotics than patients with transfascially sutured mesh. There were no significant differences in the rate of SSOs between the 2 groups. No hernia recurrences, bulges, or chronic pain occurred in either group.

Conclusions:

This is the first study to compare the outcomes of retrorectus self-adhering mesh and transfascially sutured mesh in abdominal wall reconstruction. Our results show low rates of SSO, recurrence, and bulge with both options, with significantly less acute pain with self-adhering mesh.
Robotic Vitreoretinal Surgery
Authors: Channa Roomasa , Iordachita Iulian , Handa James T.
Published: November 2016

Purpose:

To review the current literature on robotic assistance for ophthalmic surgery, especially vitreoretinal procedures.

Methods:

MEDLINE, Embase, and Web of Science databases were searched from inception to August, 2016, for articles relevant to the review topic. Queries included combinations of the terms: robotic eye surgery, ophthalmology, and vitreoretinal.

Results:

In ophthalmology, proof-of-concept papers have shown the feasibility of performing many delicate anterior segment and vitreoretinal surgical procedures accurately with robotic assistance. Multiple surgical platforms have been designed and tested in animal eyes and phantom models. These platforms have the capability to measure forces generated and velocities of different surgical movements. “Smart” instruments have been designed to improve certain tasks such as membrane peeling and retinal vessel cannulations.

Conclusion:

Ophthalmic surgery, particularly vitreoretinal surgery, might have reached the limits of human physiologic performance. Robotic assistance can help overcome biologic limitations and improve our surgical performance. Clinical studies of robotic-assisted surgeries are needed to determine safety and feasibility of using this technology in patients.
PROSPECTIVE EVALUATION OF A SUSTAINED-RELEASE DEXAMETHASONE INTRAVITREAL IMPLANT FOR CYSTOID MACULAR EDEMA IN QUIESCENT UVEITIS
Authors: Khurana Rahul N. , Bansal Alok S. , Chang Louis K. , Palmer James D. , Wu Chengqing , Wieland Mark R.
Published: November 2016

Purpose:

To investigate dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc) in the treatment of uveitic cystoid macular edema that had persisted in the absence of intraocular inflammation.

Methods:

In this prospective interventional case series, 10 patients with uveitic cystoid macular edema and quiescent uveitis were treated with dexamethasone intravitreal implant at baseline and evaluated monthly for one year. Patients were retreated whenever cystoid macular edema recurred. The primary outcome measure was best-corrected visual acuity (BCVA) at day 90.

Results:

At day 90, mean improvement from baseline BCVA was 14.4 letters (P = 0.0003), 70% of patients had a ≥10 letter BCVA improvement, 50% of patients had a ≥15 letter BCVA improvement, and the mean decrease from baseline central subfield retinal thickness was 140 μm (P = 0.008). Improvements were maintained through day 360 with retreatment as needed. At day 360, mean improvement in BCVA was 16.5 letters (P = 0.006) and the mean decrease in central subfield retinal thickness was 158 μm (P = 0.002). One patient experienced intraocular pressure >25 mmHg (managed with topical medication). Two phakic patients (2/8; 25%) had worsening of lens opacity requiring cataract extraction.

Conclusion:

Dexamethasone intravitreal implant may be an effective treatment for patients with persistent cystoid macular edema in quiescent uveitis.
IMAGE QUALITY AND ARTIFACTS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Say Emil A. T. , Ferenczy Sandor , Magrath George N. , Samara Wasim A. , Khoo Chloe T. L. , Shields Carol L.
Published: November 2016

Purpose:

To study image quality and artifacts seen on optical coherence tomography angiography (OCTA).

Methods:

Sixty-five consecutive patients with unilateral posterior uveal melanoma treated with plaque radiotherapy had OCTA during follow-up. Optical coherence tomography angiography was performed on both the affected and fellow eye. Signal strength and frequency of image artifacts on en face images were compared between affected and fellow eyes.

Results:

A total of 130 eyes in 65 patients were analyzed, the mean age at time of OCTA was 55 years (median: 56, range: 12–81 years), and 39 (39/65, 60%) were female. Majority of tumors were located in the choroid (62/65, 95%) and extramacular (55/65, 85%). The mean distance to the foveola was 4 mm (median: 3, range: 0–18 mm) and optic nerve was 4 mm (median: 4, range: 0–16 mm). Optical coherence tomography angiography was performed at a mean 46 months after plaque radiotherapy. Most patients had a history of radiation maculopathy or papillopathy in the treated eye at the time of OCTA (46/65, 71%). Overall, 95 eyes (95/130, 73%) had at least one significant artifact on OCTA. The most common major artifacts were loss of focus (71/130, 55%), broad (>5 pixels width and >4 lines) blink lines (48/130, 37%), motion artifact (34/130, 26%), specular dot (33/130, 25%), and edge duplication (10/130, 8%). Statistically, eyes treated with plaque radiotherapy (affected vs. fellow eye) were more likely to have at least one major OCTA artifact (92 vs. 54%, P < 0.001) and, specifically, loss of focus was more frequent (78 vs. 31%, P < 0.001). Multivariate analysis found decreased visual acuity significantly associated with higher incidence of broad blink lines (P = 0.0166) and loss of signal (P < 0.0001), whereas male sex was associated with increased loss of signal (P = 0.0015), and distance to the foveola was related to edge duplication (P = 0.0119).

Conclusion:

Image artifacts on OCTA are commonly encountered and appear to be more frequent in eyes with pathology and poor visual acuity. Recognition of these artifacts might help improve image interpretation and decision making.
Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery
Authors: Aravena Carolina , Yu Fei , Deng Sophie X.
Published: November 2016

Purpose:

To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous trabeculectomy or a drainage device.

Methods:

This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into 3 groups: surgical treatment (ST) group, medical treatment (MT) group, and control group. Visual improvement, endothelial cell loss, and postoperative complications, including rejection, graft failure, and intraocular pressure elevation (≥25 mm Hg) were evaluated.

Results:

The length of follow-up was 9.7 ± 7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (P = 0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1 ± 8.1 and 9.2 ± 6.3 lines, respectively) than in the control (4.8 ± 5.6 lines, P < 0.05). The mean time to BCVA was 2.9 ± 2.8 months for the ST group, 4.7 ± 5.3 months for the MT group, and 3.0 ± 3.3 months for the control (P = 0.75). Endothelial cell loss was greater in the ST group (44.6 ± 17.8%) than in the MT group (29.9 ± 12.0%) and the control group (32.7 ± 11.3%, P = 0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative intraocular pressure elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P = 0.04). There was no difference in the air injection rate among all groups (P = 1.0).

Conclusions:

DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.
Retinal Vessel Oxygen Saturation and Vessel Diameter in Inactive Graves Ophthalmopathy
Authors: Yang Xiaonan , Huang Danping , Ai Siming , Liang Xuanwei , Zhao Jing , Fang Lei
Published: November 2016

Purpose:

To investigate whether inactive thyroid-associated ophthalmopathy (TAO) affects retinal oxygen saturation and/or vessel diameter.

Methods:

Via an observational case–control study, retinal circulation was measured in patients with inactive TAO (mild, moderate, and severe) and normal subjects by retinal oximetry. Complete ophthalmologic examination, including noncontact tonometry and Hertel exophthalmometry, was performed; history of smoking and dysthyroid disease were recorded. Analysis of variance or the Kruskal–Wallis test was used to compare oximetry values between TAO and controls. Simple linear regression was used to analyze the correlation of Hertel, smoking, and intraocular pressure with oximetry values.

Results:

Seventy-six eyes were enrolled: 19 controls, and 17 mild, 21 moderate, and 19 severe inactive TAO. Retinal oxygen saturation did not change significantly in inactive TAO versus controls; arteriole saturation: severe, 95.7% ± 7.0%; moderate, 93.2% ± 3.9%; mild, 90.3% ± 4.8%; and controls, 93.1% ± 6.4%; vein saturation: severe, 57.4% ± 7.1%; moderate, 59.0% ± 7.0,; mild, 56.3% ± 7.9%; and controls, 58.5% ± 6.5%; arteriovenous saturation: severe, 38.3% ± 8.0%; moderate, 34.2% ± 7.1%; mild, 33.9% ± 6.8%; and controls, 34.6% ± 5.9%. However, retinal venous diameter with severe TAO (137.3 ± 12.5 μm) significantly decreased in comparison with controls (148.8 ± 10.2 μm, p = 0.017). Otherwise, no significant change in vessel diameter was found between TAO and controls. No statistically significant correlations were found between Hertel values or intraocular pressure and oximetry values. However, there was a positive significant correlation between smoking and arteriovenous oxygen saturation (p = 0.017, β = 4.61).

Conclusions:

In inactive TAO versus controls, retinal oxygen saturation fluctuated and could be affected by smoking; however, the retinal venous diameter only decreased significantly for severe TAO. This implies that TAO may affect retinal circulation; this effect could be accelerated by smoking.
Conjunctival Melanoma Responsive to Combined Systemic BRAF/MEK Inhibitors
Authors: Dagi Glass Lora R. , Lawrence Donald P. , Jakobiec Frederick A. , Freitag Suzanne K.
Published: November 2016

This report demonstrates a unique case of conjunctival melanoma harboring a BRAF V600E mutation responsive to systemic therapy with BRAF and MEK inhibitors. While systemic therapy would not be appropriate in patients with local disease alone, it may act therapeutically in cases of higher stage ocular surface and eyelid melanoma.
Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles
Authors: Baron Ralf , Maier Christoph , Attal Nadine , Binder Andreas , Bouhassira Didier , Cruccu Giorgio , Finnerup Nanna B. , Haanpää Maija , Hansson Per , Hüllemann Philipp , Jensen Troels S. , Freynhagen Rainer , Kennedy Jeffrey D. , Magerl Walter , Mainka Tina , Reimer Maren , Rice Andrew S.C. , Segerdahl Märta , Serra Jordi , Sindrup Sören , Sommer Claudia , Tölle Thomas , Vollert Jan , Treede Rolf-Detlef ,   on behalf of the German Neuropathic Pain Research Network (DFNS), and the EUROPAIN, and NEUROPAIN consortia
Published: November 2016

Patients with neuropathic pain are heterogeneous in etiology, pathophysiology, and clinical appearance. They exhibit a variety of pain-related sensory symptoms and signs (sensory profile). Different sensory profiles might indicate different classes of neurobiological mechanisms, and hence subgroups with different sensory profiles might respond differently to treatment. The aim of the investigation was to identify subgroups in a large sample of patients with neuropathic pain using hypothesis-free statistical methods on the database of 3 large multinational research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, and Neuropain). Standardized quantitative sensory testing was used in 902 (test cohort) and 233 (validation cohort) patients with peripheral neuropathic pain of different etiologies. For subgrouping, we performed a cluster analysis using 13 quantitative sensory testing parameters. Three distinct subgroups with characteristic sensory profiles were identified and replicated. Cluster 1 (sensory loss, 42%) showed a loss of small and large fiber function in combination with paradoxical heat sensations. Cluster 2 (thermal hyperalgesia, 33%) was characterized by preserved sensory functions in combination with heat and cold hyperalgesia and mild dynamic mechanical allodynia. Cluster 3 (mechanical hyperalgesia, 24%) was characterized by a loss of small fiber function in combination with pinprick hyperalgesia and dynamic mechanical allodynia. All clusters occurred across etiologies but frequencies differed. We present a new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles. These 3 profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.
Correlation of Transtibial Prosthetic Alignment Quality and Step-by-Step Variance of Gait
Authors: Fiedler Goeran , Johnson Mariah Susan
Published: November 2016

Introduction

The quality of lower-limb prosthetic alignment cannot easily be measured directly but may be described by its effects on gait comfort and efficiency. It is known that gait stability and step variability are correlated, as are gait stability and prosthetic alignment. This study investigated the hypothesis that prosthetic alignment and step variability are correlated. This would have the implication that step variability can be measured to assess the quality of prosthetic alignment (and possibly other relevant factors such as prosthetic fit and componentry selection).

Materials and Methods

Twelve experienced users of transtibial prostheses were subjected to a protocol that introduced malalignments of their prosthetic ankle plantarflexion angle in a randomized crossover design. Perceived alignment quality was recorded via a visual analog scale. Step-by-step variability in horizontal ground reaction forces and axial ankle torsion moment was measured using a prosthesis-integrated load cell and was statistically compared with the degree of misalignment by bivariate correlation analysis.

Results

Findings suggest that variance in axial torsion moment and step duration may be correlated to alignment quality.

Conclusions

Subjective patient feedback is the recommendable criterion for alignment assessment in active and experienced users of prostheses. Further research is recommended before step variance may help assess prosthetic alignment quality in patients with less experience in prosthetic use.
Role of low-molecular-weight heparins in prevention of thromboembolic complication after transarterial chemoembolization in hepatocellular carcinoma
Authors: Negm Osama , Abou Saif Sabry , El Gharib Mohamed , Yousef Mohamed , Abd-Elsalam Sherief
Published: November 2016

Background and aim

Portal vein thrombosis (PVT) is a common complication after transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). This is the first clinical study to evaluate the role of low-molecular-weight heparins (LMWHs) with TACE in HCC for the prevention of thromboembolism complications (PVT).

Patients and methods

This study was carried out on 40 patients with HCC requiring TACE who presented to the Tropical Medicine Department, Tanta University and Interventional Radiology Department of Ain-Shams University Hospitals starting from April 2015. Patients were divided in two groups: group I included 20 patients with HCC treated by TACE only. Group II included 20 patients with HCC treated by TACE and an adjuvant dose of LMWH. Radiological assessment of efficacy of procedure and detection of PVT as a complication was performed using ultrasound abdomen and pelvis and triphasic spiral computed tomography with contrast.

Results

This study was carried out on 40 patients with HCC requiring TACE who presented to the Tropical Medicine Department of Tanta University and Interventional Radiology Department of Ain-Shams University Hospitals. The incidence of PVT after TACE was higher in group I than group II, with seven cases in group I and only one case in group II.

Conclusion

LMWH with TACE in HCC is strongly recommended for prevention of thromboembolism complications (PVT). However, larger randomized-controlled studies are needed to confirm these obvious findings.
Matching Procedures at the Time of Immediate Breast Reconstruction: An American College of Surgeons National Surgical Quality Improvement Program Study of 24,191 Patients
Authors: Cooney Carisa M. , Sebai Mohamad E. , Ogbuagu Onyebuchi , Devulapalli Chris , Manahan Michele A. , Rosson Gedge D.
Published: November 2016

Background:

The purpose of this study was to assess for compounded risk of postoperative morbidity with the addition of a simultaneous contralateral breast matching procedure at the time of mastectomy and immediate breast reconstruction.

Methods:

2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program databases were used to identify cases of mastectomy and immediate breast reconstruction with and without simultaneous contralateral breast matching procedures. Matching procedures included mastopexy, reduction mammaplasty, and augmentation mammaplasty. Thirty-day postoperative morbidity was assessed using univariable and multivariable logistic regression.

Results:

Of 59,766 mastectomy patients, 24,191 (40 percent) underwent immediate breast reconstruction: 903 (3.7 percent) underwent matching procedures and 23,288 (96.3 percent) did not. Univariable logistic regression demonstrated that the matching procedure group had statistically significantly higher overall morbidity (OR, 1.288; 95 percent CI, 1.022 to 1.623; p = 0.032). Although surgical and systemic morbidity did not differ significantly, the matching procedure group demonstrated higher risk for superficial surgical-site infection (OR, 1.57; 95 percent CI, 1.066 to 2.31; p = 0.022), reconstruction failure (OR, 1.69; 95 percent CI, 1.014 to 2.814; p = 0.044), and pulmonary embolism (OR, 2.54; 95 percent CI, 1.01 to 6.37; p = 0.048). Controlling for possible confounders, multivariable logistic regression rendered the relationship between matching procedure and complications insignificant (OR, 1.17; 95 percent CI, 0.92 to 1.48; p = 0.2).

Conclusion:

These data suggest that preoperative comorbidities and other patient-related factors may have a larger influence on postoperative morbidity than the addition of a contralateral matching procedure alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Sleep Architecture Linked to Airway Obstruction and Intracranial Hypertension in Children with Syndromic Craniosynostosis
Authors: Spruijt Bart , Mathijssen Irene M. J. , Bredero-Boelhouwer Hansje H. , Cherian Perumpillichira J. , Corel Linda J. A. , van Veelen Marie-Lise , Hayward Richard D. , Tasker Robert C. , Joosten Koen F. M.
Published: November 2016

Background:

Children with syndromic craniosynostosis often have obstructive sleep apnea and intracranial hypertension. The authors aimed to evaluate (1) sleep architecture, and determine whether this is influenced by the presence of obstructive sleep apnea and/or intracranial hypertension; and (2) the effect of treatment on sleep architecture.

Methods:

This study included patients with syndromic craniosynostosis treated at a national referral center, undergoing screening for obstructive sleep apnea and intracranial hypertension. Obstructive sleep apnea was identified by polysomnography, and categorized into no, mild, moderate, or severe. Intracranial hypertension was identified by the presence of papilledema on funduscopy, supplemented by optical coherence tomography and/or intracranial pressure monitoring. Regarding sleep architecture, sleep was divided into rapid eye movement or non–rapid eye movement sleep; respiratory effort–related arousals and sleep efficiency were scored.

Results:

The authors included 39 patients (median age, 5.9 years): 19 with neither obstructive sleep apnea nor intracranial hypertension, 11 with obstructive sleep apnea (four moderate/severe), six with intracranial hypertension, and three with obstructive sleep apnea and intracranial hypertension. Patients with syndromic craniosynostosis, independent of the presence of mild obstructive sleep apnea and/or intracranial hypertension, have normal sleep architecture compared with age-matched controls. Patients with moderate/severe obstructive sleep apnea have a higher respiratory effort–related arousal index (p < 0.01), lower sleep efficiency (p = 0.01), and less rapid eye movement sleep (p = 0.04). An improvement in sleep architecture was observed following monobloc surgery (n = 5; rapid eye movement sleep, 5.3 percent; p = 0.04).

Conclusions:

Children with syndromic craniosynostosis have in principle normal sleep architecture. However, moderate/severe obstructive sleep apnea does lead to disturbed sleep architecture, which fits within a framework of a unifying theory for obstructive sleep apnea, intracranial hypertension, and sleep.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
E-Cigarettes and Potential Implications for Plastic Surgery
Authors: Taub Peter J. , Matarasso Alan
Published: November 2016

The use of tobacco-based products, most notably cigarettes, is related directly to wound healing problems and poorer outcomes in plastic surgery. Current abstracts have highlighted the potential complications from nicotine, specifically following plastic surgery in patients who choose to smoke. Recently, products that use electricity to vaporize liquid nitrogen have been gaining popularity. New rules were recently proposed that would give the federal government authority over electronic cigarettes. However, the health-related issues surrounding e-cigarettes are still largely unknown or misunderstood. These issues also extend to their impact on surgical procedures, notably their effect on plastic surgical procedures that rely heavily on the vascularity of either the host wound bed or the replacement tissue.
Psychological Outcomes of Labiaplasty: A Prospective Study
Authors: Sharp Gemma , Tiggemann Marika , Mattiske Julie
Published: November 2016

Background:

Although the demand for labiaplasty has increased rapidly over the past decade, little is known about the psychological outcomes of this procedure. In particular, there is a lack of prospective controlled studies to assess the effects of labiaplasty on women’s psychological well-being and intimate relationship quality. Nor has research investigated whether preoperative patient characteristics predict satisfaction with surgery.

Methods:

The current study used a prospective controlled design. Participants were 29 adult Australian women who underwent labia minora reduction and 22 comparison women who did not. Both groups completed a baseline questionnaire (preoperatively for the labiaplasty group) and a follow-up questionnaire 6 months later. The questionnaires contained standardized measures of genital appearance satisfaction, relationship satisfaction, sexual confidence, psychological distress, self-esteem, and life satisfaction.

Results:

Of the 29 women who underwent labiaplasty, the vast majority reported that they were “moderately” or “extremely” satisfied with the aesthetic (82.8 percent), functional (86.2 percent), and overall (82.8 percent) outcomes. For the standardized measures, the only significant change from baseline to follow-up for the labiaplasty group relative to the comparison group was a reduction in genital appearance dissatisfaction with large effect size (p < 0.001, d = 3.26). Higher levels of psychological distress (p = 0.001) and having a romantic partner (p = 0.016) preoperatively were significantly related to lower satisfaction with surgical outcomes.

Conclusions:

Labiaplasty appears to have a positive effect on women’s genital appearance satisfaction, but not their general psychological well-being or intimate relationship quality. Medical professionals should be mindful of patients with greater psychological distress, as this may compromise satisfaction with surgical outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Abdominal Contouring: Can the American Society of Anesthesiologists Classification System Help Determine When to Say No?
Authors: Familusi Olatomide T. , Doscher Matthew , Manrique Oscar J. , Shin Joseph , Benacquista Teresa
Published: November 2016

Background:

The purpose of this study was to determine whether the American Society of Anesthesiologists classification system could be used preoperatively to identify patients at high risk for complications after abdominal contouring.

Methods:

Using the National Surgical Quality Improvement Program database from 2007 to 2012, patients undergoing abdominal contouring procedures were identified and stratified by American Society of Anesthesiologists class. The primary outcome was any complication within 30 days. Secondary outcomes included minor wound, major surgical, and medical complication. Adjusted odds ratios were calculated using logistic regression.

Results:

A total of 3637 patients were analyzed; 14.6 percent of patients were class I, 59.1 percent were class II, 23.4 percent were class III, and 2.9 percent were class IV. Overall complication and mortality rates were 12 percent and 0.2 percent, respectively. There was a significant trend of increasing odds of any complication with increasing class (class I, OR, 1.0; class II, OR, 1.5; class III, OR, 2.5; class IV, OR, 5.6; p-trend < 0.001). This trend was seen consistently for minor wound complications, medical complications, and major surgical complications (p = 0.007, p = 0.005, and p = 0.001, respectively).

Conclusions:

The American Society of Anesthesiologists classification system, which is simple and universally applicable, appears to predict significant complications and can be used to rapidly screen patients before abdominal contouring. Furthermore, the authors’ results can be used to inform patient-physician discussion about the risks incurred when undergoing these procedures based on their individual class. Together with optimization of high-risk patients, patient selection using American Society of Anesthesiologists classification may prevent complications and improve outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Alveolar Bone Grafting and Cleft Lip and Palate: A Review
Authors: Weissler E. Hope , Paine Kaitlyn M. , Ahmed Mairaj K. , Taub Peter J.
Published: November 2016

Alveolar bone grafting in the mixed dentition stage is an accepted step in the management of cleft alveoli, providing maxillary arch support for dentition and mastication. Points of contention regarding best practices remain, including specific timing, perioperative orthodontic management, bone harvest and substitutes, pain management, and outcomes evaluations. SCOPUS and MEDLINE were searched for articles about alveolar bone grafting, which were read independently by two authors and selected for inclusion on the basis of relevance and merit. Articles on which recommendations were based were rated using the methodological index for non-randomized studies criteria. Three hundred thirty-three distinct articles were found, of which 64 were found to be suitable and relevant for inclusion. The average methodological index for non-randomized studies score was 10.39, with an interrater weighted kappa of 0.7301. Prospective comparative studies about alveolar bone grafting are rare, but available evidence suggests grafting before canine eruption with targeted preoperative orthopedic interventions, the continued use of iliac crest corticocancellous autologous graft, and adjunctive pain control methods. Greater consensus must be reached about valuable outcome measures for research, including use of imaging and indications for regrafting following graft failure.
Comparison of Endothelial Differentiation Capacities of Human and Rat Adipose-Derived Stem Cells
Authors: Orbay Hakan , Devi Kamaljit , Williams Priscilla A. , Dehghani Tima , Silva Eduardo A. , Sahar David E.
Published: November 2016

Background:

The authors compared the endothelial differentiation capacities of human and rat adipose-derived stem cells to determine whether human adipose-derived stem cells can be a source of endothelial cells clinically.

Methods:

Human and rat adipose-derived stem cells were harvested and characterized with flow cytometry and trilineage differentiation. Cells from passages III through V were fed with endothelial cell differentiation medium for up to 3 weeks. Cells were harvested after 1, 2, and 3 weeks, and endothelial differentiation was evaluated with quantitative reverse-transcriptase polymerase chain reaction, flow cytometry, and angiogenic sprouting assays.

Results:

Both human and rat adipose-derived stem cells were CD90+, CD44+, and CD31− before differentiation. The cells were successfully differentiated into adipogenic, osteogenic, and chondrogenic lineages. Expression of endothelial cell–specific genes peaked at the second week of differentiation in both human and rat cells. The fold changes in expression of CD31, vascular endothelial growth factor receptor-1, nitric oxide synthase, and von Willebrand factor genes at week 2 were 0.4 ± 0.1, 34.7 ± 0.3, 2.03 ± 0.25, and 12.5 ± 0.3 respectively, in human adipose-derived stem cells; and 1.5 ± 1.01, 21.6 ± 1.7, 17.9 ± 0.6, and 11.2 ± 1.3, respectively, in rat cells. The percentages of CD31+ cells were 0.2, 0.64, and 1.6 in human cell populations and 0.5, 5.91, and 11.5 in rat cell populations at weeks 1, 2, and 3, respectively. Rat adipose-derived stem cell–derived endothelial cells displayed enhanced sprouting capability compared with the human cells.

Conclusions:

Human adipose-derived stem cells responded less strongly to EGM-2MV endothelial differentiation medium than did the rat cells. Still, the human cells have the potential to become a clinical source of endothelial cells with modifications in the differentiation conditions.
Timing of Presentation of Pediatric Compartment Syndrome and Its Microsurgical Implication: A Retrospective Review
Authors: Ziolkowski Natalia I. , Zive Leanne , Ho Emily S. , Zuker Ronald M.
Published: November 2016

Background:

Pediatric forearm compartment syndrome can lead to severe functional disability. Although it is known that earlier presentation with decompression leads to better outcomes, it is not known when presentation after injury leads to significant loss of function requiring microsurgical intervention. The authors describe the rate of microsurgical reconstruction after pediatric forearm compartment syndrome as related to timing of presentation.

Methods:

A retrospective chart review was conducted of pediatric patients with forearm compartment syndrome between January 1, 2000, and March 22, 2013, after a traumatic upper extremity injury. Demographic information, cause, time to decompression, complications, and functional outcome were recorded.

Results:

Thirty-five patients aged between 2 and 16 years (8.97 ± 4.12 years) met inclusion criteria. The majority (74 percent) were boys. The right upper extremity was predominantly involved (54 percent), with a predilection for ulnar fractures (66 percent). Fasciotomies were completed for 32 patients (91 percent). Two patients had no decompression (6 percent) because of late presentation. The average time to fasciotomy was less than 12 hours after injury in 16 patients (46 percent), 12 to 48 hours in 15 patients (43 percent), and greater than 48 hours in four patients (11 percent). Complications (63 percent) included nerve injury (40 percent), skin graft (37 percent), scar revision (11 percent), and long flexor tightness requiring serial casting (17 percent). Forearm muscle necrosis requiring microsurgical reconstructive surgery with a gracilis muscle flap occurred in two patients (6 percent). Increased time to decompression was statistically associated with long flexor tightness and gracilis reconstructive surgery.

Conclusion:

Presentation after 48 hours resulted in significant functional deficits requiring reconstructive surgery (gracilis muscle flap reconstruction) or long-term conservative management (serial casting).
Orthognathic Surgery with Simultaneous Autologous Fat Transfer for Correction of Facial Asymmetry
Authors: Wang Yu-Ching , Wallace Christopher Glenn , Pai Betty Chien-Jung , Chen Hui-Ling , Lee Yueh-Tse , Hsiao Yen-Chang , Chang Chun-Shin , Liao Yu-Fang , Chen Philip Kuo-Ting , Chen Yu-Ray
Published: November 2016

Background:

Most patients treated with orthognathic surgery for facial asymmetry would value improvement in residual soft-tissue asymmetry. Autologous fat transfer is widely used to augment facial soft tissue. The authors assessed the effect of combining orthognathic surgery with autologous fat transfer for treating patients with facial asymmetry.

Methods:

In this retrospective study, 15 consecutive adults underwent combined orthognathic surgery and autologous fat transfer between January of 2013 and December of 2015. Lower facial profile symmetry was assessed using postoperative standard frontal photographs.

Results:

Lower facial symmetry was much improved by combining orthognathic surgery and autologous fat injection.

Conclusion:

The combined use of orthognathic surgery and autologous fat transfer is a promising technique for improving facial symmetry in patients with facial asymmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery
Authors: Weissler Jason M. , Stern Carrie S. , Schreiber Jillian E. , Amirlak Bardia , Tepper Oren M.
Published: November 2016

Throughout history, the technological advancements of conventional clinical photography in plastic surgery have not only refined the methods available to the plastic surgeon, but have invigorated the profession through technology. The technology of the once traditional two-dimensional photograph has since been revolutionized and refashioned to incorporate novel applications, which have since become the standard in clinical photography. Contrary to traditional standardized two-dimensional photographs, three-dimensional photography provides the surgeon with an invaluable volumetric and morphologic analysis by demonstrating true surface dimensions both preoperatively and postoperatively. Clinical photography has served as one of the fundamental objective means by which plastic surgeons review outcomes; however, the newer three-dimensional technology has been primarily used to enhance the preoperative consultation with surgical simulations. The authors intend to familiarize readers with the notion that three-dimensional photography extends well beyond its marketing application during surgical consultation. For the cosmetic surgeon, as the application of three-dimensional photography continues to mature in facial plastic surgery, it will continue to bypass the dated conventional photographic methods plastic surgeons once relied on. This article reviews a paradigm shift and provides a historical review of the fascinating evolution of photography in plastic surgery by highlighting the clinical utility of three-dimensional photography as an adjunct to plastic and reconstructive surgery practices. As three-dimensional photographic technology continues to evolve, its application in facial plastic surgery will provide an opportunity for a new objective standard in plastic surgery.