bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral primitive neuroectodermal tumour – a rare cause of a popliteal fossa mass: A case report and review of the literature
Authors: Davis Colin M , Choong Andrew Mtl , Sharp David , Taheri Touraj , Senewiratne Shireen , Hinckley Vedella
Published: March 2018

A literature review of peripheral primitive neuroectodermal tumours, illustrated with an index case report describing an 80-year-old woman who presented with a mass in the left popliteal fossa, is reported. An excision biopsy was performed, revealing a possible peripheral primitive neuroectodermal tumour as the primary pathology. Normally confined to the chest wall and axial soft tissues of children and young adults, reports of this tumour existing in other areas and in the elderly population are scarce.
Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate
Authors: Silvestre Jason , Tahiri Youssef , Paliga J Thomas , Taylor Jesse A
Published: March 2018

Objective

To determine the incidence of obstructive sleep apnea (OSA) in children with isolated cleft lip and/or palate (CL/P).

Methods

The present prospective study was performed at a pediatric tertiary care centre. Consecutive patients evaluated at the cleft clinic from January 2011 to August 2013 were identified. Patients' families prospectively completed the Pediatric Sleep Questionnaire (PSQ), a validated tool used to predict moderate to severe OSA. Patients with CL/P and an underlying syndrome or other craniofacial diagnosis were excluded. A positive OSA screen was recorded if the ratio of positive to total responses was >0.33. Risk factors associated with a positive screen were identified using the Student's t or ANOVA test.

Results

A total of 867 patients completed the PSQ, 489 of whom with isolated CL/P met inclusion criteria. The mean age was 8.4 years. The overall incidence of positive screening was 14.7%. The most commonly reported symptoms among positive screeners were ‘fidgets with hands or feet’ (73.6%), ‘interrupts others’ (69.4%) and ‘mouth breather during the day’ (69.4%). The most sensitive items were ‘stops breathing during the night’ and ‘trouble breathing during sleep’, with positive predictive values of 0.78 and 0.67, respectively. Sex, body mass index, ancestry and cleft type were not significantly associated with increased risk for positive screening.

Conclusion

One in seven children with isolated CL/P screened positively for OSA according to the PSQ. This finding highlights the potential importance of routine screening in this at-risk group.
Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review
Authors: Chamata Edward , Mahabir Raman , Jupiter Daniel , Weber Robert A
Published: March 2018

Background

Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience.

Objective

To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved.

Methods

The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011).

Results

Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve.

Conclusion

The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve.
Inhibitory effects of low-level laser therapy on skin-flap survival in a rat model
Authors: Baldan Cristiano S , Masson Igor Fb , Júnior Ivaldo Esteves , Baldan Alessandra Maria S , Machado Aline F P , Casaroto Raquel A , Liebano Richard E
Published: March 2018

Background

Although several studies have demonstrated the effects of low-level laser therapy (LLLT) on skin flap viability, the role of higher doses has been poorly investigated.

Objective

To investigate the inhibitory effect of the LLLT (λ=670 nm) on the viability of random skin flaps in a rat model using an irradiation energy of 2.79 J at each point.

Methods

Sixteen Wistar rats were randomly assigned into two groups: sham laser irradiation (n=8); and active laser irradiation (n=8). Animals in the active laser irradiation group were irradiated with a 670 nm diode laser with an energy of 2.79 J/point, a power output 30 mW, a beam area of 0.028 cm2, an energy density of 100 J/cm2, an irradiance of 1.07 W/cm2 for 93 s/point. Irradiation was performed in 12 points in the cranial skin flap portion. The total energy irradiated on the tissue was 33.48 J. The necrotic area was evaluated on postoperative day 7.

Results

The sham laser irradiation group presented a mean (± SD) necrotic area of 47.96±3.81%, whereas the active laser irradiation group presented 62.24±7.28%. There was a significant difference in skin-flap necrosis areas between groups (P=0.0002).

Conclusion

LLLT (λ=670 nm) increased the necrotic area of random skin flaps in rats when irradiated with an energy of 2.79 J (100 J/cm2).
Buffered lidocaine and bupivacaine mixture -the ideal local anesthetic solution?
Authors: Best Corliss A , Best Alyssa A , Best Timothy J , Hamilton Danielle A
Published: March 2018

The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery.
Horizontal mattress technique for anastomosis of size-mismatched vessels
Authors: Odobescu Andrei , Moubayed Sami P , Daniels Eugene , Danino Michel Alain
Published: March 2018

Objective

To evaluate the horizontal mattress technique in microvascular anastomosis for size-mismatched vessels.

Methods

The present study involved cadaveric simulation using size-mismatched (1.5:1) Thiel-embalmed cadaveric arteries. The authors performed horizontal mattress anastomoses using 9-0 nylon suture and recorded the procedure. Vessel patency was evaluated by saline infusion. Vessels were cut open and photographed; histological slides were prepared and stained with hematoxylin and eosin.

Results

Four anastomoses were performed. Vessels were found to be patent in all cases, with grade 0 leaks. Intima-on-intima apposition with no intraluminal exposure of muscularis nor adventitia were observed.

Conclusion

The present cadaveric study supports the technical feasibility of using horizontal mattress sutures in size-mismatched end-to-end anastomoses.
Acute choke zone effects: Lessons from radioactive and fluorescent microspheres in a pig model muscle flap
Authors: Courtemanche Dj , Cannon Wg , Courtemanche Rjm , Williamson Js , Lyster D
Published: March 2018

Background

Choke vessels dilate and contract to regulate blood flow between adjacent arterial angiosomes. In skin flap surgery, when arterial inflow to an angiosome is ligated, choke vessels allow blood supply from an adjacent angiosome. In muscle flap surgery, the vascular anatomy is analogous to skin flaps; however, while it is established that the choke vessels will fully dilate irreversibly after two to three days, no study has yet analyzed the acute changes in each vascular region immediately following ligation of one pedicle.

Objective

To establish whether the choke vessels open or close immediately following ligation of a pedicle, and how this change affects blood flow in the adjacent proximal and distal vascular regions.

Methods

Radioactive and fluorescent microspheres in a pig model were used to study the regional intramuscular blood flow in each anatomical zone of a rectus abdominis flap. Blood flow measurements for each zone were calculated relative to the entire muscle at preligation, ligation and various times (15 min to 90 min) postligation.

Results

There was no statistically significant difference in blood flow across choke zones as a result of ligation. This signifies that the choke vessels do not significantly dilate to produce a statistically significant measureable change in blood flow.

Conclusions

Given these results and previous literature findings, the anatomical presence of choke vessels in a muscle is the strongest determining factor for acute flap viability in surgery.
Cell-assisted lipotransfer in the clinical treatment of facial soft tissue deformity
Authors: Ma Li , Wen Huicai , Jian Xueping , Liao Huaiwei , Sui Yunpeng , Liu Yanping , Xu Guizhen
Published: March 2018

Cosmetic surgeons have experimented with a variety of substances to improve soft tissue deformities of the face. Autologous fat grafting provides significant advantages over other modalities because it leaves no scar, is easy to use and is well tolerated by most patients. Autologous fat grafting has become one of the most popular techniques in the field of facial plastic surgery. Unfortunately, there are still two major problems affecting survival rate and development: revascularization after transplantion; and cell reservation proliferation and survival. Since Zuk and Yosra developed a technology based on adipose-derived stem cells and cell-assisted lipotrophy, researchers have hoped that this technology would promote the survival and reduce the absorption of grafted fat cells. Autologous adipose-derived stem cells may have great potential in skin repair applications, aged skin rejuvenation and other aging-related skin lesion treatments. Recently, the study of adipose-derived stem cells has gained increased attention. More researchers have started to adopt this technology in the clinical treatment of facial soft tissue deformity. The present article reviews the history of facial soft tissue augmentation and the advent of adipose-derived stem cells in the area of the clinical treatment of facial soft tissue deformity.
Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study
Authors: Karayel Hikmet , Kaya Burak , Caydere Muzaffer , Terzioğlu Ahmet , Aslan Gürcan
Published: March 2018

Background

There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps.

Objective

To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A.

Methods

Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically.

Results

The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P<0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A.

Conclusion

Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke.
Needle aponeurotomy for Dupuytren contracture: Effectiveness of postoperative night extension splinting
Authors: Tam Louisa , Chung Yin-Yin
Published: March 2018

Background

Night extension splinting has been used to treat patients with Dupuytren contracture to improve active range of motion (AROM) of the hand. A published case study demonstrated the benefit of splinting following needle aponeurotomy; however, no larger studies have evaluated the impact of postoperative splinting.

Objectives

To compare the impact of night extension splinting on AROM, specifically extension, following needle aponeurotomy for Dupuytren contracture.

Methods

A retrospective chart review was conducted in which the charts of 53 patients who underwent needle aponeurotomy for Dupuytren contracture between 2009 and 2013 were reviewed. The control group consisted of patients who underwent needle aponeurotomy only, whereas the treatment group was also referred for fabrication of custom night extension splints after surgery. Comparisons in pre- and postoperative AROM measurements for the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were made between both groups of patients. The degrees of change in AROM for each joint were categorized in terms of levels of change: mild (0° to 29°); moderate (30° to 60°); and significant (≥61°).

Results

All patients exhibited increased AROM after surgery for both MCP and PIP joints. Both groups had a greater increase in AROM in the MCP joint. Twelve joints from the control group had moderate changes and two from the treatment group had significant changes. When both groups were compared, the levels of change of AROM between both groups did not vary significantly.

Conclusion

Night extension splinting following needle aponeurotomy may not improve AROM of the MCP or PIP joints.
Postoperative monitoring of free flap reconstruction: A comparison of external Doppler ultrasonography and the implantable Doppler probe
Authors: Hosein Rayaad C , Cornejo Agustin , Wang Howard T
Published: March 2018

Hypothesis

The time to detection of vascular compromise and the postoperative time to reexploration are shorter using the implantable Doppler (ID) probe, thereby resulting in earlier surgical reexploration and a higher flap salvage rate.

Methods

A single-centre experience with 176 consecutive free flap reconstructions in 167 patients from 2000 to 2008 in a university-based teaching hospital by retrospective chart review is presented.

Results

There was a significant difference in overall flap survival (ID 98.0%, external Doppler [ED] 89.3%) and total flap loss (ID 2.0%, ED 10.7%) between the two groups (P=0.03). The difference in flap salvage rate was not significant (ID 90.9%, ED 63.6%; P=0.068). The false-positive (ID 0%, ED 3%; P=0.18) and false-negative rates (ID 0.0%, ED 4.5%; P=1.0) were not significantly different. There was also a lower median postoperative time to reexploration for the ID group, from 48 h to one week after initial surgery (ID 74.5 h, ED 136.8 h; P=0.05).

Conclusion

The present analysis revealed a potential benefit for the ID probe in the postoperative monitoring of free tissue transfers.
A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value
Authors: Timashpolsky Alisa , Dagum Alexander B , Sayeed Syed M , Romeiser Jamie L , Rosenfeld Elisheva A , Conkling Nicole
Published: March 2018

Background

There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources.

Objective

A blinded prospective study was undertaken to assess the predictive value of physical examination findings in detecting maxillofacial fracture in trauma patients, and in determining whether a patient will require surgical intervention.

Methods

Over a four-month period, the authors' team examined patients admitted with facial trauma to the emergency department of their hospital. The evaluating physician completed a standardized physical examination evaluation form indicating the physical findings. Corresponding CT scans and surgical records were then reviewed, and the results recorded by a plastic surgeon who was blinded to the results of the physical examination.

Results

A total of 57 patients met the inclusion criteria; there were 44 male and 13 female patients. The sensitivity, specificity, positive predictive value and negative predictive value of grouped physical examination findings were determined in major areas. In further analysis, specific examination findings with n≥9 (15%) were also reported.

Conclusions

The data demonstrated a high negative predictive value of at least 90% for orbital floor, zygomatic, mandibular and nasal bone fractures compared with CT scan. Furthermore, none of the patients who did not have a physical examination finding for a particular facial fracture required surgery for that fracture. Thus, the instrument performed well at ruling out fractures in these areas when there were none. Ultimately, these results may help reduce unnecessary radiation and costly imaging in patients with facial trauma without facial fractures.
Complications in body contouring stratified according to weight loss method
Authors: Chetta Matthew D , Aliu Oluseyi , Patrick Bao Anh , Abdulghani Mariam , Kidwell Kelly M , Momoh Adeyiza O
Published: March 2018

Background

Body contouring procedures following massive weight loss have become increasingly common and, unfortunately, continue to be associated with a high complication rate.

Objective

To evaluate how weight loss method affects complications following abdominally based body contouring procedures.

Methods

Patients undergoing abdominally based contouring procedures were retrospectively evaluated over an 11-year period and stratified into two groups based on method of weight loss: diet and exercise; or bariatric surgery. Complications, including seroma, wound dehiscence, skin necrosis, infection, hematoma and venous thromboembolism, were included if they required intervention. An adjusted logistic model was used to examine the effect of weight loss method on aggregate complication rates.

Results

A total of 307 patients were included: 77 (25%) lost weight through diet and exercise; and 230 (75%) through bariatric surgery. Results from the logistic model showed no difference in complication rates between weight loss methods (OR 1.01 [95% CI 0.51 to 2.02]). However, there was a strong correlation between body mass index at the time of surgery and complication rates (OR 1.05 [95% CI 1.02 to 1.08]; P<0.01).

Conclusions

The findings reveal no difference in complication rates following abdominal body contouring procedures attributable to method of weight loss. Rather, there was a proportional rise in complication rates in patients with a higher body mass index at the time of surgery. Surgeons and patients should be aware of this trend, and it should be part of any discussion of abdominal body contouring procedures and informing patients of their risk profile.
The use of the radial styloid in the extended osteocutaneous radial forearm free flap
Authors: Matthews Jennifer , Ng Wendy , Archibald Stuart , Levis Carolyn
Published: March 2018

Background

The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply.

Methods

The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected.

Results

Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion.

Conclusions

The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.
Assessing the effects of melatonin and N-acetylcysteine on the McFarlane flap using a rat model
Authors: Tunç Süphan , Kesiktas Erol , Yilmaz Yeliz , Açikalin Arbil , Oran Gökgen , Yavuz Metin , Gencel Eyüphan , Eser Cengiz
Published: March 2018

Objective

To determine the effects of N-acetylcysteine (NAC) and melatonin, alone and in combination, on McFarlane flap viability in a rat model.

Methods

Forty Wistar rats were divided into four groups and received daily intraperitoneal injections for one week before surgery: control (sham [n=10]); melatonin (n=10); NAC (n=10); and NAC+melatonin (n=10). One week after surgery, the experiment was terminated and photographs were taken for topographic studies. A transillumination study was performed to observe vascularization in the flaps and biopsies were obtained for histopathological studies.

Results

Flap viability was significantly greater in the antioxidant- (ie, NAC and melatonin) treated groups compared with the control group; however, there were no significant differences among the groups that received antioxidants.

Conclusions

Melatonin and NAC are important antioxidants that can be used alone or in combination to increase flap viability and prevent distal necrosis in rats.
Evaluation of the complex treatment for congenital blepharoptosis
Authors: Iljin Aleksandra , Zieliński Tomasz , Broniarczyk-Loba Anna , Antoszewski Bogusław
Published: March 2018

Objective

To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders.

Methods

Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed.

Results

Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients

Conclusions

Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.
Variations in the Anatomical Structures of the Guyon Canal
Authors: Fadel Zahir T. , Samargandi Osama A. , Tang David T.
Published: March 2018

Background:

Compression neuropathy of the ulnar nerve at the Guyon canal is commonly seen by hand surgeons. Different anatomical variations of structures related to the Guyon canal have been reported in the literature. A thorough knowledge of the normal contents and possible variations is essential during surgery and exploration.

Objectives:

To review the recognized anatomical variations within and around the Guyon canal.

Methods:

This study is a narrative review in which relevant papers, clinical studies, and anatomical studies were selected by searching electronic databases (PubMed and EMBASE). Extensive manual review of references of the included studies was performed. We also describe a case report of an aberrant muscle crossing the Guyon canal.

Results:

This study identified several variations in the anatomical structures of the Guyon canal reported in the literature. Variations of the ulnar nerve involved its course, branching pattern, deep motor branch, superficial sensory branch, dorsal cutaneous branch, and the communication with the median nerve. Ulnar artery variations involved its course, branching pattern, the superficial ulnar artery, and the dorsal perforating artery. Aberrant muscles crossing the Guyon canal were found to originate from the antebrachial fascia, pisiform bone, flexor retinaculum, the tendon of palmaris longus, flexor carpi ulnaris, or flexor carpi radialis; these muscles usually fuse with the hypothenar group.

Conclusion:

The diverse variations of the contents of the Guyon canal were adequately described in the literature. Taking these variations into consideration is important in preventing clinical misinterpretation and avoiding potential surgical complications.
Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction Versus Mastectomy Alone
Authors: Sousa Janelle , Sood Ravi , Liu Daniel , Calhoun Kristine , Louie Otway , Neligan Peter , Said Hakim , Mathes David
Published: March 2018

Objectives:

Immediate implant-based techniques are common practice in post-mastectomy breast reconstruction. Previous studies have shown an increased complication rate in the setting of immediate versus delayed, MD reconstruction. We aimed to quantify any additional risk in complications when implant-based immediate breast reconstruction (IBR) is performed versus mastectomy alone.

Materials and Methods:

We retrospectively reviewed all IBR cases and all mastectomies without reconstruction from 2007 to 2011. Patient characteristics, operative details, and complication rates were reviewed and analyzed.

Results:

IBR was performed in 315 consecutive women; mastectomy alone was performed in 401 women. Patients undergoing mastectomy alone were more often older, diabetic, and more frequently underwent neoadjuvant chemotherapy or radiation. Overall complications were higher in the IBR group, most commonly reoperation and delayed wound healing. In a multivariate analysis, IBR, increasing age, body mass index, history of radiation therapy, smoking, and nipple-sparing mastectomy were independently associated with increased risk of complications. However, IBR was only independently associated with increased risk of major complications such as reoperation or readmission for intravenous antibiotics, not minor complications.

Conclusion:

Patients selected for IBR are inherently different than those undergoing mastectomy alone. After adjusting for these differences, the increased risk of complications seen in IBR is moderately increased over the risk of complications in mastectomy alone. The observed increased risk of major complications after IBR is largely due to the aggressive management of complications in the setting of a prosthetic implant. IBR is a safe reconstructive strategy with only a slightly increased risk over mastectomy alone.
Forces Required to Pull the Superficial Fascia in Facelifts
Authors: Byun Jin Suk , Hwang Kun , Lee Sang Yun , Song Jae Min , Kim Hun
Published: March 2018

Purpose:

The aims of this study were to characterize the histology of the sideburn and cheek area and to measure the force required to pull the superficial fascia (SF) of Asians in facelift procedures.

Methods:

The hemiface of a formalin-fixed Korean male adult cadaver (77 years old) was used to study the histology of the sideburn and cheek area. In 42 patients during facelift procedures, the force needed to pull the overlying skin at the midpoint between the sideburn and nasolabial fold 2 mm was measured using a tensiometer.

Results:

In the cheek, the superficial fatty layer of the superficial fascia (SFS) was found to maintain its thickness throughout the region between the dermis and the membranous layer of the superficial fascia (MSF). The MSF was continuous with the superficial temporal fascia (STF). In the sideburn, the MSF and parotid fascia closely adhered to each other. The force required to move the overlying skin 2 mm when pulling the MSF (10.27 ± 3.64 N) was more than twice as great (217%) as the force required when pulling the SFS (4.73 ± 2.15 N; P < .001). The forces required when pulling the MSF and SFS to move the overlying skin 2 mm were significantly greater in the sideburn area (11.56 ± 3.37 N and 5.52 ± 2.08 N, respectively) than in the cheek area (8.97 ± 3.43 N and 5.52 ± 2.08 N, respectively; P < .001).

Conclusion:

When lifting the SF at the cheek or sideburn area, lifting the SFS requires less tension than MSF to move the overlying skin. In the cheek area, less tension is needed to move the overlying skin than in the sideburn area.
How Competitive Is Plastic Surgery? An Analysis of the Canadian and American Residency Match
Authors: Morzycki Alexander , Bezuhly Michael , Williams Jason G.
Published: March 2018

Background:

Plastic surgery (PS) is considered to be one of the most competitive specialties. As a result, some students are discouraged from applying, reducing the overall number of PS candidates. Still, much of what we know of the match is based in conjecture.

Objective:

To examine the Canadian PS match data from 1997 to 2016. To our knowledge, this is the first long-term analysis of the Canadian PS residency match.

Method:

We examined the Canadian Residency Matching Service reports from 1997 to 2016, extracting key match statistics, including available positions, number of applicants, positions filled, positions unfilled, and gender-specific match results. To examine competitiveness, the ratio of total applicants per quota per year (CR) and the ratio of applicants who chose PS as their first-choice specialty per quota per year were calculated (FC-CR). The National Residency Matching Program data were used to assess the American integrated PS match over the past decade and served as a comparison.

Results:

The CR of Canadian PS programs declined over the last 20 years ( P < .001), indicating fewer applicants applied to the program per available position. Similarly, the FC-CR also declined over the last 20 years ( P < .001). The number of females matching to their first-choice discipline of PS increased from 1997 ( P < .001). There was no significant change in the number of males matching to their first-choice discipline of PS ( P = .15). There was no significant change in the competitiveness (CR) of the American integrated PS match over the last decade ( P = 0.087).

Conclusion:

Encouragingly, today PS has more training positions and more female residents; yet, the overall number of applicants has remained relatively static over the past 20 years. This analysis serves as a valuable reference for PS programs and should assist in developing strategies to encourage the best applicants to apply.
Delivering Breast Reconstruction Information to Patients: Women Report on Preferred Information Delivery Styles and Options
Authors: Webb Carmen , Sharma Vishal , Temple-Oberle Claire
Published: March 2018

Purpose:

To discover missed opportunities for providing information to women undergoing breast reconstruction in an effort to decrease regret and improve patient education, teaching modalities, and satisfaction.

Method:

Thirty- to 45-minute semi-structured interviews were conducted exploring patient experiences with information provision on breast reconstruction. Purposeful sampling was used to include women with a variety of reconstruction types at different time points along their recovery. Using grounded theory methodology, 2 independent reviewers analyzed the transcripts and generated thematic codes based on patient responses. BREAST-Q scores were also collected to compare satisfaction scores with qualitative responses.

Results:

Patients were interested in a wide variety of topics related to breast reconstruction including the pros and cons of different options, nipple-sparing mastectomies, immediate breast reconstruction, oncological safety/monitoring and the impact of chemotherapy and radiotherapy, secondary procedures (balancing, nipple reconstruction), post-operative recovery, and long-term expectations. Patients valued accessing information from multiple sources, seeing numerous photographs, being guided to reliable information online, and having access to a frequently asked questions file or document. Information delivery via interaction with medical personnel and previously reconstructed patients was most appreciated. Compared with BREAST-Q scores for satisfaction with the plastic surgeon (mean: 95.7, range: 60-100), informational satisfaction scores were lower at 74.7 (50-100), confirming the informational gaps expressed by interviewees.

Conclusions:

Women having recently undergone breast reconstruction reported key deficiencies in information provided prior to surgery and identified preferred information delivery options. Addressing women’s educational needs is important to achieve appropriate expectations and improve satisfaction.
Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review
Authors: Lamplot Joseph D. , Schafer Kevin A. , Matava Matthew J.
Published: March 2018

Background:

Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed attempt at cartilage repair or reconstruction.

Purpose:

To investigate outcomes of revision cartilage restoration procedures for symptomatic articular cartilage lesions of the knee following a previously failed cartilage reconstructive procedure.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A literature search was performed by use of the PubMed, EMBASE, and MEDLINE/Ovid databases for relevant articles published between 1975 and 2017 that evaluated patients undergoing revision cartilage restoration procedure(s) and reported outcomes using validated outcome measures. For studies meeting inclusion criteria, relevant information was extracted.

Results:

Ten studies met the inclusion criteria. Lesions most commonly occurred in the medial femoral condyle (MFC) (52.8%), with marrow stimulation techniques (MST) the index procedure most frequently performed (70.7%). Three studies demonstrated inferior outcomes of autologous chondrocyte implantation (ACI) following a previous failed cartilage procedure compared with primary ACI. One study comparing osteochondral allograft (OCA) transplant following failed microfracture (MFX) with primary OCA transplant demonstrated similar clinical outcomes and graft survival at midterm follow-up. No studies reported outcomes following osteochondral autograft transfer (OAT) or newer techniques.

Conclusion:

This systematic review of the literature reporting outcomes following revision articular cartilage restoration procedures (most commonly involving the MFC) demonstrated a high proportion of patients who underwent prior MST. Evidence is sufficient to suggest that caution should be taken in performing ACI in the setting of prior MST, likely secondary to subchondral bone compromise. OCA appears to be a good revision treatment option even if the subchondral bone has been violated from prior surgery or fracture.
Why Does North Korea Engage in Provocations?
Authors: Hess Ashley A.C.
Published: March 2018

Given the increasing number and severity of North Korean provocations, this article quantitatively analyses the relationship between North Korean actions and different types of events and actions taken by the international community commonly described as ‘triggers’ for these provocations. A database of 257 possible trigger events and 88 North Korean provocations, covering the period from 1 January 2012 through 21 November 2016, was developed for investigation. Statistical analyses assessed correlations between specific types of trigger events and North Korean provocations writ large as well as the specific level of provocation. The article concludes that, despite media and academic assessments to the contrary, the notional trigger events explored in this article appear to be uncorrelated with either North Korea undertaking a provocation or its level of severity. The strongest finding supports the concept of provocation cycles, in which the clearest predictor of a North Korean provocation is simply whether or not another provocation has recently taken place. Yet, the article also finds that in these situations additional provocations may more likely be of a lower level, such as short-range missile tests or limited naval incursions. International leaders’ decisions should be informed by this apparent lack of significant correlation between provocations and events such as USA–South Korean military exercises, United Nations Security Council resolutions, or a high-level US visit to the region.
The Clash of Power and Nationalism: The Sino-Japan Territorial Dispute
Authors: Kim Jihyun
Published: March 2018

The East Asian security order has been affected by the increasing rivalry between China and Japan in recent years against the backdrop of the evolving Sino-Japan balance of power and the renewed nationalism in both countries. These developments have emerged as powerful wild cards, reinforcing the security dilemma and undermining the prospect for building a lasting peace between these two major powers in the region. This research is designed to examine Sino-Japan relations as well as the overall security order in East Asia. In particular, it looks into how the politics of nationalism intertwined with the changing regional power dynamics could affect the East China Sea dispute by creating an environment more conducive to bilateral tensions rather than mutual trust and cooperation.
Using Google Trends to Measure Issue Salience for Hard-to-Survey Populations
Authors: Chykina Volha , Crabtree Charles
Published: March 2018

Some populations are difficult to survey. This poses a problem for researchers who want to understand what issues matter to these populations and how the salience of those concerns varies over time. In this visualization article, the authors illustrate how Google Trends can be used to examine issue salience for hard-to-survey mass populations. Applying this method to immigrant concerns over deportation, the authors show that anxieties over removal increased in response to (potential) policy changes, such as Arizona’s Support Our Law Enforcement and Safe Neighborhoods Act (Senate Bill 1070) and the immigration policies that were considered in the wake of Donald Trump’s election.
Pilot Study of an Internet-Based Self-Management Program for Symptom Control in Patients With Early-Stage Breast Cancer
Authors: Henry N. Lynn , Kidwell Kelley M. , Alsamarraie Cindy , Bridges Celia M. , Kwiatkowski Christine , Clauw Daniel J. , Smith Ellen M. L. , Williams David A.
Published: March 2018

Purpose

Many survivors of breast cancer experience an array of chronic symptoms, including pain, insomnia, and fatigue. Few effective therapies have been identified. Behavioral management programs to address similar symptom clusters in other chronic conditions have been effective. The objective of this study was to determine the effect of an Internet-based lifestyle and behavioral self-management program on cancer-related symptoms.

Patients and Methods

Women with stage 0 to 3 breast cancer who reported insomnia, pain, or fatigue as their primary symptom of concern during the 7 days before enrollment were enrolled. Local therapies and/or chemotherapy were completed at least 3 months before enrollment. Patients were assessed at baseline and after 8 weeks, and they completed the Patient-Reported Outcomes Measurement Information System (PROMIS)–29 Profile and Patient Global Impression of Change (PGIC) questionnaire electronically. Change in each of the eight symptom domains was assessed.

Results

Fifty patients enrolled. In the 45 patients with both baseline and 8-week PROMIS data, statistically significant improvements in anxiety, sleep, fatigue, activity level, and pain severity were reported. Of the 35 patients who responded to the PGIC, 62.9% reported improvement in their primary symptom. Those who reported fatigue as their primary symptom reported greatest overall benefit in multiple symptom improvement, including improvements in fatigue, anxiety, pain severity, pain interference, and participation in social activities.

Conclusions

These findings suggest that this lifestyle and behavioral management program may improve multiple symptoms in breast cancer survivors when delivered via the Internet. Randomized studies are warranted to evaluate the efficacy of the online intervention compared with standard symptom management approaches and to identify patients most likely to benefit.
miR-106a Increases Granulosa Cell Viability and Is Downregulated in Women With Diminished Ovarian Reserve
Authors: Hong Liming , Peng Sha , Li Ying , Fang Ying , Wang Qin , Klausen Christian , Yin Chenghong , Wang Shuyu , Leung Peter C K , Yang Xiaokui
Published: March 2018

Context

Women with diminished ovarian reserve (DOR) have reduced fertility, cardiovascular events, and osteoporosis. Although differential microRNA (miRNA) expression has been described in several ovarian disorders, little is known about the role of miRNAs in the pathogenesis of DOR.

Objective

Identify differentially expressed miRNAs in DOR and explore the role of miR-106a in human granulosa cell proliferation.

Design

miRNA microarray (n = 3) and quantitative reverse transcription polymerase chain reaction (n = 30) were used to examine miRNA expression in serum and granulosa cells from normal-cycling and women with DOR. Primary human granulosa cells were treated alone or in combination with miR-106a mimic, miR-106a inhibitor, apoptosis signal-regulating kinase 1 (ASK1) small interfering RNA (siRNA), or p38 mitogen-activated protein kinase (MAPK) inhibitor (SB203580) before assessment of cell viability and apoptosis. Western blot was used to measure ASK1 protein and phosphorylation/activation of p38 MAPK. Binding of miR-106a to ASK1 mRNA was examined by 3′ untranslated region (3′UTR) luciferase analysis.

Results

Fifteen miRNAs were differentially expressed (n = 30), and miR-106a was downregulated in serum and granulosa cells of women with DOR. miR-106a mimic increased cell viability and attenuated apoptosis, whereas the converse occurred following treatment with miR-106a inhibitor. miR-106a suppressed ASK1 expression by directly targeting its 3′UTR. miR-106a inhibitor increased p38 MAPK phosphorylation/activation, and this effect was abolished by treatment with ASK1 siRNA. Whereas knockdown of ASK1 abolished the effects of miR-106a inhibitor on cell viability/apoptosis, pretreatment with SB203580 did not significantly alter the effects of miR-106a inhibitor.

Conclusions

Downregulation of miR-106a may contribute to the pathogenesis of DOR by reducing granulosa cell viability and promoting apoptosis via enhanced ASK1 signaling.
Noradrenergic Activity in the Human Brain: A Mechanism Supporting the Defense Against Hypoglycemia
Authors: Belfort-DeAguiar Renata , Gallezot Jean-Dominique , Hwang Janice J , Elshafie Ahmed , Yeckel Catherine W , Chan Owen , Carson Richard E , Ding Yu-Shin , Sherwin Robert S
Published: March 2018

Context

Hypoglycemia, one of the major factors limiting optimal glycemic control in insulin-treated patients with diabetes, elicits a brain response to restore normoglycemia by activating counterregulation. Animal data indicate that local release of norepinephrine (NE) in the hypothalamus is important for triggering hypoglycemia-induced counterregulatory (CR) hormonal responses.

Objective

To examine the potential role of brain noradrenergic (NA) activation in humans during hypoglycemia.

Design

A hyperinsulinemic-hypoglycemic clamp was performed in conjunction with positron emission tomographic imaging.

Participants

Nine lean healthy volunteers were studied during the hyperinsulinemic-hypoglycemic clamp.

Design

Participants received intravenous injections of (S,S)-[11C]O-methylreboxetine ([11C]MRB), a highly selective NE transporter (NET) ligand, at baseline and during hypoglycemia.

Results

Hypoglycemia increased plasma epinephrine, glucagon, cortisol, and growth hormone and decreased [11C]MRB binding potential (BPND) by 24% ± 12% in the raphe nucleus (P < 0.01). In contrast, changes in [11C]MRB BPND in the hypothalamus positively correlated with increments in epinephrine and glucagon levels and negatively correlated with glucose infusion rate (all P < 0.05). Furthermore, in rat hypothalamus studies, hypoglycemia induced NET translocation from the cytosol to the plasma membrane.

Conclusions

Insulin-induced hypoglycemia initiated a complex brain NA response in humans. Raphe nuclei, a region involved in regulating autonomic output, motor activity, and hunger, had increased NA activity, whereas the hypothalamus showed a NET-binding pattern that was associated with the individual’s CR response magnitude. These findings suggest that NA output most likely is important for modulating brain responses to hypoglycemia in humans.
M Archive
Authors: Gumbs Alexis Pauline
Published: March 2018

Following the innovative collection Spill, Alexis Pauline Gumbs's M Archive—the second book in a planned experimental triptych—is a series of poetic artifacts that speculatively documents the persistence of Black life following a worldwide cataclysm. Engaging with the work of the foundational Black feminist theorist M. Jacqui Alexander, and following the trajectory of Gumbs's acclaimed visionary fiction short story “Evidence,” M Archive is told from the perspective of a future researcher who uncovers evidence of the conditions of late capitalism, antiblackness, and environmental crisis while examining possibilities of being that exceed the human. By exploring how Black feminist theory is already after the end of the world, Gumbs reinscribes the possibilities and potentials of scholarship while demonstrating the impossibility of demarcating the lines between art, science, spirit, scholarship, and politics.