bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Timing for Reduction Mammaplasty in Adolescents
Authors: Nuzzi Laura C. , Pramanick Tannishtha , Walsh Landis R. , Firriolo Joseph M. , Massey Gabrielle G. , DiVasta Amy D. , Labow Brian I. 
Published: November 2020

Background:
Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological “sweet spot,” for reduction mammaplasty to minimize the risk of breast regrowth in adolescents.

Methods:
The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes.

Results:
Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41).

Conclusions:
Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient’s biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth.

Clinical Question/Level of Evidence:
Risk, III.
Four-Year Follow-Up of the World’s First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?
Authors: Azoury Saïd C. , Milbar Niv , Kimia Rotem , Nguyen Jie C. , Othman Sammy , McAndrew Christine , Kovach Stephen J. , Carrigan Robert B. , Steinberg David R. , Bozentka David J. , Lin Ines C. , Levin L. Scott , Chang Benjamin 
Published: November 2020

Background:
In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time.

Methods:
Forearm and hand radiographs were obtained annually. Radius and ulna measurements were performed by multiple coauthors and mathematically normalized using a standardized methodology. The Greulich and Pyle atlas was used to estimate hand bone age.

Results:
From July of 2015 to July of 2019, unadjusted bone length (metaphysis to metaphysis) increased 38.8 and 39.6 mm for the left radius and ulna, and 39.5 and 35.8 mm for the right radius and ulna, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes. Normalized growth between the two limbs was statistically similar. At each annual follow-up, the bone age increased by 1 year.

Conclusions:
Successful pediatric hand-forearm transplantation offers the advantage of growth similar to that of nontransplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. Chronologic age parallels the increase in bone age.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Single-Stage Adipofascial Turnover Flap as an Alternate Option for Large Nasal Defects Usually Requiring Two-Stage Forehead Flap
Authors: Gallagher Thomas M. , Capito Anthony E. 
Published: November 2020

Background:
Large nasal defects involving the tip, ala, and/or columella with denuded cartilage have traditionally required a two-stage forehead flap. As many Mohs patients are presenting older with increased medical comorbidities, a single-stage adipofascial turnover flap with a full-thickness skin graft was developed by the senior author as an alternative method. The authors hypothesize that the adipofascial turnover flap would have similar success rates and cost less than the forehead flap.

Methods:
A retrospective review of all patients in the senior author’s practice who underwent either a forehead flap or adipofascial turnover flap between January of 2016 and February of 2019 was conducted. The two groups were compared regarding success, complications, and cost.

Results:
There were seven forehead flap patients and 11 patients with adipofascial turnover flaps. Overall complications were three of seven (43 percent) for the forehead flap group and one of 11 (9 percent) for the adipofascial turnover flap group. There was one mortality, one revision for asymmetry, and one with airflow obstruction in the forehead group. The adipofascial turnover flap group had one partial skin graft loss that healed with local wound care only. There were no flap failures in either group, and the cost savings averaged over $22,000 in the adipofascial turnover flap group.

Conclusions:
The single-stage adipofascial turnover flap with full-thickness skin grafting is a safe, reliable, and less expensive alternate to the forehead flap. The forehead flap will remain a workhorse in nasal reconstruction, but multiple operations increase cost and may contribute to higher complication rates. The adipofascial turnover flap appears to be an efficacious and reasonable option compared with the forehead flap.
Prevalence of Psychosocial Distress in Transmen Seeking Gender-Affirming Mastectomy
Authors: Lane Megan , Kirsch Michael J. , Sluiter Emily C. , Hamill Jennifer B. , Ives Graham C. , Gilman Robert H. , Cederna Paul S. , Kuzon William M. , Wilkins Edwin G. 
Published: November 2020

Background:
Although the benefits of gender-affirming surgery may be apparent to patients and providers, there remains a paucity of studies assessing the impact of these procedures. As an initial step, preoperative patient-reported outcomes using validated measures of depression, anxiety, and body image were used and compared to cisgender normative data.

Methods:
Patients presenting for gender-affirming mastectomy were approached and surveyed using validated instruments measuring anxiety, depression, and body image. In addition, clinical data were collected from the medical record. Results were compared to published instrument norms in the general cisgender population.

Results:
One hundred three patients completed the preoperative assessment; 70.3 percent and 66.3 percent of the cohort screened positive for mild to severe depression and anxiety, respectively. Only 25 percent and 29.8 percent of the cohort, respectively, had a previous diagnosis of depression and anxiety. The rates of depression and anxiety were significantly higher than those in cisgender normative data [mean Patient Health Questionnaire score, 2.7 (p < 0.0001); mean Generalized Anxiety Disorder Scale 7 score, 2.66 (p < 0.0001)]. Body Image Quality of Life Index and BREAST-Q scores were also significantly lower than those in cisgender normative data.

Conclusions:
Patients seeking gender-affirming mastectomy have a significant mental health burden that appears to be underdiagnosed. They further have significant challenges with body image compared with cisgender normative data. These findings signify dramatic mental health disparities in the preoperative transgender population and the need for ongoing prospective research of gender-affirming surgery.
Quantifying the Evolving Contribution of HIV Interventions and Key Populations to the HIV Epidemic in Yaoundé, Cameroon
Authors: Silhol Romain , Baral Stefan , Bowring Anna L. , Mukandavire Christinah , Njindam Iliassou M. , Rao Amrita , Schwartz Sheree , Tamoufe Ubald , Billong Serge C. , Njoya Oudou , Zoung-Kanyi Bissek Anne-Cecile , Calleja Jesus M. G. , Vickerman Peter , Mishra Sharmistha , Boily Marie-Claude 
Published: November 2020

Background:
Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission.

Setting:
Yaoundé, Cameroon.

Methods:
We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group.

Results:
Condom use and ART together may have averted 43% (95% uncertainty interval: 31–54) of incident infections over 1980–2018 and 72% (66–79) over 2009–2018. Most onward transmissions over 2009–2018 stemmed from sex between lower-risk individuals [47% (32–61)], clients [37% (23–51)], and MSM [35% (20–54)] with all their partners. The contribution of commercial sex decreased from 25% (8–49) over 1989–1998 to 8% (3–22) over 2009–2018, due to higher intervention coverage among FSW.

Conclusion:
Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
18F-FDG PET and 18F-FDG PET/CT in Vulvar Cancer
Authors: Triumbari Elizabeth K.A. , de Koster Elizabeth J. , Rufini Vittoria , Fragomeni Simona M. , Garganese Giorgia , Collarino Angela 
Published: November 2020

Aim
The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for preoperative lymph node staging.

Patients and Methods
PubMed/Medline and Embase databases were searched to identify studies evaluating 18F-FDG PET/CT in vulvar cancer patients. The assessment of methodological quality of the included articles was performed. Per-patient and per-groin pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated.

Results
Ten articles were included in the systematic review, 7 among which evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for lymph node staging. Qualitative per-patient analysis (72 patients from 4 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.70 (95% CI, 0.44–0.95), 0.90 (95% CI, 0.76–1.04), 0.86 (95% CI, 0.66–1.06), 0.77 (95% CI, 0.56–0.97), and 10.49 (95% CI, 1.68–65.50), respectively. Qualitative per-groin analysis (245 groins from 5 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.76 (95% CI, 0.57–0.94), 0.88 (95% CI, 0.82–0.94), 0.70 (95% CI, 0.55–0.85), 0.92 (95% CI, 0.86–0.97), and 19.43 (95% CI, 6.40–58.95), respectively.

Conclusions
Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one.
Infection Control of COVID-19
Authors: Nawwar Ayah Adel , Searle Julie , Green Christopher , Lyburn Iain Douglas 
Published: November 2020

Abstract
In accordance with published international COVID-19 pandemic guidance (American College of Nuclear Medicine, British Nuclear Medicine Society, and European Association of Nuclear Medicine), the use of face masks has become an essential part of infection control for both patients and staff. A 56-year-old man with mantle cell lymphoma underwent staging FDG PET/CT, which demonstrated avid lymphadenopathy below the diaphragm and an unusual diffuse FDG uptake projected over the face, raising the suspicion of cutaneous lymphomatous involvement. On reflection of the clinical scenario and scanning conditions, cutaneous involvement was discounted; the pattern of uptake and lack of CT correlate were supportive of a cutaneous artifact related to the presence of the patient's mask.
Ultra-Low-Dose Computed Tomography Protocol for Preoperative Evaluation in Children With Craniofacial Anomalies
Authors: Komarraju Aparna , Mehta Sagar T. , Glacier Charles , Nabaweesi Rosemary , Choudhary Arabinda , Ramakrishnaiah Raghu 
Published: November 2020

Purpose:
Preoperative three-dimensional computed tomography is currently the gold standard imaging modality in patients with craniofacial anomalies. In these patients, bone structural evaluation is paramount for surgical planning and evaluation of brain parenchyma is often secondary. With the significant complexity of these patients, a majority of patients undergo multiple Computed Tomography (CT) studies from infancy into adulthood. This study presents an ultra-low-dose CT protocol that limits the radiation exposure per CT scan in patients with craniofacial anomalies.

Material and Methods:
A total of 200 consecutive patients who underwent head CT for preoperative evaluation of craniofacial anomalies at Tertiary Children's Hospital were included in the study. The kVp, (KiloVoltage Peak) mA (milliAnperage), CT dose index (CTDI), and dose-length product (DLP) were documented from the dose page. Patients were stratified based on age for determining age specific effective dose and for age matched comparison. The age specific effective dose was derived by using the established conversion factor as described in the paper. (1) Standard t test was performed to determine the statistical significance of radiation dose reduction. The Institutional Review Board approved the study and data was collected from 2012–2014.

Findings:
Of the 200 patients assessed in our study, 90 patients had low-dose CT scans and 110 patients had ultra-low-dose CT scans of the head. All patients had diagnostic quality CT studies. The low-dose CT was performed at 120 kVp and 100 mA. The ultra-low-dose CT was performed at 80 kVp and fixed 80 mA. The minimum, maximum and mean effective dose before the introduction of the ultra-low-dose protocol was 0.8 mSv, 6.9 mSV and 2.82 mSv. The minimum, maximum and mean effective dose after the introduction of the ultra-low-dose protocol was 0.6 mSv, 3.8 mSV, and 1.37 mSv. The reduction in the effective radiation dose was statistically significant (standard t test; P = 0.0001).

Conclusion:
Compared to the regular low-dose protocol, the ultra-low-dose CT protocol provided appropriate diagnostic images with a significantly decreased radiation dose.
Clinical Difference Between Capillary and Cavernous Hemangiomas of Nasal Cavity
Authors: Lim Hye Rin , Lee Dong Hoon , Lim Sang Chul 
Published: November 2020

Objective:
The authors analyzed the clinical characteristics and treatment results of capillary and cavernous hemangiomas in the nasal cavity.

Patients and Methods:
A total of 14 patients who underwent surgical treatment for sinonasal hemangiomas between January 2010 and May 2020 were analyzed. The study population was subdivided into capillary and cavernous hemangiomas groups.

Results:
The 14 patients with sinonasal hemangiomas involved 8 (57.1%) capillary hemangiomas and 6 (42.9%) cases of cavernous hemangioma. Clinical features, such as age, gender, medical condition, symptom, duration of symptom, size and site of sinonasal hemangiomas, surgery, anesthesia method, treatment outcomes, and recurrence of capillary and cavernous hemangiomas of nasal cavity showed no statistically significant difference (P > 0.05). A case of relapse involving a patient with cavernous hemangioma of vestibule was observed without recurrence after reoperation.

Conclusion:
The comparison of clinical features of capillary and cavernous hemangiomas of nasal cavity showed no statistical significance. Transnasal endoscopic tumor removal including the surrounding structure is a safe and effective procedure for sinonasal hemangiomas.
Have There Been any Changes in the Epidemiology and Etiology of Maxillofacial Trauma During the COVID-19 Pandemic? An Italian Multicenter Study
Authors: Salzano Giovanni , Dell’Aversana Orabona Giovanni , Audino Giovanni , Vaira Luigi Angelo , Trevisiol Lorenzo , D’Agostino Antonio , Pucci Resi , Battisti Andrea , Cucurullo Marco , Ciardiello Cristina , Barca Ida , Cristofaro Maria Giulia , De Riu Giacomo , Biglioli Federico , Valentini Valentino , Nocini Pier Francesco , Califano Luigi 
Published: November 2020

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on people's behavior. The aim of this study has been to evaluate how the SARS-CoV-2 pandemic has impacted the incidence and the features of maxillofacial fractures presented at 6 Italian tertiary centers. Clinical records of all the patients diagnosed for facial fractures between February 23 and May 23, 2019 and 2020 were retrospectively reviewed. Any differences in patient number and characteristics and fracture etiology and site between the 2 groups were then statistically analyzed.
There has been a 69.1% decrease in the number of incoming patients during the pandemic. The number of foreign patients has decreased significantly (23.3% versus 9.6%, P = 0.011) while the average age has increased (38.6 versus 45.6 years old, P = 0.01). Specific statistical significant differences for accidental falls (31.8% versus 50.1%, P = 0.005) and sports injuries (16.9% versus 1.4%, P < 0.001) were found. Concerning fracture sites, significant differences have been found in relation to nasal (22.5% versus 11.4%, P = 0.009) and frontal sinus (0.9% versus 4.4%, P = 0.037) fractures. In conclusion, SARS-CoV-2 pandemic has significantly changed the epidemiology and the etiology of facial traumas.
Frontal Bone is Thicker in Women and Frontal Sinus is Larger in Men: A Morphometric Analysis
Authors: Ekşi Murat Şakir , Güdük Mustafa , Usseli Murat Imre 
Published: November 2020

Abstract
Cranial bone thickness and frontal sinus size are important parameters to be known before cranial procedures. Deep-learning systems have become popular for making bulk analyses to diagnose diseases/disorders and plan treatment algorithms in diverse fields of medicine. Deep-learning systems would be valuable assets also for cranial procedures. Deep-learning systems need normative values and variances of the population on which they are used. In the present study, the authors aimed to find out the normative values for skull bone thickness at 4 anatomical locations, and frontal sinus size. the authors also analyzed whether gender affected these values. Consecutive adult female and male patients that had presented to our outpatient and emergency clinics between December 2019 and April 2020 were evaluated. We included 174 patients (98 female and 76 male) into the final analysis. Skull bone thickness was measured in 4 anatomical compartments, and vertical dimension of the left and right frontal sinuses were measured. The mean thickness of frontal, parietal, temporal, and occipital bones was 7.9 mm, 9.7 mm, 6 mm, and 10.1 mm for men; 8.7 mm, 10.2 mm, 6.1 mm, and 10.1 mm for women, respectively. Women had significantly thicker frontal bone when compared to men (P = 0.009). Men had significantly larger frontal sinuses compared to women (16.1 mm versus 13.7 mm for right frontal sinus, P = 0.031; 16.4 mm versus 13.9 mm for left frontal sinus, P = 0.023). Women and men had thicker frontal bone, and larger frontal sinuses, respectively.
The Rising Interest in Canthoplasty: An Analysis of Online Search Trends
Authors: Panayi Adriana C. , Wu Mengfan , Liu Qinxin , Haug Valentin , Yu Zhen 
Published: November 2020

Abstract
Canthoplasty as a cosmetic procedure appears to be on the rise in the West. Online search query data offers a powerful tool for analyzing population trends, including changes in patient interest in surgical procedures. Cosmetic surgeons can utilize the internet to increase patient education and interest, as well as to provide information and address misinformation. In this study we sought to verify the increase in cosmetic canthoplasty, for the first time, through analysis of Internet search data, and to establish trends in the interest of Internet users for cosmetic canthoplasty. These trends were subsequently compared with trends in literature publication to establish whether there is a correlation between patient and surgeon interest in the procedure.
A New Graft Technique For Rhinoplasty: Modified One-Piece Nasal Cap With Alar Strut Graft
Authors: Resuli Ali Seyed , Oktem Fatih 
Published: November 2020

Objectives:
This study was aimed to evaluate the effectiveness of the new graft technique-modified one-piece nasal cap with alar strut graft in rhinoplasty; both for aesthetical appearance and nasal functions.

Methods:
Forty-two patients, who underwent primary rhinoplasty operation with the new graft technique, were evaluated visually by photographing and functionally by the Cottle test and rhinomanometry measurement.

Results:
All of the patients had sufficient nasal vision; also nasal valve angles became wider and Cottle tests were negative in all patients after surgery. Postoperative nasal airflow values (both left and right) were significantly higher, and airway resistance (left, right, and total) values were significantly lower than preoperative values.

Conclusion:
With the new graft technique, the authors obtained both satisfying aesthetic results and intended functional improvement. This technique may be an alternative to combination of multiple graft techniques; with advantages of practical performing and less complication risks.
Findings and Prognostic Value of Lung Ultrasonography in Coronal Virus Disease 2019 (COVID-19) Pneumonia
Authors: Li Lu , Qin Aihua , Yang Xiao , Zhou Shuliang , Luo Yun , Zhu Fangfang , Hu Bo , Li Jianguo , Cai Shuhan , Peng Zhiyong 
Published: November 2020

ABSTRACT

Purpose:
We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value.

Patients and Methods:
We performed lung ultrasonography on 48 COVID-19 patients in an intensive care unit (ICU) (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted.

Results:
25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines (B-pattern) on lung ultrasonography; 13% areas with confluent B lines (B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = −0.498, P < 0.05) and positively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under receiver operator characteristic curves of lung ultrasonography score were 0.735 (95% CI: 0.586–0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively.

Conclusions:
Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality.