bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumor Size in Breast Carcinoma: Gross Measurement Is Important!
Authors: Hamza Ameer , Sakhi Ramen , Alrajjal Ahmed , Ibrar Warda , Miller Shelby , Salehi Sajad , Edens Jacob , Ockner Daniel
Published: March 2018

Introduction. The staging of breast carcinoma is mainly dependent on tumor size and lymph node status. Small increments in tumor size upstage the patient. An accurate determination of the tumor size is therefore critically important. Although the final staging is based on microscopic size, pathologists rely on gross measurements in a considerable number of cases. Methods. We investigated the concordance between gross and microscopic measurements of breast carcinoma as well as factors affecting this concordance. This study is a retrospective review of surgical pathology reports of invasive breast carcinomas. Data were collected for 411 cases. Concordance was defined as a size difference within ±2 mm. Results. Gross and microscopic sizes were identical in 33.1% of cases. Gross and microscopic size difference was within ±2 mm in 56% of cases. Despite the size difference, stage classification ended up being the same in 68.6% of cases. Tumor stage was over estimated by gross measurement in 17.0% of cases and underestimated in 14.4% of cases. The concordance was significantly higher for those tumors in which final pathologic tumor (pT) size was greater than 2 cm (≥pT2) as compared with those less than or equal to 2 cm (≤pT1; P < .0001). A higher proportion of mastectomy specimens (61.4%) were concordant as compared with lumpectomy specimens (52.1%). Conclusion. Gross and microscopic tumor sizes were concordant in 56% of cases. Stage classification based on gross and microscopic tumor size was different in nearly one third (31.4%) of cases. Gross tumor size is critically important in accurate staging at least in cases where tumor size cannot be confirmed microscopically.
Bleeding Events in Thrombocytopenic Patients With Cancer Undergoing Acute Rehabilitation
Authors: Neal Jacqueline , Shahpar Samman , Spill Gayle , Semik Patrick , Marciniak Christina
Published: March 2018

Objectives:

To determine incidence of bleeding in thrombocytopenic patients with cancer undergoing acute inpatient rehabilitation.

Design:

This is an observational cross-sectional retrospective study.

Setting:

Acute inpatient academic rehabilitation facility.

Participants:

Adult patients admitted to acute inpatient rehabilitation with functional impairments secondary to cancer.

Methods:

Electronic records were reviewed for thrombocytopenic patients with cancer to determine platelet counts, bleeding events during rehabilitation, and anticoagulant medications prescribed.

Main outcomes measurements:

Type and number of bleeding events, severity of bleeding by World Health Organization criteria.

Results:

Of the 278 patients with cancer admitted to acute rehabilitation over a 27-month time frame, 119 had at least one platelet count <150 000/µL. In all, 37 (31.1%) had a history of a bleeding event prior to the rehabilitation admission and 34 (28.6%) had at least one bleeding complication during their stay. Most events (87.5%) were of low grade (Grade 1 and 2 World Health Organization criteria). There was no association between platelet counts <11 000 or counts 11 000 to 20 000/µL and the occurrence of bleeding ( P = .106 and P = .319, respectively). Although anticoagulants were common, there was no association found with a bleeding event and either anticoagulation status (receiving or not on such agents), specific anticoagulant or antiplatelet agents, or a combination.

Conclusions:

Bleeding events in patients with cancer with thrombocytopenia during acute rehabilitation stay are not uncommon but are typically mild in severity and not associated with the degree of thrombocytopenia. Patients taking anticoagulants when platelet levels rose did experience bleeding events, but not at a statistically greater rate than those not taking such medications.
‘But I liked it, I liked it’: Revealing agentive aspects of women’s engagement in informal economy on the EU external borders
Authors: Sasunkevich Olga
Published: March 2018

The aim of this article is to shed light on women’s experience of informal trade on one of the EU external borders: Belarus–Lithuania. The article suggests looking at the informal economy beyond the notion of precarity and to pay attention to how women themselves understand their involvement in trading practices. The author argues that, although economic necessity is an important motivation for women to start trading activities, this experience rewards them not only financially but also through non-economic aspects such as self-respect, solidarity and socializing. Theoretically, the article brings together the discussion of the gendered nature of informal work with the feminist theory of agency. It shows that women’s experience of informal cross-border trade is agentive. Trade provides women with a sense of pride, self-confidence and respect and enables them to recognize their self-sufficiency. However, it is also argued that agency is not synonymous with autonomy and individualism. Theoretically and empirically, the article stresses a relational understanding of agency. On the one hand, women acknowledge their financial achievements as the capability to take proper care of their children, especially in situations when the second breadwinner is absent. On the other hand, they also value their trading experience as a space of socializing with other women. The success of cross-border trade depends on the sense of solidarity and collective action to resist the system represented by customs and border control.
A grounded theory approach to assess indoor soundscape in historic religious spaces of Anatolian culture: A case study on Hacı Bayram Mosque
Authors: Yilmazer Semiha , Acun Volkan
Published: March 2018

This study presents a research that is concerned with the indoor soundscape in historical mosque. Hacı Bayram Mosque and its surroundings area of Hamamönü has been selected as the research site due to being the historical centre of Ankara. Although there are studies concerned with the acoustical characteristics of mosques, there is not enough research focusing on user’s expectation and interpretation of the indoor soundscape within a historical space. This study adopts the user-focused grounded theory to capture individuals’ auditory sensation and interpretation of the indoor soundscape within a historical mosque. In-depth interviews are held with congregation of the mosque and with the individuals sitting around the surrounding area. Based on their subjective responses, a theoretical framework is generated to gain an insight on the factors that affect individuals understanding and expectation from mosques. The conceptual framework generated through grounded theory shows how indoor soundscape may influence their individuals’ response to the physical environment of the mosque showing the association between the soundscape elements, spatial function and place identity.
Influence of steel–concrete bond damage on the dynamic stiffness of cracked reinforced concrete beams
Authors: Xu Tengfei , Huang Jiantao , Castel Arnaud , Zhao Renda , Yang Cheng
Published: March 2018

In this article, experiments focusing at the influence of steel–concrete bond damage on the dynamic stiffness of cracked reinforced concrete beams are reported. In these experiments, the bond between concrete and reinforcing bar was damaged using appreciate flexural loads. The static stiffness of cracked reinforced concrete beam was assessed using the measured load–deflection response under cycles of loading and unloading, and the dynamic stiffness was analyzed using the measured natural frequencies with and without sustained loading. Average moment of inertia model (Castel et al. model) for cracked reinforced beams by taking into account the respective effect of bending cracks (primary cracks) and the steel–concrete bond damage (interfacial microcracks) was adopted to calculate the static load–deflection response and the natural frequencies of the tested beams. The experimental results and the comparison between measured and calculated natural frequencies show that localized steel–concrete bond damage does not influence remarkably the dynamic stiffness and the natural frequencies both with and without sustained loading applied. Castel et al. model can be used to calculate the dynamic stiffness of cracked reinforced concrete beam by neglecting the effect of interfacial microcracks.
Self-report measure as a useful tool to identify prenatal substance use and predict adverse birth outcomes
Authors: Washio Yukiko , Goldstein Neal D , Butler Richard , Rogers Stephanie , Paul David A , Terplan Mishka , Hoffman Matthew K
Published: March 2018

Objectives

The purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records.

Methods

Pregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses ( N = 11,020). Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and logistic models were evaluated for the associations between substance use and each birth outcome (preterm birth, low birth weight, neonatal intensive care unit admission).

Results

The average maternal age was 30 years (standard deviation: 6), 37% receiving Medicaid. Over 58% were White, 26% were Black, and 13% were Hispanic. Cigarette smoking only showed the highest prevalence among substance users (53%). Self-reported cigarette smoking and illicit drug use other than marijuana significantly predicted all three adverse birth outcomes (Adjusted Odds Ratio [AOR] range: 1.33 (95% Confidence Interval [CI]: 1.08–1.64)–3.09 (95% CI: 2.03–4.67)). Nonresponders to the cigarette smoking question also significantly predicted two adverse birth outcomes of preterm birth delivery (AOR: 4.16; 95% CI: 1.27–14.71) and having low birth weight babies (AOR: 3.50; 95% CI: 1.04–12.61). Conclusions/Importance: Prenatal cigarette smoking only had the highest prevalence, and co-use with illicit drugs was also high, leading to significant associations with adverse birth outcomes. The study findings indicate that the self-report measurement is a useful tool to identify prenatal substance use and predict resulting adverse birth outcomes.
Low-Information Voting: Evidence From Instant-Runoff Elections
Authors: Alvarez R. Michael , Hall Thad E. , Levin Ines
Published: March 2018

How do voters make decisions in low-information contests? Although some research has looked at low-information voter decision making, scant research has focused on data from actual ballots cast in low-information elections. We focus on three 2008 Pierce County (Washington) Instant-Runoff Voting (IRV) elections. Using individual-level ballot image data, we evaluate the structure of individual rankings for specific contests to determine whether partisan cues underlying partisan rankings are correlated with choices made in nonpartisan races. This is the first time that individual-level data from real elections have been used to evaluate the role of partisan cues in nonpartisan races. We find that, in partisan contests, voters make avid use of partisan cues in constructing their preference rankings, rank-ordering candidates based on the correspondence between voters’ own partisan preferences and candidates’ reported partisan affiliation. However, in nonpartisan contests where candidates have no explicit partisan affiliation, voters rely on cues other than partisanship to develop complete candidate rankings.
Paradox and Pedagogy in The Stanley Parable
Authors: Sarian Antranig Arek
Published: March 2018

The Stanley Parable uses metafiction and elements borrowed from the “Theatre of the Absurd” to reveal a didactic, pedagogical, and despotic voice that lies below many of the choices found within gamebooks, literary games, and interactive narratives. The satirical character of the “narrator,” coupled with the game’s use of paradoxes, makes choosers aware of the catechistic structure that many didactic choices employ. This pedagogic choice structure has its roots in the TutorText series of programmed learning novels—a structure repeated (and hidden) by the Choose Your Own Adventure-style gamebooks that followed and that is subsequently parodied in The Stanley Parable. The Stanley Parable itself provides players with choices that lack a solution, with choices such as the “two doors” embodying a juxtaposition between the closed choices of TutorText and the open choices presented by the game.
An optimal inspection and replacement policy for a two-unit system
Authors: Yang Li , Zhao Yu , Ma Xiaobing , Qiu Qingan
Published: March 2018

We study a preventive maintenance policy for a system composed of two units, a binary state unit and a three-state unit. Failures of both units are hard and self-announcing. The intermediate, defective state for the second unit can be regarded as a signal of pending failures. Unit 2 is inspected when its age attains integral multiples of interval [Formula: see text] and when unit 1 fails, and preventive replacement is immediate once the defective state is revealed. This strategy could be extended by further providing preventive replacement for the first unit. A case study on an offshore wind turbine is presented for illustration. We find that opportunistic maintenance schemed for both units could effectively reduce the maintenance cost.
Aromatase inhibitors are associated with a higher fracture risk than tamoxifen: a systematic review and meta-analysis
Authors: Tseng Olivia L. , Spinelli John J. , Gotay Carolyn C. , Ho Wan Y. , McBride Mary L. , Dawes Martin G.
Published: March 2018

Background:

In this paper, our aim was to systematically evaluate published evidence of bone fracture risk associated with tamoxifen and aromatase inhibitors in women aged 65 and under, and diagnosed with nonmetastatic breast cancer.

Methods:

We comprehensively searched MEDLINE, EMBASE and CINAHL databases from January 1997 through May 2015, and reference lists of the selected articles to identify English-language randomized controlled trials and cohort studies of fracture risk. Two independent reviewers screened articles and assessed methodological quality using Risk of Bias assessment for randomized controlled trials and the Newcastle–Ottawa Scale for cohort studies. Fracture risk was estimated as pooled risk ratios using a random-effects model and inverse variance method.

Results:

Of 1926 identified articles, 21 independent studies fulfilled our selection criteria. Similar fracture risk was observed in women treated and not treated with tamoxifen [pooled risk ratio (RR) 0.95; 95% confidence interval (CI) 0.84–1.07]. A 35% (95% CI 1.21–1.51) higher fracture risk was observed in the aromatase inhibitor group compared with the tamoxifen group. A 17% (95% CI 1.07–1.28) higher fracture risk was observed in the aromatase inhibitor group than the no aromatase inhibitor group. Compared with the tamoxifen group, aromatase inhibitor-associated fracture risk increased by 33% (pooled RR 1.33; 95% CI 1.21–1.47) during the tamoxifen/aromatase inhibitor treatment period, but did not increase (pooled RR 0.99; 95% CI 0.72–1.37) during the post-tamoxifen/aromatase inhibitor treatment period.

Conclusions:

Fracture risk is significantly higher in women treated with aromatase inhibitors, especially during the treatment period. Tamoxifen is not associated with lower fracture risk while tamoxifen could potentially preserve bone mass. Better osteoporosis management programs, especially during the treatment period, are needed for this group of women.
A Bayesian network meta-analysis of PCSK9 inhibitors, statins and ezetimibe with or without statins for cardiovascular outcomes
Authors: Khan Safi U , Talluri Swapna , Riaz Haris , Rahman Hammad , Nasir Fahad , Bin Riaz Irbaz , Sattur Sudhakar , Ahmed Haitham , Kaluski Edo , Krasuski Richard
Published: March 2018

Background

The comparative effects of statins, ezetimibe with or without statins and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors remain unassessed.

Design

Bayesian network meta-analysis was conducted to compare treatment groups.

Methods

Thirty-nine randomized controlled trials were selected using MEDLINE, EMBASE, and CENTRAL (inception – September 2017).

Results

In network meta-analysis of 189,116 patients, PCSK9 inhibitors were ranked as the best treatment for prevention of major adverse cardiovascular events (Surface Under Cumulative Ranking Curve (SUCRA), 85%), myocardial infarction (SUCRA, 84%) and stroke (SUCRA, 80%). PCSK9 inhibitors reduced the risk of major adverse cardiovascular events compared with ezetimibe + statin (odds ratio (OR): 0.72; 95% credible interval (CrI), 0.55–0.95; Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria: moderate), statin (OR: 0.78; 95% CrI: 0.62–0.97; GRADE: moderate) and placebo (OR: 0.63; 95% CrI: 0.49–0.79; GRADE: high). The PCSK9 inhibitors were consistently superior to groups for major adverse cardiovascular event reduction in secondary prevention trials (SUCRA, 95%). Statins had the highest probability of having lowest rates of all-cause mortality (SUCRA, 82%) and cardiovascular mortality (SUCRA, 84%). Compared with placebo, statins reduced the risk of all-cause mortality (OR: 0.88; 95% CrI: 0.83–0.94; GRADE: moderate) and cardiovascular mortality (OR: 0.84; 95% CrI: 0.77–0.90; GRADE: high). For cardiovascular mortality, PCSK9 inhibitors were ranked as the second best treatment (SUCRA, 78%) followed by ezetimibe + statin (SUCRA, 50%).

Conclusion

PCSK9 inhibitors were ranked as the most effective treatment for reducing major adverse cardiovascular events, myocardial infarction and stroke, without having major safety concerns. Statins were ranked as the most effective therapy for reducing mortality.
Sula Wines: A Foray into Uncharted Territory
Authors: Singh Swati , Srivastava Pallavi
Published: March 2018

This case revolves around how Rajeev Samant, Founder and CEO, Sula Vineyards, Nashik (Maharashtra, India), changed the face of Indian wine industry and made Sula wines a successful brand in both Indian and international landscape. Sula has become a pioneer brand which not only changed the consumption pattern of Indian alco-beverage market but also led to acceptance of wines in Indian scenario. Sula Vineyards is also a leader in sustainable winemaking and has created direct and indirect employment opportunities for thousands of rural youths. It has positioned itself globally as India’s largest and leading wine producer. The case exhibits how well-planned brand-building strategies can make an unacceptable product acceptable in the market. It clearly exhibits various strategies adopted by Samant in building Sula wines, a brand to reckon with. This includes an exploration of the mindset of consumers to strategically place new product among the existing pallet of choice.
Assessing patient safety in Canadian ambulatory surgery facilities: A national survey
Authors: Ahmad Jamil , Ho Olivia A , Carman Wayne W , Thoma Achilles , Lalonde Donald H , Lista Frank
Published: March 2018

Background

There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely.

Objective

To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices.

Methods

All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions.

Results

In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention.

Conclusion

The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery.
Long-term outcomes of major upper extremity replantations
Authors: Ng Wendy Ky , Kaur Manraj Nirmal , Thoma Achilleas
Published: March 2018

Background

Long-term outcomes of major upper extremity replantations are infrequently reported. It is believed that replantation is indicated for amputations at all levels in children and for all distal amputations in adults. Replantations of arm or proximal forearm amputations in adults are controversial.

Objective

To evaluate the results of major upper extremity replantations, defined as those that are transmetacarpal, through the wrist, forearm, elbow or arm.

Methods

A review of these types of replantations performed at the authors' institution from 2002 to 2012 was conducted. Patients' strength, range of motion and two-point discrimination were assessed. Patients completed the Disabilities of the Arm, Shoulder and Hand (DASH), the Michigan Hand Questionnaire (MHQ), and the Hospital Anxiety and Depression scale (HADS).

Results

Seventeen patients underwent major upper extremity replantation surgery. The majority (16 of 17 [94%]) of the included patients were male. Of 17 patients, 13 (76.5%) required reoperations. The mean (± SD) DASH score of seven patients who consented to completing all questionnaires was 75.4±14.2 of 100 (range 59.2 to 91.1). On the MHQ, the mean score for affected hand function was 16% compared with 84% in the unaffected hand. Patients generally demonstrated at least mild levels of anxiety and depression on the HADS.

Discussion

The results suggest that major upper extremity injuries and replantations have a significant impact on patients' long-term hand function, and produce long-term anxiety and depressive symptoms.
Reconstruction of post-traumatic full-thickness defects of the upper one-third of the auricle
Authors: Helal Hesham Aly , Mahmoud Nada Abdel Sattar , Abd-Al-Aziz Abd-Al-Aziz Hanafy
Published: March 2018

Background

Reconstruction of partial ear defects represents a difficult challenge to the plastic surgeon due to the delicate and intricate architecture of the chondrocutaneous sandwich of the external ear.

Methods

Fourteen patients with acute or previous traumatic subtotal loss of the upper one-third of the auricle were treated with autologous contralateral conchal cartilage graft and superficial temporoparietal fascia flaps.

Results

The symmetry of the reconstructed ears was satisfactory and the cosmetic appearance was acceptable for 13 patients. Minor hematoma at the conchal cartilage graft donor site occurred in one (7.1%) patient and marginal loss of temporoparietal flap in another (7.1%). Revision surgery was required for widening of the scar and obscuring of the upper pole contour in one (7.1%) patient. No additional complications were encountered.

Conclusion

The authors recommend using this combined technique for reconstruction of full-thickness auricular defects.
A review of hydrofluoric acid burn management
Authors: Mckee Daniel , Thoma Achilleas , Bailey Kristy , Fish Joel
Published: March 2018

Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a basic understanding of the pathophysiology, the range of severity in presentation and the current treatment options available for HF burns.

The present article reviews the current understanding of the pathophysiology and systemic effects associated with severe HF burns. Furthermore, it distinguishes between minor and life-threatening HF burns and describes several of the basic techniques that are available to treat patients with HF burns.
Complications and management of breast enhancement using hyaluronic acid
Authors: Ishii Hidenori , Sakata Kazuaki
Published: March 2018

The authors report on their experience with using hyaluronic acid of non-animal origin manufactured using commercially available technology (Macrolane, Q-Med AB, Sweden) for breast enhancement in 4000 women treated since 2004 and describe the most common complications and their successful treatment. On average, 30 mL to 40 mL of Macrolane was injected into each breast. Of 274 women who returned to the clinic during 2007, <10% experienced local adverse events (eg, gel dislocation, Macrolane nodules and rare cases of infection). There were no serious systemic events and treatment was well tolerated. To prevent local complications, such as infection, an aseptic injection technique was required and early treatment of adverse events is recommended. While only small volumes of Macrolane were injected, it is comparatively easy and safe to perform breast enhancement of up to one cup size to correct asymmetry between breasts and to create fullness in the upper portion of the breast.
Inflammatory myofibroblastic tumours of the maxillary sinus: A brief clinical report and review of the literature
Authors: Murthy AS , Albert S , Klonk C
Published: March 2018

Although inflammatory myofibroblastic tumours (IMTs) have been accepted as a clonal neoplasm, their pathology is poorly understood due to variable presentation. There is no identifiable cause and they are usually observed as tumour growth combined with inflammation. In the current WHO classification, IMTs are designated as intermediate malignancies. In terms of biological potential, IMTs are classified under ‘rarely metastasizing’. IMTs are rare in the maxillary sinus but, when reported, can be locally aggressive or even destructive if they invade the orbit. The authors present a brief clinical report describing a five-year-old girl with a slow-growing mass in the right maxillary sinus extending into the lacrimal sac and its management.
Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population
Authors: Doherty Christopher , Nickerson Duncan , Southern Danielle A , Kieser Teresa , Appoo Jehangir , Dawes Jeffery , De Souza Michael A , Harrop Alan R , Rabi Doreen
Published: March 2018

Background

It appears that the medical profile of patients undergoing coronary artery bypass graft (CABG) surgery has changed. The impact of this demographic shift on CABG outcomes, such as sternal wound dehiscence, is unclear.

Objectives

To quantify the incidence and trends of sternal wound dehiscence, quantify the demographic shift of those undergoing CABG and identify patient factors predictive of disease.

Methods

A prospective analysis was performed on a historical cohort of consecutive patients who underwent CABG (without valve replacement) in Alberta between April 1, 2002 and November 30, 2009. The incidence and trends of sternal wound dehiscence were determined. In addition, the trend of the mean Charlson index score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (capturing patient comorbidities) was analyzed. Univariable analysis and multivariable models were performed to determine factors predictive of wound dehiscence.

Results

A total of 5815 patients underwent CABG during the study period. The incidence proportion of sternal wound dehiscence in Alberta was 1.86% and the incidence rate was 1.98 cases per 100 person-years. Although both the EuroSCORE and Charlson scores significantly increased over the study period, the incidence of sternal wound dehiscence did not change significantly. Factors predictive of sternal wound dehiscence were diabetes (OR 2.97 [95% CI 1.73 to 5.10]), obesity (OR 1.55 [95% CI 1.05 to 2.27]) and female sex (OR 1.90 [95% CI 1.26 to 2.87]).

Conclusions

The incidence proportion of sternal wound dehiscence in Alberta was comparable with the incidence previously published in the literature. While patients undergoing CABG had worsening medical profiles, the incidence of sternal wound dehiscence did not appear to be increasing significantly.
Follicular unit transplantation for the treatment of secondary cicatricial alopecia
Authors: Shao Huawei , Hang HU , Yunyun Jin , Hongfei Jiang , Chunmao Han , Zhang Jufang , Shen Haiyan , Zhu Fei , Jia Ming , Wang Yuyan , Guo Xiaobo
Published: March 2018

Background

Cicatricial alopecia encompasses a diverse group of disorders characterized by the permanent destruction of hair follicles and irreversible hair loss. Follicular unit transplantation was developed in 1994. However, large-scale clinical trials are necessary to study follicular unit transplantation for treating Chinese cicatricial alopecia patients.

Objective

To investigate the efficacy of follicular unit transplantation in the treatment of cicatricial alopecia in Chinese patients.

Methods

Patients with cicatricial alopecia were enrolled. The designated recipient area, follicular unit density of the donor site, transplanted density and operative time were recorded. Postoperative follow-up was conducted within six to 24 months; the density of hair in the recipient area was calculated using a Folliscope (Hansderma Co, USA). Patients' self-reported satisfaction and long-term complications were recorded.

Results

Thirty-seven patients were enrolled. Cicatricial alopecia was caused by burns (n=8), trauma (n=21) and plastic surgery (cleft lip and palate repair [n=8]). Burn patients had a significantly larger bald area than the other patients (P<0.01). The operative time was significantly correlated with recipient area. The longest operation was 14.5 h; the largest transplanted area was 96 cm2. At follow-up, the surviving follicular unit density/transplanted follicular unit density rate was 64.29% to 95.00% (mean 78.96%); the surviving/transplanted (S/T) area was 100% for 30 patients, 90% to 100% for five patients and <90% for two patients. The lowest S/T area was 82.81%. The S/T index was significantly and inversely correlated with operative time. Regarding long-term complications, two patients had postoperative epidermoid cysts that healed with local treatment.

Conclusion

Follicular unit transplantation is an effective method for treating cicatricial alopecia. It is relatively safe and yields satisfactory postoperative results. Extending the results of the present study to Chinese clinical practice is warranted.
Evaluating the effect of polytetrafluoroethylene and extractum cepae-heparin-allantoin gel in peripheral nerve injuries in a rat model
Authors: Kahraman Ahmet , Kahveci Ramazan
Published: March 2018

Background

Peripheral nerves can be injured by congenital, mechanical, thermal or chemical causes. Peripheral nerve injuries are increasing in frequency, particularly in countries that are becoming more industrialized. Nerve and extremity injuries result in work loss and high treatment costs, and can lead to separation of patients from their social environment. Failure of nerve repair causes muscle functional losses, sensory losses and painful neuropathies.

Objectives

To compare the effects of condensed polytetrafluoroethylene (cPTFE) and cPTFE-extractum cepae-heparin-allantoin (cPTFE-EHA) gel compound on nerve and functional recovery, and the prevention of adhesion and scar tissue formation after total peripheral nerve injury repaired by primary suture in a rat model.

Results

cPTFE alone and cPTFE-EHA gel was found to provide better functional recovery and nerve regeneration compared with primary repair only. In the macroscopic evaluation, the cPTFE-EHA gel was found to have no negative effect on wound healing and, despite increasing extraneural scar tissue and adhesions, it had no negative effect on nerve function; in addition, it facilitated functional recovery.

Conclusions

Compared with the cPTFE application alone, the application of perineural cPTFE-EHA gel during peripheral nerve surgery appeared to provide better functional recovery without causing any significant changes in epineural and extraneural scar tissue formation.
Isolated limb infusion: Efficacy, toxicity and an evolution in the management of in-transit melanoma
Authors: Chin-Lenn Laura , Temple-Oberle Claire , Mckinnon J Gregory
Published: March 2018

Background

Isolated limb infusion (ILI) delivers low-flow chemotherapy via percutaneous catheters to treat melanoma in-transit metastases.

Objective

To describe the experience of two regional referral centres with ILI.

Methods

A retrospective review of patients who underwent ILI between 2002 and 2012 was performed. Outcomes were measured using the WHO criteria for response, the Wieberdink toxicity score and long-term limb function using the Toronto Extremity Salvage Score (TESS).

Results

Fifty-two patients (mean age 66 years [range 27 to 90 years], female sex 65%, and lower [treated] limb in 86%) with 54 ILIs were reviewed. Wieberdink toxicity score was ≥3 in 21 (39%) procedures. Median follow-up was 18 months (range one to 117 months). Initial complete response (CR) was 29%, partial response 27%, stable disease 18% and progressive disease 27%. Predictors of better initial response were low disease burden and previous treatment. One or more treatments after ILI were common (65%). At 12 months, 19% of ILI patients had died from melanoma but 44% of surviving patients experienced limb CR. At 24 months, 57% of surviving patients experienced limb CR. The quality of life in the surviving, contactable patients according to the Toronto Extremity Salvage Score was 89%.

Conclusion

Even if ILI does not result in CR for melanoma intransit metastases. it may slow disease progression as a single therapy, but more frequently in combination with other modalities.
Accuracy of medical models made by consumer-grade fused deposition modelling printers
Authors: Petropolis Christian , Kozan Daniel , Sigurdson Leif
Published: March 2018

Background

Additive manufacturing using fused deposition modelling (FDM) has become widely available with the development of consumer-grade three-dimensional printers. To be useful in maxillofacial surgery, models created by these printers must accurately reproduce the craniofacial skeleton.

Objective

To determine the accuracy of consumer-grade FDM printers in the production of medical models compared with industrial selective laser sintering (SLS) printers.

Methods

Computed tomography images of a dry skull were manipulated using OsiriX (OsiriX, Switzerland) and ZBrush (Pixologic, USA) software. Models were fabricated using a consumer-grade FDM printer at 100 μm, 250 μm and 500 μm layer heights and an industrial SLS printer. Seven linear measurements were made on the models and compared with the corresponding dry skull measurements using an electronic caliper.

Results

A dimensional error of 0.30% was observed for the SLS models and 0.44%, 0.52% and 1.1% for the 100 μm, 250 μm and 500 μm FDM models, respectively.

Conclusion

Consumer-grade FDM printers can produce medical models with sufficient dimensional accuracy for use in maxillofacial surgery. With this technology, surgeons can independently produce low-cost maxillofacial models in an office setting.
A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps
Authors: Kesiktas Erol , Eser Cengiz , Gencel Eyüphan , Aslaner Emrah Efe
Published: March 2018

Background

Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions.

Objective

To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region.

Methods

Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma.

Results

All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed.

Conclusion

This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.
Microcirculatory effect of topical vapocoolants
Authors: Galdyn Izabela , Swanson Edward , Gordon Chad , Kwiecien Grzegorz , Bena James , Siemionow Maria , Zins James
Published: March 2018

Background

Vapocoolant sprays are commonly used to minimize pain following minor interventions such as venipuncture, shave biopsy or needle insertion. Although these sprays have been widely used in clinical practice, little is known about their effect on microcirculation or cutaneous blood flow.

Objective

To evaluate the real-time effect of a topical vapocoolant using a well-established, rat cremaster muscle microcirculatory model, allowing direct measurement of changes in vessel diameter, capillary density and leukocyte behaviour.

Method

Fifty rats were divided into a control and four experimental groups: group 1: 4 s spray with vapocoolant at 18 cm distance; group 2: 10 s spray at 18 cm distance; group 3: 4 s spray at 8 cm distance; and group 4: 10 s spray at 8 cm distance. Vessel diameters, capillary density and leukocyte behaviour were monitored for 1 h thereafter. Muscle was harvested for immunohistochemistry analysis of proangiogenic markers (vascular endothelial growth factor and von Willebrand factor), leukocyte behaviour markers (E-selectin, vascular cell adhesion molecule, intercellular adhesion molecule), pimonidazole-hypoxia staining and ApopTag (Millipore, USA) staining for apoptosis. Gene expression for inflammatory markers (interleukin [IL]-1β, IL-2, IL-4, IL-6, IL-10, tumour necrosis factor-alpha and interferon-gamma) was evaluated using polymerase chain reaction and myeloperoxidase assay for inflammation was performed.

Result

The use of refrigerant spray decreased vessel diameter and capillary density initially, although none of these decreases were statistically significant. Polymerase chain reaction showed no significant changes. The myeloperoxidase assay showed statistically significant increase in myeloperoxidase activity in groups 2, 3 and 4. Immunohistochemistry was negative for angiogenic and proinflammatory markers.

Conclusions

The lack of statistically significant changes in vessel diameter and inflammatory markers corroborated the safety on microcirculation.
Minor surgery procedures: A retrospective review and prospective survey in a pediatric population
Authors: Chan Emily , Bucevska Marija , Verchere Cynthia
Published: March 2018

Objective

The present study evaluated minor surgery procedures undertaken by a single plastic surgeon at BC Children's Hospital (Vancouver, British Columbia) for patient and physician satisfaction, parent impressions, psychological concerns and complications.

Methods

Data were collected from a retrospective chart review and a prospective patient survey. Eligible subjects for the retrospective study included all pediatric patients undergoing minor surgery between May 2011 and April 2013. Parameters of interest included patient demographics, minor surgery specifics, complications and outcomes. Eligible subjects for the prospective patient survey included consecutive patients undergoing minor surgery between June 2013 and August 2013, as well as their parents.

Results

A total of 219 procedures were included in the retrospective review. The mean age of subjects was 13.1 years (range two weeks to 18 years). The median length of follow-up was 46 days (range four to 606 days). There were no major complications; however, 45 minor complications in 36 patients were found. Complications included crusting (4.6%), delayed wound healing (3.2%), hypersensitivity (2.3%), scar hypertrophy (1.8%), infection (0.9%) and other (7.8%). Outcomes were categorized as one of four outcomes: both satisfied (89.9%); patient satisfied but physician unsatisfied (0.8%); patient unsatisfied and physician satisfied (3.1%); and both unsatisfied (6.2%). In the prospective study, 32 subjects consented to participate in the survey. Of these subjects, 10 children and 12 parents responded to the questionnaires. Eighty-three percent of respondents indicated that their goals were accomplished by their procedure and that they would be willing to undergo minor surgery again.

Conclusion

Minor surgery is possible and practical in pediatric plastic surgery clinics, with few complications and high patient and surgeon satisfaction.
Examining perception and actual knowledge change among learners in a standardized burn course
Authors: Spiwak Rae , Lett Ronald , Rwanyuma Laurean , Logsetty Sarvesh
Published: March 2018

Background

Essential Burn Management (EBM) is a burn training program created for East Africa and aims to meet the needs of low- and middle-income countries. The authors present a report on objective testing of change in knowledge, with pre and post tests, and comparison of this testing with the self perception of knowledge gained to explore course utility.

Objective

To evaluate the ability of EBM to improve knowledge in burn care among course participants; and to explore whether participants' self-perception of knowledge gained is comparable with their actual change in knowledge.

Methods

Twenty health care providers from a variety of disciplines participated in EBM and completed the pre and post course burn care knowledge test. Participants also self-rated knowledge in burn care both pre and post course. All tests and self-rated assessments were anonymous and consent was obtained. Paired t tests were conducted on pre and post test scores. Improvements in pre-post scores according to module or topic area were examined to determine the proportion correct, and then analyzed using Wilcoxon signed-rank tests. Module scores pre-post course were compared with individuals' self-rating of knowledge both before and after the course for that particular module.

Results

Pre-post course tests reflected an increase in knowledge. An increase in self-rated knowledge was matched with a significant increase in module test scores for primary survey, burn resuscitation, wound management, infection control and electrical injury, but not inhalation injury and compartment syndrome modules.

Conclusion

Findings support a combination of self-report and objective pre-post testing to evaluate courses designed to teach burn management.
Surgical mesh for ventral incisional hernia repairs: Understanding mesh design
Authors: Rastegarpour Ali , Cheung Michael , Vardhan Madhurima , Ibrahim Mohamed M , Butler Charles E , Levinson Howard
Published: March 2018

Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis
Authors: Swanson Edward W , Cheng Hsu-Tang , Susarla Srinivas M , Lough Denver M , Kumar Anand R
Published: March 2018

Background

Despite advances in surgical technique, ventral hernia repair (VHR) remains associated with significant postoperative wound complications.

Objective

A systematic review and meta-analysis was performed to identify whether the application of negative pressure wound therapy to closed incisions (iNPWT) following VHR reduces the risk of postoperative wound complications and hernia recurrence.

Methods

The PubMed/MEDLINE, EMBASE and SCOPUS databases were searched for studies published through October 2015. Publications that met the following criteria were included: adult patients undergoing VHR; comparison of iNPWT with conventional dressings; and documentation of wound complications and/or hernia recurrence. The methodological quality of included studies was independently assessed using the Methodological Index for Non-Randomized Studies guidelines. Outcomes assessed included surgical site infection (SSI), wound dehiscence, seroma, and hernia recurrence. Meta-analysis was performed to obtain pooled ORs.

Results

Five retrospective cohort studies including 477 patients undergoing VHR were included in the final analysis. The use of iNPWT decreased SSI (OR 0.33 [95% CI 0.20 to 0.55]; P<0.0001), wound dehiscence (OR 0.21 [95% CI 0.08 to 0.55]; P=0.001) and ventral hernia recurrence (OR 0.24 [95% CI 0.08 to 0.75]; P=0.01). There was no statistically significant difference in the incidence of seroma formation (OR 0.59 [95% CI 0.27 to 1.27]; P=0.18).

Conclusion

For patients undergoing VHR, current evidence suggests a decreased incidence in wound complications using incisional NPWT compared with conventional dressings.