bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Small Bowel Motility and SMA Blood Flow Studied with Transabdominal Ultrasound
Authors: Nylund Kim , Gjengstø Andreas Jessen , von Volkmann Hilde Løland , Gilja Odd Helge
Published: September 2022

Purpose Gastrointestinal ultrasound (GIUS) is a noninvasive imaging technique that may be used to study physiological changes in the small bowel. The aim of the study was to investigate the feasibility of measuring blood flow (BF) in the superior mesenteric artery (SMA) and regional motility in the small bowel with GIUS before and after a test meal and to compare ultrasound parameters to demographic factors such as age, sex, height, weight, and smoking habits.

Materials and Methods 122 healthy volunteers aged 20 to 80 were examined after an overnight fast. Small bowel motility was registered in the upper left and lower right quadrants (ULQ and LRQ) with TUS and BF in the SMA with pulsed wave Doppler. The first 23 volunteers also received a 300 Kcal test meal and were re-examined 30 min postprandial.

Results The feasibility of measuring BF was 97% in fasting patients while motility could be detected in 52% and 62% in the ULQ and LRQ, respectively. Females had a lower resistive index (RI) and a higher mean velocity than males, while the overall BF correlated with height. The RI had a negative correlation with age. Healthy volunteers with motility in the ileum were on average younger than those without motility. After the test meal, motility could be detected in the ULQ and LRQ in 95% and 90%, respectively, and the mean number of contractions in the ULQ increased significantly. As expected, there was a clear increase in all BF-parameters postprandially.

Conclusion Regional motility in the small bowel was easier to detect after a test meal. There were some associations between demographic parameters and ultrasound parameters but overall the effects were relatively small.
The Influence of Cartoon-Soundscape Irrelevant Sound Effects on Young Children's Auditory Processing and Working Memory Skills
Authors: B. Pratheeksha , Mohan Kishan Madikeri , Thomas Nitha , B. Rajashekhar
Published: September 2022

Abstract Background Irrelevant sound or speech effect affects an individual's serial recall task of visual and auditory presentations. Cartoon soundscape mimics irrelevant sound effects. A constant and repeated exposure to cartoons in early childhood should influence
children's auditory learning or recall performance. Purpose To investigate the effects of cartoons' soundscape irrelevant sound effects on young children's auditory processing and working memory skills. Research Design A cross-sectional study was used to observe
the influence of the cartoon soundscape irrelevant sound effects on children. Study Sample Sixty young children having hearing thresholds within 15 dB HL, in the age range 5 to 6 years, exposed to cartoons (Indian plus non-Indian) were considered for the study. Data
Collection and Analysis Pitch pattern test (PPT), duration pattern test (DPT), and Corsi block working memory apparatus were applied to the participants exposed to cartoons. The data obtained were compared statistically in terms of the groups' performances. Results There
was a significant difference in PPT (p = 0.023) and DPT (p = 0.001) between the exposed and nonexposed groups. In contrast, there was no significant difference between the two groups in Corsi block working memory (p > 0.05).
Conclusion Cartoon soundscape irrelevant sound or speech affects young children's auditory processing skills. The visual-spatial recall follows a different developmental pattern in young children without recoding to phonological aspects. It is predicted that our study findings
might help determine the ill effects of cartoons on the auditory and language development process.
From Esthetic Medicine to Optimizing Reconstructive Outcome: A Feasibility Trial on Secondary Refinement of Fasciocutaneous Anterolateral Thigh Flaps with Cryolipolysis
Authors: Nagel Sarah S. , Rauh Annika , Siegwart Laura C. , Hundeshagen Gabriel , Kotsougiani-Fischer Dimitra , Kuepper Simon , Kneser Ulrich , Hirche Christoph
Published: September 2022

Background Free adipocutaneous anterolateral thigh (ALT) flaps have evolved as workhorse flaps to reconstruct complex, multicompound defects. While coverage is safely achieved, flaps may remain bulky. As a standard of care, flaps are refined with liposuction, partial excision, or combination of both. Cryolipolysis is widely used for fat reduction in esthetic medicine. This pilot comparative study analyses whether cryolipolysis may serve as a safe alternative method to effectively reduce volume in fasciocutaneous flaps. Moreover, patients' satisfaction with the procedure is evaluated.

Methods In this single-center, retrospective, interventional comparative cohort study, 10 patients with free subfascial ALT flaps for distal extremity reconstruction underwent cryolipolysis (60 minutes, −9°C). Circumference of the extremities and subcutaneous fat thickness were determined before (T1) and 12 weeks (T2) after cryolipolysis. Patient satisfaction was evaluated with a questionnaire of Likert's scale questions. Duration of hospital stay, intervention time, costs, and possible complications were analyzed and compared with surgical flap contouring (n = 12).

Results All patients undergoing cryolipolysis were male, with a median age of 52 years without arterial disease-like state or deep vein thrombosis (DVT). At T2, a significant reduction of circumference of 1.8 ± 0.9 cm (p < 0.001) and subcutaneous fat layer of 7.7 ± 3.0 mm (p < 0.0001) was recorded. Overall, 90% of the patients were satisfied with the result. Cryolipolysis was well tolerated. One patient developed a second-degree frostbite which healed without further intervention. Cryolipolysis proofed to be as safe as surgical flap contouring. Hospital stay was significantly shorter (p < 0.01) and personal resources were spared when flap contouring was performed with cryolipolysis.

Conclusion This is a novel application of evolving body-contouring cryolipolysis from esthetic medicine into optimizing outcomes in reconstructive surgery. Cryolipolysis has been shown to be relatively safe and effective to reduce ALT's volume with high patients' satisfaction. This successful pilot study encourages further investigation with a prospective randomized control trial.
Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment
Authors: Fernandes Marina Silva , Takano Claudia Cristina , Chrispin Thyeres Teixeira Bueno , Marquini Gisele Vissoci , Girão Manoel João Batista Castello , Sartori Marair Gracio Ferreira
Published: September 2022

Objective The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA).

Methods A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient.

Results There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27–3.84) and the effect size (95% CI) was 4.58 (2.88–6.28).

Conclusion The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.
Late Seroma in Breast Implants: A Coronavirus Disease 2019 Phenomenon?
Authors: Chan Stephanie L.S , Mok James Wan Loong
Published: September 2022

The coronavirus disease 2019 (COVID-19) pandemic has been challenging in all aspects of the medical field with new clinical presentations constantly arising. Plastic surgeons are not immune to this and need to be aware of their implications. There has been a recent report of late periprosthetic seroma (breast implant) as a clinical manifestation of COVID-19 infection. To our knowledge, this phenomenon has not been further reported. We present a 53-year-old immunocompromised lady who developed late seroma after COVID-19 infection. She eventually required explantation of the implant and is awaiting autologous reconstruction. It is likely that we will increasingly continue to see this phenomenon of implant complications as a result of COVID-19 infection and should be watchful, especially regarding potential immunocompromised patients.
A Cross-Sectional Analysis of Breast Reconstruction with Fat Grafting Content on TikTok
Authors: Gupta Rohun , John Jithin , Gupta Monik , Haq Misha , Peshel Emanuela , Boudiab Elizabeth , Shaheen Kenneth , Chaiyasate Kongkrit
Published: September 2022

As of November 2021, TikTok has one billion monthly active users and is recognized as the most engaging social media platform. TikTok has seen a surge in users and content creators, ranging from athletes to medical professionals. In the past year, content creators have utilized the app to advocate for social reforms, education, and other uses that were not previously considered. Breast cancer is the most commonly diagnosed cancer in women, with an expected 281,550 new cases of invasive breast cancer in 2021. As more individuals with breast cancer choose to undergo resection, the demand for autologous fat grafting in breast reconstruction has increased due to the natural look and feel of breast tissue. The purpose of this article is to analyze content related to breast reconstruction with fat grafting found on TikTok and recommend methods to improve patient education, care, and outcomes.

We searched TikTok on November 1, 2021, for videos using the phrase “breast reconstruction with fat grafting.” The top 200 videos retrieved from the TikTok search algorithm were analyzed, and all commentaries, duplicates, and nonrelevant videos were removed. Video characteristics were collected, and two independent reviewers generated a DISCERN score

A total of 131 videos were included in the study. They were found to have a combined 1,871,980 likes, 41,113 comments, and 58,662 shares. The videos had an average DISCERN score of 2.16. Content creators had an overall low DISCERN score in items involving the use of references, disclosure of risks for not obtaining treatment, and support for shared decision-making. When stratified, the DISCERN score was higher for videos created by physicians (DISCERN average 2.48) than for videos created by nonphysicians (DISCERN average 1.99; p < 0.001).

Content creators can improve the quality of their videos by disclosing treatment risks, benefits and risks, discussing risks for not obtaining treatment, and advocating for shared decision-making. Furthermore, including citations and academic references may offer increased credibility and promote evidence practice. This article is limited by the variability seen on the TikTok platform that is influenced by algorithmic trends. The top 200 search results vary, making each compilation of videos selected for analysis unique. Furthermore, although DISCERN is a reliable source to assess patient information, it has not been tested for its reliability with videos such as on TikTok. Despite TikTok being developed as a social media platform, it has shown to be a medium for patient outreach and an educational tool.
Rhinoplasty with Recycled Dorsum Preservation: Technique and Outcomes
Authors: Rodriguez Carlos A. , Al-Sakkaf Ali M. , Verbauvede Mauricio
Published: September 2022

Rhinoplasty is one of the first surgical procedures described with evidence in the history of medicine. At first, these were performed for the reconstruction of traumatic defects caused by punishments, sequels of war, and then it had been reused after suffering from diseases such as syphilis. Many techniques have been developed from the need of aesthetics outcomes in this field.

The objective of our work is to describe a modified approach of recycled dorsum preservation procedure that we have proposed as a safe and reliable technique.

In this work, we have showed that this technique has a marked advantage of preserving the natural tissue with satisfactory postoperative result. We had no functional complications up to date. We recommend that every specialist in the field of rhinoplasty should be able to use it as a reproducible and feasible alternative.
Outcomes of Closed versus Open Rhinoplasty: A Systematic Review
Authors: Gupta Rohun , John Jithin , Ranganathan Noopur , Stepanian Rima , Gupta Monik , Hart Justin , Nossoni Farideddin , Shaheen Kenneth , Folbe Adam , Chaiyasate Kongkrit
Published: September 2022

Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case–control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.
Mandibular Fracture in a Hemifacial Microsomia Patient following Implant Failure and Hardware Infection: A Case Report
Authors: Ali Kausar , Dibbs Rami P. , Maricevich Renata S.
Published: September 2022

Hemifacial microsomia (HFM) is a complex congenital condition with heterogeneous malformations of the facial skeleton that almost always involves mandibular hypoplasia. Here we introduce a unique case in which a patient with HFM had initially successful optimization of facial symmetry using a polyetheretherketone implant for mandibular augmentation. However, multiple factors associated with the intraoperative and postoperative course, including hardware failure and infection, led to diminished mechanical strength of the mandible, ultimately resulting in a mandibular fracture. In this unique case presentation of HFM, we discuss the various factors that contributed to mandibular weakness and increased susceptibility to fracture.
Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial
Authors: Dyrberg Diana L. , Bille Camilla , Koudahl Vibeke , Gerke Oke , Sørensen Jens A. , Thomsen Jørn B.
Published: September 2022

Background The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women.

Methods In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the “Nipple, Surrounding skin, Entire breast (NSE)” grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale.

Results We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively.

Conclusion The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.
Free Flap Salvage in the Ischemic Foot: A Case Report
Authors: Seo Dongkyung , Dannnoura Yutaka , Ishii Riku , Tada Keisuke , Kawashima Kunihiro , Yoshida Tetsunori , Horiuchi Katsumi
Published: September 2022

We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.
Use of Heparin Cream for Venous Congestion in the Extended Reverse Metacarpal Artery Flap: A Case Report
Authors: Tatar Burak Erguün , Sabancıoğullarından Fahri , Gelbal Caner , Bozkurt Mehmet
Published: September 2022

Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.
Rare Tumors Causing Median Nerve Compression in Adults—A Narrative Review
Authors: Natroshvili Tinatin , Peperkamp Kirsten , Malyar Masoud A. , Wijnberg David , Heine Erwin P. , Walbeehm Erik T.
Published: September 2022

The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options.

The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained.

Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months.

The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.
The Great Saphenous Vein—An Underrated Recipient Vein in Free Flap Plasty for Lower Extremity Reconstruction: A Retrospective Monocenter Study
Authors: Meiwandi Abdulwares , Kamper Lars , Küenzlen Lara , Rieger Ulrich M. , Bozkurt Ahmet
Published: September 2022

Background Reconstruction of large soft tissue defects of the lower extremity often requires the use of free flaps. The main limiting factor and potential for complications lie in the selection of proper donor and recipient vessels for microvascular anastomosis. While the superficial veins of the lower leg are easier to dissect, they are thought to be more vulnerable to trauma and lead to a higher complication rate when using them instead of the deep accompanying veins as recipient vessels. No clear evidence exists that proves this concept.

Methods We retrospectively studied the outcomes of 97 patients who underwent free flap plasty to reconstruct predominantly traumatic defects of the lower extremity at our institute. The most used flap was the gracilis muscle flap. We divided the population into three groups based on the recipient veins that were used for microvascular anastomosis and compared their outcomes. The primary outcome was the major complication rate.

Results Overall flap survivability was 93.81%. The complication rates were not higher when using the great saphenous vein as a recipient vessel when comparing to utilizing the deep concomitant veins alone or the great saphenous vein in combination to the concomitant veins.

Conclusions In free flap surgery of the lower extremity, the selection of the recipient veins should not be restricted to the deep accompanying veins of the main vessels. The superficial veins, especially the great saphenous vein, offer an underrated option when performing free flap reconstruction.
Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis
Authors: Escandón Joseph M. , Mohammad Arbab , Mathews Saumya , Bustos Valeria P. , Santamaría Eric , Ciudad Pedro , Chen Hung-Chi , Langstein Howard N. , Manrique Oscar J.
Published: September 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure.

A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed.

Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap.

Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.
Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach
Authors: Winaikosol Kengkart , Surakunprapha Palakorn
Published: September 2022

Background Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping.

Methods A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses.

Result The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery.

Conclusions The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.
Watch One, Do One? A Systematic Review and Educational Analysis of YouTube Microsurgery Videos, and a Proposal for a Quality Assurance Checklist
Authors: Fernandez-Diaz Oscar F. , Navia Alfonso , Berner Juan Enrique , Ahmad Fateh , Guerra Claudio , Ragbir Maniram
Published: September 2022

Background Educational resources on the internet are extensively used to obtain medical information. YouTube is the most accessed video platform containing information to enhance the learning experience of medical professionals. This study systematically analyzed the educational value of microsurgery-related videos on this platform.

Methods A systematic review was conducted on YouTube from April 18 to May 18, 2020, using the following terms: “microsurgery,” “microsurgical,” “microsurgical anastomosis,” “free flap,” and “free tissue transfer.” The search was limited to the first 100 videos, and two independent reviewers screened for eligible entries and analyzed their educational value using validated scales, including a modified version of the DISCERN score (M-DISCERN), Journal of the American Medical Association (JAMAS) benchmark criteria, and the Global Quality Score (GQS). Evaluation of video popularity was also assessed with the video power index (VPI).

Results Of 356 retrieved videos, 75 (21%) were considered eligible. The educational quality of videos was highly variable, and the mean global scores for the M-DISCERN, JAMAS, and GQS for our sample were consistent with medium to low quality.

Conclusions A limited number of videos on YouTube for microsurgical education have high-educational quality. The majority scored low on the utilized criteria. Peer-reviewed resources seem to be a more reliable resource. Although the potential of YouTube should not be disregarded, videos should be carefully appraised before being used as an educational resource.
Maxillo-mandibular Defect Reconstruction with Bilateral Free Fibula Flaps with Dental Implant Placement and Immediate Loading: A Case Report of the Three-team Approach
Authors: Nazarian David , Dikarev Aleksei , Mokhirev Mikhail , Zakharov Georgy , Fedosov Alexander , Potapov Maksim , Chernenkiy Mikhail , Vasilev Yuriy , Kyalov Grigoriy , Chausheva Saniyat , Khachatryan Arbak , Tevosyan Artur , Arakelyan Gevorg
Published: September 2022

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.
Comparative Study of Multimodal Therapy in Facial Palsy Patients
Authors: Neville Catriona , Gwynn Tamsin , Young Karen , Jordan Elizabeth , Malhotra Raman , Nduka Charles , Kannan Ruben Yap
Published: September 2022

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes.

Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale.

Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (p < 0.01), more chemodenervation episodes (p < 0.01), increased doses of botulinum toxin (p < 0.001), and having higher EGGS score (p < 0.001).

Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.
Dermoid Cyst of Nasal Tip with a Sinus Tract Extending to the Intracranium: A Case Report
Authors: Lee Seungjun , Kim Seong-Ik , Kim Min-Seo , Kim Jong-Ho
Published: September 2022

Nasal dermoid cysts are rare congenital anomalies that affect one in 20,000 to one in 40,000 individuals. Herein, we report a case of an initially misdiagnosed nasal dermoid cyst with intracranial extension. Among nasal dermoids, the lesion of the nasal tip is considered uncommon. Therefore, this should always be considered as a differential diagnosis of midline nasal masses, and a proper diagnostic approach should be taken.
Could Plasma CXCL12 Predict Ventricular Dysfunction in Patients with Severe Myocardial Infarction?
Authors: Murad Hussam A. S. , Bakarman Marwan A.
Published: September 2022

Plasma level of chemokine CXCL12 can predict adverse cardiovascular outcomes in patients with coronary artery disease, but data on its relationship with severity of coronary stenosis in cases of severe myocardial infarction (MI) are scarce and conflicting. The objective of this study was to investigate link between plasma CXCL12 levels and different grades of left ventricular ejection fraction (LVEF) in statin-treated and -untreated patients with severe MI. A total of 198 consecutive patients with first-time severe MI (ST-elevated myocardial infarction [STEMI], n = 121 and non-ST-elevated myocardial infarction [NSTEMI], n = 77) were recruited from Coronary Care Unit, King Abdulaziz University Hospital. They have one to two coronary arteries blocked ≥50%, or three arteries blocked 30 to 49%. Demographic and clinical criteria were collected and plasma CXCL12 level was measured. No correlations were detected between demographic and clinical criteria and CXCL12 level. While troponin peaks and LVEF significantly differed between STEMI and NSTEMI patients, CXCL12 level showed nonsignificant changes. Plasma CXCL12 levels decreased significantly in statin-treated patients compared with those untreated. From receiver operating characteristic (ROC) analysis, high CXCL12 levels were associated with no statin therapy. For STEMI and NSTEMI patients, area under the receiver operating characteristic curve for CXCL12 test were 0.685 and 0.820, while sensitivity and specificity values were 75.9 and 54.8%, and 73.1 and 84%, respectively. Plasma CXCL12 levels showed nonsignificant changes with different ranges of LVEF and troponin peaks. In patients with severe MI, irrespective of statin therapy, plasma CXCL12 showed no correlation with different ranges of LVEF suggesting that it cannot predict left ventricular dysfunction in these cases. However, cross-sectional design of this study is a limitation.
Management of Feline Femoral, Tibial and Humeral Fractures Using a 3.5 mm Titanium Interlocking Nail
Authors: Mund Georg Michael , Bitterli Thomas , Häußler Thomas Christian , Gerwing Martin , Feichtenschlager Christian
Published: September 2022

Objective Our objectives were to report complications associated with stabilization of long-bone fractures in cats using a 3.5-mm titanium interlocking nail and to examine the influences of signalment, fracture type and fixation evaluations on the occurrence of complications.

Study Design Retrospective clinical study.

Material and Methods Medical and radiographic records of cats with long-bone fractures treated with an interlocking nail were reviewed. Data included age, sex, weight, cause of the fracture, fractured bone(s) and fracture type. Complications were classified as minor and major complications. Fisher's exact tests and logistic regression analysis were used to test whether certain variables of signalment and interlocking nail configuration had an effect on the occurrence of complications.

Results Sixty-seven fractures of 67 cats were examined in this study. Forty-eight femora, sixteen tibiae and three humeri were included. Complications occurred in 11/67 fractures. Major complications occurred in 8/67 fractures and included screw breakage (n = 3), nail breakage (n = 2), nail bending (n = 1), screw loosening (n = 1), non-union (n = 1). Statistical analysis showed a significant difference between fracture types and the occurrence of major complications (p = 0.02).

Conclusion In conclusion, use of this commercially available standard 3.5-mm titanium interlocking nail for stabilization of comminuted and oblique humeral, femoral and tibial fractures in cats is feasible.
Accuracy of the Surface Contour of Three-Dimensional-Printed Canine Pelvic Replicas
Authors: Ming Lu , Lam Griselda , Jeong Junemoe , Sun Young Kim
Published: September 2022

Objective The aim of this study was to determine the differences in surface contour between models of native pelvic bones and their corresponding three-dimensional (3D)-printed replicas.

Study Design Digital 3D models of five cadaveric hemipelves and five live dogs with contralateral pelvic fractures were generated based on computed tomographic images and 3D printed. The 3D-printed replicas underwent 3D scanning and digital 3D models of the replicas were created. The digital 3D model of each replica was superimposed onto the model of the native hemipelvis. Errors in the replicas were determined by comparing the distances of 120,000 corresponding surface points between models. The medial surface, lateral surface and dorsal surface of the acetabulum (DSA) of each hemipelvis were selected for further analysis. The root mean square error (RMSE) was compared between various selected areas using a one-way repeated measures analysis of variance, followed by a Bonferroni post-hoc test.

Results The RMSE of the hemipelvis was 0.25 ± 0.05 mm. The RMSE significantly decreased from the medial surface (0.28 ± 0.06mm), to the lateral surface (0.23 ± 0.06mm), to the DSA (0.04 ± 0.02mm) (p < 0.001).

Conclusion The 3D-printed replicas were adequate in serving as a template for the pre-contouring of bone plates in fracture repair of pelvic fractures, particularly those that demand accurate reduction such as acetabular fractures.
Supporting adolescents’ mental health during COVID-19 by utilising lessons from the aftermath of the Great East Japan Earthquake
Authors: Okuyama Junko , Izumi Shin-Ichi , Funakoshi Shunichi , Seto Shuji , Sasaki Hiroyuki , Ito Kiyoshi , Imamura Fumihiko , Willgerodt Mayumi , Fukuda Yu
Published: September 2022

Historical data can determine how adolescents recover from difficult situations such as the Coronavirus disease 2019 (COVID-19) pandemic. This study analysed 3 years of data obtained from high-school students who had been affected by the 2011 Great East Japan Earthquake and consequently evidenced the importance of increasing resilience among affected adolescents. This involved identifying factors contributing to resilience through a model that assessed for each tsunami disaster. This model was determined by assessing the correlation between survivors’ resilience scores and their measured psychological and lifestyle scores. This approach showed that, in all tsunami damage models, resilience was most affected by the depressed emotions. Thus, our approach suggests that interventions for improving the depressed mood may improve resilience in adolescents during the COVID-19 pandemic.
Modeling narrative features in TV series: coding and clustering analysis
Authors: Rocchi Marta , Pescatore Guglielmo
Published: September 2022

TV series have gained both economic and cultural relevance. Their development over time can hardly be traced back to the simple programmatic action of creative intentionality. Instead, TV series might be studied as narrative ecosystems with emergent trends and patterns. This paper aims to boost quantitative research in the field of media studies, first considering a comparative and data-driven study of the narrative features in the US medical TV series, one of the most popular and longest-running genres on global television. Based on a corpus of more than 400 h of video, we investigate the storytelling evolution of eight audiovisual serial products by identifying three main narrative features (i.e., isotopies). The implemented schematization allows to grasp the basic components of the social interactions showing the strength of the medical genre and its ability to rebuild, in its microcosm, the essential traits of the human macrocosm where random everyday life elements (seen in the medical cases plot) mix and overlap with working and social relationships (professional plot) and personal relationships (sentimental plot). This study relies on data-driven research that combines content analysis and clustering analysis. It significantly differs from traditional studies regarding the narrative features of medical dramas and broadly the field of television studies. We proved that the three isotopies are good descriptors for the medical drama genre and identified four narrative profiles which emphasize the strong stability of these serial products. Contrary to what is often taken for granted in many interpretative studies, creative decisions rarely significantly change the general narrative aspects of the wider series.
Virial relations for elongated plasmas in a tokamak and their potential use in magnetic diagnostics
Authors: Pustovitov V. D.
Published: September 2022

Virial relations are traditionally considered as providing the diamagnetic parameter, poloidal beta βp, and internal inductance ℓi through the integrals determined by the plasma shape and poloidal magnetic field at the plasma–vacuum interface. This gives rise to discussions of their potential applications for diagnostic purposes. Recently, this concept was analyzed in the numerical study of Bongard et al. [Phys. Plasmas 23, 072508 (2016)]. Here, we analytically calculate three main virial integrals (traditionally denoted as S1, S2, and S3) for the plasma with elliptical cross section. The results are expressed through the plasma elongation, its radial derivative, and a similar derivative Δ′ of the Shafranov shift, all taken at the plasma boundary. The geometry of magnetic surfaces inside is not constrained, which guaranties the applicability of the results in a wide area. It is shown that S1 must be a constant, S3 weakly depends on ℓi, and only S2 is a sensitive function of the plasma state through Δ′. This makes S2 the quantity most suitable for diagnostics, while independence of S1 on the plasma shape, βp, and ℓi can be good for calibrations. The difficulties of inferring ℓi from the measured S3 are now shown explicitly.
A new path-independent variable to model ductile damage
Authors: Krishnaswamy Hariharan , Balaji Vikram , Bharti Sahil
Published: September 2022

The effective plastic strain is a commonly used damage variable within continuum damage framework. The value of effective plastic strain at fracture, however, depends on strain rate, temperature and strain path. An alternate state variable is proposed in this work that can provide a unique path-independent2 fracture locus. The average dislocation density is a microstructure-based state variable and has been established in the past to describe the constitutive behaviour of plastic deformation. It is demonstrated that when the average dislocation density is used to model fracture initiation, the fracture locus is unique over a range of strain rates, unlike the conventionally used fracture strain.
Memory B cell responses to Omicron subvariants after SARS-CoV-2 mRNA breakthrough infection in humans
Authors: Wang Zijun , Zhou Pengcheng , Muecksch Frauke , Cho Alice , Ben Tanfous Tarek , Canis Marie , Witte Leander , Johnson Brianna , Raspe Raphael , Schmidt Fabian , Bednarski Eva , Da Silva Justin , Ramos Victor , Zong Shuai , Turroja Martina , Millard Katrina G. , Yao Kai-Hui , Shimeliovich Irina , Dizon Juan , Kaczynska Anna , Jankovic Mila , Gazumyan Anna , Oliveira Thiago Y. , Caskey Marina , Gaebler Christian , Bieniasz Paul D. , Hatziioannou Theodora , Nussenzweig Michel C.
Published: September 2022

Individuals who receive a third mRNA vaccine dose show enhanced protection against severe COVID-19, but little is known about the impact of breakthrough infections on memory responses. Here, we examine the memory antibodies that develop after a third or fourth antigenic exposure by Delta or Omicron BA.1 infection, respectively. A third exposure to antigen by Delta breakthrough increases the number of memory B cells that produce antibodies with comparable potency and breadth to a third mRNA vaccine dose. A fourth antigenic exposure with Omicron BA.1 infection increased variant-specific plasma antibody and memory B cell responses. However, the fourth exposure did not increase the overall frequency of memory B cells or their general potency or breadth compared to a third mRNA vaccine dose. In conclusion, a third antigenic exposure by Delta infection elicits strain-specific memory responses and increases in the overall potency and breadth of the memory B cells. In contrast, the effects of a fourth antigenic exposure with Omicron BA.1 are limited to increased strain-specific memory with little effect on the potency or breadth of memory B cell antibodies. The results suggest that the effect of strain-specific boosting on memory B cell compartment may be limited.
Nerve-dependent distribution of subsynaptic type 1 inositol 1,4,5-trisphosphate receptor at the neuromuscular junction
Authors: Volpe Pompeo , Bosutti Alessandra , Nori Alessandra , Filadi Riccardo , Gherardi Gaia , Trautmann Gabor , Furlan Sandra , Massaria Gabriele , Sciancalepore Marina , Megighian Aram , Caccin Paola , Bernareggi Annalisa , Salanova Michele , Sacchetto Roberta , Sandonà Dorianna , Pizzo Paola , Lorenzon Paola
Published: September 2022

Inositol 1,4,5-trisphosphate receptors (IP3Rs) are enriched at postsynaptic membrane compartments of the neuromuscular junction (NMJ), surrounding the subsynaptic nuclei and close to nicotinic acetylcholine receptors (nAChRs) of the motor endplate. At the endplate level, it has been proposed that nerve-dependent electrical activity might trigger IP3-associated, local Ca2+ signals not only involved in excitation–transcription (ET) coupling but also crucial to the development and stabilization of the NMJ itself. The present study was undertaken to examine whether denervation affects the subsynaptic IP3R distribution in skeletal muscles and which are the underlying mechanisms. Fluorescence microscopy, carried out on in vivo denervated muscles (following sciatectomy) and in vitro denervated skeletal muscle fibers from flexor digitorum brevis (FDB), indicates that denervation causes a reduction in the subsynaptic IP3R1-stained region, and such a decrease appears to be determined by the lack of muscle electrical activity, as judged by partial reversal upon field electrical stimulation of in vitro denervated skeletal muscle fibers.