bluuebunny/crossref_metadata_2025 huggingface dataset:
The Reliability and Validity of the Turkish Version of the Lymphedema Life Impact Scale in Patients With Breast Cancer–Related Lymphedema
Authors: Orhan Ceren , Üzelpasaci Esra , Baran Emine , Nakip Gülbala , Özgül Serap , Aksoy Sercan , Akbayrak Türkan
Published: March 2019

Background

Health-related quality of life is measured to detect the influence of lymphedema on physical, functional, and social aspects of life in patients with breast cancer–related lymphedema (BCRL).

Objective

This study aimed to perform the psychometric evaluation of the Lymphedema Life Impact Scale (LLIS) in Turkish patients with BCRL.

Methods

Patients with BCRL (n = 78) filled out the Turkish LLIS, Lymphedema Quality of Life, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and Quick Disability of Arm, Shoulder and Hand scales. Breast cancer survivors without BCRL (n = 35) completed only the Turkish LLIS. Psychometric properties were analyzed with the internal consistency, test-rest reliability, construct, criterion, and discriminant validity.

Results

The internal consistency of the Turkish LLIS was strong (Cronbach’s α coefficient >.70). Test-retest reliability was strong to very strong (intraclass correlation coefficients from 0.88 to 0.93; P < .001). Similar to the original structure of the scale, exploratory factor analysis identified 3 factors. Criterion validity was supported by moderate to strong correlations between the LLIS, Lymphedema Quality of Life, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and quick Disability of Arm, Shoulder and Hand. There were significant differences in the total and subscale scores of the LLIS between participants with and without BCRL (P < .05).

Conclusions

The present study provided the evidence to confirm reliability and clinical validity of the Turkish LLIS.

Implications of Practice

The Turkish LLIS is a reliable and valid condition-specific scale to measure the physical, functional, and psychological aspects of health-related quality of life in patients with BCRL.
Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample
Authors: Thorsteinsson Einar B. , Brown Rhonda F. , Owens Michelle T.
Published: March 2019

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.
An Unusual Case of Homicide by Impalement With a Battering Ram
Authors: Franceschetto Lisa , Carlini Luigi , Lancia Massimo , Bacci Mauro
Published: March 2019

Impalement injuries occur when a large foreign body traverses or penetrates a body cavity or extremity. Nowadays, impalement injuries are uncommon and are usually a consequence of a fall onto a blunt object or a road accident. The authors report a case of a woman found dead in her apartment, seemingly killed by a firearm injury to the abdomen. However, after the autopsy was carried out, it became clear that the injuries had the features of an impalement. After the inquiry, the murder weapon was identified as a battering ram, used by the robbers to break into the house of the woman. This is the first case ever described in literature where a battering ram has been used to impale someone. This case emphasizes the importance of an accurate description of injuries, also with photographs, in order to achieve effective recognition of the wound patterns as they may correspond to specific and unusual weapons.
Tuberculosis Surveillance in Taiwan Forensic Autopsy Cases
Authors: Hu Hsuan-Yun , Wei Shyh-Yuh , Wu Tai-Yun , Huang Wei-Hsiang , Pan Chih-Hsin
Published: March 2019

Tuberculosis (TB) is one of the most important public health issues worldwide, and global efforts have altered the TB epidemic. This study analyzed 71 cases of TB at autopsy notified via Taiwan Medical Examiner Surveillance for Lethal Infectious Disease (Taiwan Med-X) between 2012 and 2017 and applied immunohistochemistry to formalin-fixed lung tissue. Tuberculosis was present in 0.57% (71/12,369) forensic autopsy cases in the institute. Among the study cases, 30 (42.3%) cases were newly diagnosed with TB at autopsy, whereas 41 (57.7%) cases were notified before death and have still seen the TB pathological changes. Regarding the death investigation, cause of death was TB accounted for 46.5%, and non-TB, 53.5% (including trauma, 26.8%; other diseases, 19.7%; drowning, 4.2%; and drug abuse, 2.8%, respectively). Compared with the staining signal, immunohistochemistry has better sensitivity than acid-fast staining. This study provides a reassessment of the reference value to estimate the burden of disease caused by TB and emphasizes the importance of biosafety in an autopsy room.
Impact of Ankle-Foot Orthosis on Gait Efficiency in Ambulatory Children With Cerebral Palsy
Authors: Betancourt Jean P. , Eleeh Prince , Stark Stacy , Jain Nitin B.
Published: March 2019

Objective

Children with cerebral palsy experience functional limitations because of excessive muscle weakness, spasticity, and impaired motor control. They are prescribed ankle-foot orthoses to assist with ambulation. Our objective was to analyze stride length and dorsiflexion data comparing the effectiveness of “ankle-foot orthoses” with “barefoot or shoes only” on ambulatory children with cerebral palsy.

Design

An electronic literature search was conducted. Studies were screened by two reviewers based on our inclusion criteria: prospective cohort study or randomized clinical trial, participants younger than 18 yrs with a primary diagnosis of cerebral palsy, ankle-foot orthoses with a control group, 20 combined participants in the experimental and control groups for cohort studies, and 10 participants for randomized clinical trials.

Results

Seventeen studies were selected. Pooled results of the meta-analyses showed that stride length was significantly better in the ankle-foot orthoses group as compared with the control group (mean difference between groups = 0.05 m (95% confidence interval = 0.04–0.06). The dorsiflexion angle (5 studies, 124 participants) was improved in patients with ankle-foot orthoses as compared with barefoot or shoes only (mean difference between groups = 8.62 degrees (95% confidence interval = 8.05–9.2).

Conclusions

Children with cerebral palsy using ankle-foot orthoses had improved stride length and dorsiflexion angle during gait in a pooled meta-analyses of cohort studies and clinical trials.
The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence
Authors: Oranges Carlo M. , Striebel Julia , Tremp Mathias , Madduri Srinivas , Kalbermatten Daniel F. , Harder Yves , Schaefer Dirk J.
Published: March 2019

Background:

Several methods to prepare the recipient site in fat grafting have been proposed in recent decades. However, to date, these procedures have never been reviewed exhaustively. The purpose of the present study is to provide a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in preclinical studies, with resulting outcomes and underlying mechanisms of action.

Methods:

The PubMed/MEDLINE database was queried to search for preclinical investigations on the preparation of the recipient site in fat grafting using the following algorithm: ((recipient site) AND (fat grafting) OR (lipofilling) OR (lipograft)). A priori criteria were applied to review the resulting articles.

Results:

Thirteen animal studies met inclusion criteria. Overall, five techniques were identified: external volume expansion, implantation of alloplastic material (silicone sheets), administration of cell-proliferation factors (i.e., vascular endothelial growth factor, adipose tissue–derived stromal vascular fraction, and interleukin-8), ischemia, and microneedling. A positive effect on cellular activity (cell proliferation and angiogenesis) was demonstrated by all studies and achieved with all techniques. Seven of the eight authors who examined this aspect reported enhancement of fat graft survival.

Conclusions:

Improvement of fat grafting surgical outcomes is documented preclinically using different recipient-site preparation techniques, particularly through enhancement of vascularization and soft-tissue expansion. This understanding will lead to further clinical research, especially for those cases where improvement of the recipient site is recommended, such as contracted scars or preirradiated tissues.
Abdominoplasty in the Obese Patient: Risk versus Reward
Authors: Batac Joseph , Hamade Malack , Hamade Hassan , Glickman Laurence
Published: March 2019

Background:

The incidence of obesity is on the rise worldwide. Many surgeons elect not to perform abdominoplasty on patients with a high body mass index, fearing an increased risk of perioperative complications. In this study, the authors compare the outcomes of obese and nonobese patients who underwent abdominoplasty.

Methods:

A retrospective chart analysis was performed on all patients who underwent abdominoplasty by a single surgeon from 2009 to 2016. Complication rates were compared in obese and nonobese patients. Patients were excluded if they did not undergo a full abdominoplasty, underwent a combined surgical procedure, or underwent liposuction in an area outside of the abdomen or flanks at the time of the abdominoplasty.

Results:

A total of 83 patients were included: 62 nonobese and 21 obese patients. The obese group had a higher average body mass index (34. 9 kg/m2 versus 25.1 kg/m2; p < 0.001). Follow-up time was similar (310 days versus 265 days; p = 0.468). No significant differences were seen with regard to perioperative seroma formation (14.2 percent versus 22.5 percent; p = 0.419)), wound dehiscence (9.5 percent versus 11.29 percent; p = 0.822), hematoma formation (4.7 percent versus 1.6 percent; p = 0.438), or surgical-site infection (9.5 percent versus 8.0 percent; p = 0.835). No instances of venous thromboembolism were observed.

Conclusions:

Abdominoplasty, with or without concurrent liposuction, in obese patients, is a safe and effective procedure with similar perioperative complication rates as the nonobese patient population. No significant differences were observed in perioperative complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
The Smile Index: Part 2. A Simple, Prognostic Severity Scale for Unilateral Cleft Lip
Authors: Yao Caroline A. , McCullough Meghan , Auslander Allyn , Imahiyerobo Thomas A. , Vanderburg Richard , Magee William P.
Published: March 2019

Background:

There is no universally accepted classification system for unilateral cleft lip that objectively quantifies the spectrum of disease, making it difficult to evaluate postoperative outcomes in the context of preoperative severity.

Methods:

Anthropometric measurements and photographs were prospectively collected from unilateral cleft lip patients in Morocco, Bolivia, Vietnam, and Madagascar. Columellar angle, cleft width, nostril widths, vertical lip heights, and horizontal vermillion lengths were measured preoperatively and postoperatively. “Unacceptable” postoperative outcomes were defined as those with a cleft-side/non–cleft-side vertical lip height discrepancy greater than 3 mm, based on previous sociologic and cleft outcome studies.

Results:

Of the 147 patients studied, 22 had unacceptable outcomes. Univariate logistic and multivariate logistic stepwise models showed that among preoperative characteristics, cleft width ratio (preoperative cleft width divided by commissure width) was the most significant predictor for unacceptable outcomes, controlling for surgeon experience. Cleft width ratio was normally distributed. Two severity categories were created based on iterative data and regression analysis: “severe” (cleft width ratio >0.5) and “not-severe” (cleft width ratio <0.5). Severe patients had a higher likelihood of unacceptable outcomes versus not-severe patients (OR, 2.9; 95 percent CI, 1.1 to 7.7; p = 0.029; 27 percent versus 11 percent). The probability of having unacceptable outcomes for severe individuals was higher versus not-severe individuals (positive predictive value, 73 percent versus 89 percent).

Conclusions:

Preoperative cleft width ratio greater than 0.5 is associated with having an unacceptable surgical outcome. The authors propose a simple, objective, and clinically reproducible scale to unify the language of unilateral cleft lip severity, as a step toward improving algorithms of care, directing surgical technique, guiding patient/family discussions, and optimizing patient outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Plastic Surgery and Social Media: Examining Perceptions
Authors: Chopan Mustafa , Sayadi Lohrasb , Clark Eric M. , Maguire Kevin
Published: March 2019

Background:

Social media play an important role in plastic surgery, yet there are limited studies in the literature to guide plastic surgeons’ social networking practices. To address this deficiency and provide further insight, the authors set out to investigate the public’s attitude toward plastic surgery using Twitter, a popular social media platform. The authors examined a large body of messages (tweets) related to plastic surgery using novel techniques of natural language processing and sentiment analysis.

Methods:

The authors collected over 1 million tweets with the keywords “plastic,” “cosmetic,” “aesthetic,” and “reconstruction” surgery spanning from 2012 to 2016 from the Twitter Gardenhose feed. Using hedonometrics, the authors extracted the average happiness/positivity (h
avg) of tweets and created word-shift graphs to determine the most influential words.

Results:

The positivity scores for keywords “plastic,” “cosmetic,” “aesthetic,” and “reconstruction” surgery were 5.72, 6.00, 6.16, and 6.09, respectively. In relation to “plastic,” keywords “cosmetic” and “aesthetic” were more positive because they lacked antagonistic words, such as “fake,” “ugly,” “bad,” “fails,” or “wrong.” The keyword “reconstruction,” however, was more positively associated than the term “plastic” because of an increase in positive words, such as “honor,” “amazing,” “successful,” and “respect.”

Conclusions:

Tweets containing the term “plastic” surgery trended toward negativity, and may be explained by the increase in unfavorable, associative words. Conversely, related terms such as “aesthetic,” “cosmetic,” and “reconstruction” were more favorably regarded because of the lack of antagonistic words and the presence of supportive words. The authors’ results are informative and may serve to guide plastic surgeons’ social media practices.
Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature
Authors: Crowe Christopher S. , Cho Daniel Y. , Kneib Cameron J. , Morrison Shane D. , Friedrich Jeffrey B. , Keys Kari A.
Published: March 2019

Background:

Reconstruction of the plantar surface of the foot is challenging because of its distinctive anatomy and microarchitecture. Unfortunately, no single coverage option meets the needs of all patients and defects. A comprehensive literature review is presented to better define available reconstructive options for resurfacing the plantar foot.

Methods:

A systematic literature search was performed to identify articles relating to reconstruction of the plantar skin and soft tissue. The PubMed, Embase, and Scopus databases were queried for published articles. After the exclusion of duplicate records, 1624 articles were available for review. A total of 280 unique articles were included for analysis, with a total of 2684 individual reconstructions.

Results:

Of the articles reviewed, 10 percent described a skin grafting technique, 53 percent described a locoregional flap, 32 percent described free tissue transfer, and 5 percent described multiple reconstructive methods. Isolated heel defects were the most frequently reconstructed subunit of the plantar foot (73 percent). The latissimus dorsi muscle was the most commonly used free flap, whereas the reverse sural artery flap was the most commonly used locoregional flap. Protective sensation was noted in most locoregional and free flap reconstructions, regardless of primary neurotization; however, improved two-point discrimination was noted when neurofasciocutaneous flaps were used. Complication rates varied widely, although rates of flap loss approached those of flaps performed at other anatomical sites.

Conclusions:

Numerous methods exist for reconstructing the plantar surface. Proper flap selection should be determined by the size of the defect, the availability of donor tissue, and the surgeon’s experience and comfort with the reconstructive technique.
How to Improve Projection in Nipple Reconstruction: A Modified Method Using Acellular Dermal Matrix Disk and Fragments
Authors: Lee Hun Joo , Ock Jae Jin
Published: March 2019

Background:

Nipple reconstruction is an essential, final stage in breast reconstruction. However, postoperative reduction in nipple projection often results in low patient satisfaction. The authors studied the causes of the projection decline and developed a new method using acellular dermal matrix. This research studies the effectiveness of the new method.

Methods:

The nipple flap was elevated using a modified C-V flap, and acellular dermal matrix disk was fixed onto the floor. A column was made, into which acellular dermal matrix fragments were put in to retain the projection. The footprint diameter and projection at 1 year were compared with those of the control group, in which acellular dermal matrix was not used. The authors studied the correlation between diameter and projection and whether reconstruction method caused any impact.

Results:

At 1-year follow-up, the nipple diameter and projection in the acellular dermal matrix group were measured to be 102.90 percent and 64.19 percent, respectively, of the baseline. Compared with the control group, the diameter was significantly smaller (p = 0.00) and the projection was higher (p = 0.00). A significant correlation was identified between nipple diameters and projections, at 1-year follow-up, across the total 90 reconstructed nipples (p = 0.00). Different reconstruction methods did not show significant differences in terms of nipple diameter and projection, but the projections at 1 year were highest in the latissimus dorsi flap plus implant group, followed by the expander group and the transverse rectus abdominis musculocutaneous flap group.

Conclusion:

Nipple reconstruction using acellular dermal matrix disk and fragments prevents downward shifting of the nipple tissue and broadening of the footprint diameter and thus is favorable for long-term maintenance of nipple projection.
Quantitative Analysis of Paralyzed Lower Eyelid Elevation Technique: Suspension Sling versus Supporting Midcheek Lift
Authors: Min Kyunghyun , Lee Joo-Heon , Kim Sung Chan , Choi Jong Woo , Oh Tae Suk
Published: March 2019

Background:

Restoration of paralytic lower eyelid retraction is challenging in the surgical management of facial paralysis. In this study, quantitative measurements were compared between the suspension sling and lower eyelid–supporting midcheek lift techniques.

Methods:

From 2014 to 2016, 36 operations were performed on 28 patients with a mean age of 45.6 years (range, 7 to 80 years), a mean denervation time of 13.5 years (range, 0.2 to 44 years), and a mean follow-up period of 636 days (range, 261 to 1143 days). The surgical techniques included autologous tendon sling (n = 9), Mitek suspension (n = 12), and midcheek lift (n = 15). The distance from the pupil center to the lower eyelid margin was measured, and the ratio of the distance on the paralyzed side to that on the normal side was analyzed.

Results:

The change in the ratio between the paralyzed side and the normal side was 0.098 (from 1.264 to 1.166; p = 0.353) in the autologous tendon sling group, 0.104 (from 1.231 to 1.127; p = 0.243) in the Mitek suspension group (p = 0.05), and 0.179 (from 1.234 to 1.055; p = 0.038) in the midcheek lift group. Two patients in the Mitek suspension group developed foreign body infection.

Conclusions:

The midcheek lift group showed the greatest change in the ratio between the distance from the pupil center to the eyelid margin on the paralyzed side and that on the normal side. Eyelid-supporting midcheek lift is superior to suspension sling for restoration of paralytic eyelid retraction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity
Authors: Isaac Kathryn V. , Tan Robin A. , Ganske Ingrid M. , Mulliken John B.
Published: March 2019

Background:

After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion?

Methods:

This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using the Fisher’s exact test.

Results:

Three raters assessed 61 patients aged 6 to 9 years and treated between 1995 and 2015. In 77 percent of control photographs, raters correctly judged the cleft side alar base as wider. In 65 percent of test photographs, raters incorrectly judged the alar base position as wider on the cleft side. Asymmetry of nostril outline and a transverse nostril axis were associated with misjudged photographs (p < 0.05).

Conclusions:

Alar base assessment can be altered by an optical illusion. Simple anthropometry counters this misperception. Measurement should be repeated after correction of the deviated anterocaudal septum and elevation of the lower lateral cartilage. Thereafter, a decision is made on altering the alar base position.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Genotypic and phenotypic adaptation of pathogens: lesson from the genus Bordetella
Authors: Linz Bodo , Ma Longhuan , Rivera Israel , Harvill Eric T.
Published: March 2019

Purpose of review

To relate genomic changes to phenotypic adaptation and evolution from environmental bacteria to obligate human pathogens, focusing on the examples within Bordetella species.

Recent findings

Recent studies showed that animal-pathogenic and human-pathogenic Bordetella species evolved from environmental ancestors in soil. The animal-pathogenic Bordetella bronchiseptica can hijack the life cycle of the soil-living amoeba Dictyostelium discoideum, surviving inside single-celled trophozoites, translocating to the fruiting bodies and disseminating along with amoeba spores. The association with amoeba may have been a ‘training ground’ for bacteria during the evolution to pathogens. Adaptation to an animal-associated life style was characterized by decreasing metabolic versatility and genome size and by acquisition of ‘virulence factors’ mediating the interaction with the new animal hosts. Subsequent emergence of human-specific pathogens, such as Bordetella pertussis from zoonoses of broader host range progenitors, was accompanied by a dramatic reduction in genome size, marked by the loss of hundreds of genes.

The evolution of Bordetella from environmental microbes to animal-adapted and obligate human pathogens was accompanied by significant genome reduction with large-scale gene loss during divergence.
Contextual Conditions and Performance Improvement in Primary Care
Authors: Hung Dorothy Y. , Harrison Michael I. , Liang Su-Ying , Truong Quan A.
Published: March 2019

Background:

Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns.

Methods:

We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes.

Results:

Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support.

Conclusions:

Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change.
Value of the Cinematic Rendering From Volumetric Computed Tomography Data in Evaluating the Relationship Between Deep Soft Tissue Sarcomas of the Extremities and Adjacent Major Vessels: A Preliminary Study
Authors: Li Kun , Yan Ruiying , Ma Huan , Zhang Da-fu , Ding Yingying , Li Zhen-hui
Published: March 2019

Objective

The aim of the study was to assess the value of cinematic rendering (CR) from volumetric computed tomography data in evaluating the relationship between deep soft tissue sarcomas (STSs) of the extremities and the adjacent major vessels.

Methods

Preoperative contrast-enhanced axial imaging (CEAI) in the arterial phase with three-dimensional volume rendering (VR) and CR of contrast-enhanced computed tomography were used to assess adjacent vascular invasion in 43 cases of deep STSs of the extremities. The imaging assessments were compared with surgical findings and interpreted as negative (no vascular invasion) or positive (vascular invasion was present). Intrareader and interreader agreement were assessed using Cohen κ statistics. The diagnostic performance of CEAI, VR, and CR was evaluated by receiver operating curve analysis and compared using the DeLong test.

Results

Thirty-four and nine cases were classified as negative and positive, respectively, in surgery. Intrareader agreement values for the CEAI, VR, and CR assessments were all excellent (0.984, 0.934, and 0.914, respectively), whereas the interreader agreement for CEAI assessments was greater than that for VR and CR (0.969 vs 0.804 and 0.761). Cinematic rendering showed lower accuracy (0.698), sensitivity (0.778), specificity (0.676), positive predictive values (0.389), and negative predictive values (0.920) for vascular invasion diagnosis than CEAI or VR; the accuracy, sensitivity, specificity, positive predictive values, and negative predictive values increased to 0.767, 0.889, 0.735, 0.471, and 0.962 for both CEAI and VR. The results were not statistically significant (allP> 0.05).

Conclusions

Cinematic rendering has the potential to be used to evaluate vascular invasion in cases of deep STSs of the extremities, but it should be used alongside the traditional methods such as CEAI.
Congenital Unilateral Zygomatico-Maxillo-Mandibular Fusion
Authors: Decaux Jerome , Olszewski Raphael , Laloux Marc , Mahy Pierre
Published: March 2019

Congenital fusion of the jaws (syngnathia) is a rare and severe disorder. The authors report a case of bony fusion of the left mandible with the maxilla and zygomatic complex in a 5-day-old male who was not able to feed and open his mouth normally. Early surgery was performed to release the bony fusion on the tenth day of life. The authors present a new technique based on the intraoperative use of 3-dimensional surgical guides.
Facial Anthropometric Proportion of Chinese Han Nationality
Authors: Yang Yu-han , Wang Bing , Ding Ya , Shi Yan-Wei , Wang Xiao-Guang
Published: March 2019

Facial anthropometric measurements play an important part not only in forensic cases but also in clinical treatments. The utilization of 2D photograph methods in facial anthropometric studies to found database with age, gender, ethnicity, and region was expanded by other races but little for Han nationality. This study was undertaken to describe reference ranges of facial anthropometric proportions of Han nationality and compare the anthropometric characteristics with other ethnicities. Our subjects focused on full-face photos of Han nationality in South China which consisted of 1176 healthy person (425 adult males, 421 adult females and 157 underage boys and 173 underage girls). Eight anthropometric landmarks on photos were examined by ImageJ software, and 7 anthropometric ratios were analyzed. The results indicated sex- and age- and ethnics-related anthropometric variations in Chinese Han nationality in South China. For adults, females have larger ratios in intercanthal–nasal width and lip height index and smaller nose width index; for impubes, boys were larger in lip height index and smaller in lip width ratios than girls, but as age achieved, the underage boys and girls exhibited a significantly larger nose width index and lip width index, smaller canthal index, intercanthal–nasal width and lip height index. Comparing with Japanese, India, North American and Persian, Chinese Han showed great difference in facial anthropometric proportions.
The Application of a Jigsaw Puzzle Flap Based on a Freestyle Perforator and an Aesthetic Unit for Large Facial Defects
Authors: Yu Daojiang , Cao Shikun , Zhang Shuyu
Published: March 2019

Background:

The single-stage reconstruction of large facial defects remains a conundrum due to the balance between function and aesthetics after skin cancer radical resection.

Objective:

The goal of this study was to explore a novel surgical procedure for large facial defects that not only resurfaces the large defect in single stage but also improves aesthetic outcomes for both defects and donor sites.

Methods:

The reconstructions were performed using local flaps in the form of a “jigsaw puzzle” flap based on a freestyle perforator and facial aesthetic unit. This procedure starts with a Doppler signal of the perforator and proceeds sequentially in conjunction with adjacent flaps, similar to fitting puzzle pieces, to create a new, large, jigsaw puzzle-like flap that complies with the concept of a facial aesthetic unit. All defects achieved tensionless primary closure with suturing in a concealed area.

Results:

Procedures were performed for 40 patients; the average size of the defects was 37 cm2 (range, 6–51 cm2). The patients were followed up for a range of 6 months to 2 years, and reconstruction without flap loss was 100% successful.

Conclusion:

Via a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit, we can take advantage of a greater freedom of flap selection and have a more versatile aesthetic design. The jigsaw puzzle flap concept represents a safe and favorable approach to the reconstruction of large facial defects.
Radiologic Appearance of Cranial Involvement of Rosai–Dorfman Disease
Authors: Polat Gökhan , Pirimoğlu Berhan
Published: March 2019

Rosai–Dorfman disease is very an important histoproliferative disorders. It rarely involves cranial and facial bones. It can make intracranial and extracranial region extension. Therefore, it can mimic dermal and dural pathologies. Target sign is an important sign for diagnosis on computed tomography and magnetic resonance imaging.
Frontal Sinus Osteoma: From Direct Excision to Endoscopic Removal
Authors: Karunaratne Yasiru G. , Gunaratne Dakshika A. , Floros Peter , Wong Eugene H. , Singh Narinder P.
Published: March 2019

Frontal sinus osteomas are benign bone-forming neoplasms. Ongoing advancements in endoscopic surgery have allowed less invasive surgical approaches to be adopted for removal. The authors systematically reviewed the literature to provide analysis and recommendations for management.

One hundred ninety-three publications encompassing 1399 patients met inclusion, with mean age 42.1 ± 13.8 years and a male predominance (59.2%). Symptoms included pain (70.8%); orbital/ocular (20.7%); sinonasal (36.4%); neurologic (6.0%); other (14.5%); and asymptomatic (4.8%). Osteoma was isolated to the frontal sinus (82.9%) or extended into the ethmoid (16.6%), maxillary (0.3%), and sphenoid sinuses (0.2%). There was intracranial extension in 9.5% and intraorbital extension in 18.7%. Of those proceeding to surgery, majority (59.8%) underwent open approaches, followed by endoscopic (25.0%) and combined (11.5%). A significant (P < 0.01) increase in proportion of cases utilizing endoscopic approaches versus open/combined was observed over the period studied. Seventy-one postoperative complications were reported, in 7.5% of endoscopic cases, 27% of open, and 8.8% of combined. Complications were more likely in open/combined surgery, compared with endoscopic (22.3% versus 7.5%, P < 0.001). In 181 patients, completeness of resection was reported (complete resection; 87.8%) and found to be a significant predictor (P < 0.01) for disease recurrence/progression. Mean length of stay for the endoscopic group was 3.1 ± 1.3 days, compared with 7.9 ± 3.1 for open/combined (P < 0.0001).

In the management of frontal sinus osteoma, indications for selecting endoscopic versus open approaches have expanded over the past 30 years, as techniques, equipment, and understanding of pathophysiology have evolved. Where endoscopic approaches are possible, they are associated with reduced morbidity and length of stay compared with open approaches.
Influencing Factors on the Outcome in Female Groin Hernia Repair
Authors: Köckerling Ferdinand , Lorenz Ralph , Hukauf Martin , Grau Henning , Jacob Dietmar , Fortelny René , Koch Andreas
Published: March 2019

Objective:

Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair.

Background:

In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair.

Methods:

In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified.

Results:

In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates.

Conclusions:

Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?
Authors: Yeung Kai Tai Derek , Penney Nicholas , Ashrafian Leanne , Darzi Ara , Ashrafian Hutan
Published: March 2019

Objective:

The aim of this study was to appraise the prevalence of gastroesophageal reflux disease (GERD), esophagitis, and Barrett's esophagus (BE) after sleeve gastrectomy (SG) through a systematic review and meta-analysis.

Background:

The precise prevalence of new-onset or worsening GERD after SG is controversial. Subsequent esophagitis and BE can be a serious unintended sequalae. Their postoperative prevalence remains unclear.

Methods:

A systematic literature search was performed to identify studies evaluating postoperative outcomes in primary SG for morbid obesity. The primary outcome was prevalence of GERD, esophagitis, and BE after SG. Meta-analysis was performed to calculate combined prevalence.

Results:

A total of 46 studies totaling 10,718 patients were included. Meta-analysis found that the increase of postoperative GERD after sleeve (POGAS) was 19% and de novo reflux was 23%. The long-term prevalence of esophagitis was 28% and BE was 8%. Four percent of all patients required conversion to RYGB for severe reflux.

Conclusions:

The postoperative prevalence of GERD, esophagitis, and BE following SG is significant. Symptoms do not always correlate with the presence of pathology. As the surgical uptake of SG continues to increase, there is a need to ensure that surgical decision-making and the consent process for this procedure consider these long-term complications while also ensuring their postoperative surveillance through endoscopic and physiological approaches. The long-term outcomes of this commonly performed bariatric procedure should be considered alongside its weight loss and metabolic effects.
Recalibration and External Validation of the Risk Analysis Index
Authors: Arya Shipra , Varley Patrick , Youk Ada , Borrebach Jeffrey D. , Perez Sebastian , Massarweh Nader N. , Johanning Jason M. , Hall Daniel E.
Published: March 2019

Objective and Background:

The Risk Analysis Index (RAI) predicts 30-, 180-, and 365-day mortality based on variables constitutive of frailty. Initially validated, in a single-center Veteran hospital, we sought to improve model performance by recalibrating the RAI in a large, veteran surgical registry, and to externally validate it in both a national surgical registry and a cohort of surgical patients for whom RAI was measured prospectively before surgery.

Methods:

The RAI was recalibrated among development and confirmation samples within the Veterans Affairs Surgical Quality Improvement Program (VASQIP; 2010–2014; N = 480,731) including major, elective noncardiac surgery patients to create the revised RAI (RAI-rev), comparing discrimination and calibration. The model was tested externally in the American College of Surgeons National Surgical Quality Improvement Program dataset (NSQIP; 2005–2014; N = 1,391,785), and in a prospectively collected cohort from the Nebraska Western Iowa Health Care System VA (NWIHCS; N = 6,856).

Results:

Recalibrating the RAI significantly improved discrimination for 30-day [c = 0.84–0.86], 180-day [c = 0.81–0.84], and 365-day mortality [c = 0.78–0.82] (P < 0.001 for all) in VASQIP. The RAI-rev also had markedly better calibration (median absolute difference between observed and predicted 180-day mortality: decreased from 8.45% to 1.23%). RAI-rev was highly predictive of 30-day mortality (c = 0.87) in external validation with excellent calibration (median absolute difference between observed and predicted 30-day mortality: 0.6%). The discrimination was highly robust in men (c = 0.85) and women (c = 0.89). Discrimination also improved in the prospectively measured cohort from NWIHCS for 180-day mortality [c = 0.77 to 0.80] (P < 0.001).

Conclusions:

The RAI-rev has improved discrimination and calibration as a frailty-screening tool in surgical patients. It has robust external validity in men and women across a wide range of surgical settings and available for immediate implementation for risk assessment and counseling in preoperative patients.
Medicare Reimbursement for General Surgery Procedures
Authors: Haglin Jack M. , Eltorai Adam E. M. , Richter Kent R. , Jogerst Kristen , Daniels Alan H.
Published: March 2019

Objective:

The purpose of this study is to evaluate monetary trends from 2000 to 2018 in Medicare reimbursement rates for the most common general surgery procedures.

Summary Background Data:

A complete understanding of financial trends in general surgery in the United States is lacking. As such, an evaluation of trends in reimbursement rates in general surgery is important for defining the specialty's current and future financial health.

Methods:

The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each of the 20 top codes top in general surgery. The total raw percent change in Medicare reimbursement rate for each procedure from 2000 to 2018 was calculated and averaged. All data was corrected for inflation. Both average annual and total percentage change were calculated based on these adjusted trends. Compound annual growth rate was calculated using the adjusted data.

Results:

After adjusting all data for inflation, the reimbursement rate for all included procedures decreased by an average of 24.4% throughout the study period. During this time, the adjusted reimbursement rate decreased by an average of 1.4% each year with an average compound annual growth rate of −1.6%.

Conclusion:

After adjusting for inflation, Medicare reimbursement rates in general surgery have steadily decreased from 2000 to 2018. It is important that these trends are understood and considered by surgeons, healthcare administrators, and policy-makers in order to develop and implement agreeable models of reimbursement while ensuring access to quality general surgery care in the United States.
Characteristic sounds facilitate object search in real-life scenes
Authors: Kvasova Daria , Garcia-Vernet Laia , Soto-Faraco Salvador
Published: March 2019

Real-world multisensory events do not only provide temporally and spatially correlated information, but also semantic correspondences about object identity. Semantically consistent sounds can enhance visual detection, identification and search performance, but these effects are always demonstrated in simple and stereotyped displays that lack ecological validity. In order to address identity-based crossmodal relationships in real world scenarios, we designed a visual search task using complex, dynamic scenes. Participants searched objects in video clips from real life scenes with background sounds. Auditory cues embedded in the background sounds could be target-consistent, distracter-consistent, neutral and no sound (just background noise). We found that characteristic sounds enhance visual search of relevant objects in natural scenes but fail to increase the salience of irrelevant distracters. Our findings generalize previous results on object-based crossmodal interactions with simple stimuli and shed light upon how audio-visual semantically congruent relationships play out in real life contexts.
Rapid discovery of drug target engagement by isothermal shift assay
Authors: Webb Kristofor J. , Ball Kerri A. , Coleman Stephen J. , Jacobsen Jeremy , Stowell Michael H.B. , Old William M.
Published: March 2019

Identifying protein targets directly bound by drug molecules within living systems remains challenging. Here we present the isothermal shift assay, iTSA, for rapid identification of drug targets. Compared with thermal proteome profiling, a prevailing method for target engagement, iTSA offers a simplified workflow, 4-fold higher throughput, and multiplexed experimental designs with higher replication. We demonstrate application of iTSA to identify targets for several kinase inhibitors in lysates and living cells.
Osmolyte homeostasis controls single-cell growth rate and maximum cell size ofSaccharomyces cerevisiae
Authors: Altenburg Tom , Goldenbogen Björn , Uhlendorf Jannis , Klipp Edda
Published: March 2019

Cell growth is well described at the population level, but precisely how nutrient and water uptake and cell wall expansion drive the growth of single cells is poorly understood. Supported by measurements of single-cell growth trajectories and cell wall elasticity, we present a single-cell growth model for yeast. The model links the thermodynamic quantities turgor pressure, osmolarity, cell wall elasto-plasticity, and cell size, using concepts from rheology and thin shell theory. It reproduces cell size dynamics during single-cell growth, budding, and hyper- or hypoosmotic stress. We find that single-cell growth rate and final size are primarily governed by osmolyte uptake and consumption, while bud expansion depends additionally on different cell wall extensibilities of mother and bud. Based on first principles the model provides a more accurate description of size dynamics than previous attempts and its analytical simplification allows for easy combination with models for other cell processes.