bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia
Authors: Haggie Stuart , Fitzgerald Dominic A. , Pandit Chetan , Selvadurai Hiran , Robinson Paul , Gunasekera Hasantha , Britton Philip 
Published: October 2019

Background:
The impact of universal 13-valent pneumococcal conjugate vaccine immunization on pediatric empyema rates and pathogens in Australia is not known. We aimed to describe empyema epidemiology, clinical characteristics and treatment during an 8-year period.

Methods:
A retrospective study between 2011 and 2018 of empyema cases admitted to a large pediatric referral hospital, for management with either pleural drainage and fibrinolytics or surgical intervention.

Results:
There were 195 cases in 8 years. Empyema incidence and ICU admission rates significantly increased during the study with a peak incidence of 7.1/1000 medical admissions in 2016 (χ2 for trend of incidence 37.8, P < 0.001 and for ICU admissions 15.3, P < 0.001). S. pneumoniae was the most common pathogen (75/195, 39%) with serotype 3 the most detected (27/75: 27%). S. pyogenes compared with S. pneumoniae had significantly fewer days of fever before admission (3.9 vs. 6.4, mean difference 2.4, 95% CI: 0.84–4.08, P = 0.003) and higher proportion requiring direct ICU admission (6/75; 8% vs. 7/15; 47%, P < 0.001). Compared with S. pneumoniae, cases with no pathogen detected by culture or PCR had fewer days of fever post intervention (4.4 vs. 7.4 days, mean difference 2.7 days, P = 0.002). S. aureus occurred more commonly in infants (10/25; 40% vs. 1/75; 1%, P < 0.001) and children of indigenous background (5/25; 20% vs. 1/75; 1%, P < 0.001) compared with S. pneumoniae.

Conclusions:
We report increasing rates of pediatric empyema with higher proportions requiring ICU treatment. The most common pathogens detected were S. pneumoniae, S. aureus and S. pyogenes. Despite high 13-valent pneumococcal conjugate vaccine coverage, serotype 3 was the most common S. pneumoniae serotype identified.
Experimentally induced spinal nociceptive sensitization increases with migraine frequency: a single-blind controlled study
Authors: De Icco Roberto , Perrotta Armando , Grillo Valentina , Cosentino Giuseppe , Sances Grazia , Sandrini Giorgio , Tassorelli Cristina 
Published: October 2019

Abstract
The nitric-oxide donor nitroglycerin (NTG) administration induces a facilitation of nociceptive pathways in episodic migraine. This study aims to test the hypothesis that induced spinal sensitization could be more pronounced in patients affected by high-frequency migraine (HF-MIG) with respect to low-frequency migraine (LF-MIG). We enrolled 28 patients with LF-MIG (1-5 migraine days/month), 19 patients with HF-MIG (6-14 migraine days/month), and 21 healthy controls (HCs). Spinal sensitization was evaluated with the neurophysiological recording of the temporal summation threshold (TST) of the nociceptive withdrawal reflex at the lower limb. Temporal summation threshold was recorded at baseline and 30, 60, and 120 minutes after NTG administration (0.9 mg sublingual). Spinal sensitization was detected in LF-MIG at 60 (P = 0.010) and 120 minutes (P = 0.001) and in HF-MIG at 30 (P = 0.008), 60 (P = 0.001), and 120 minutes (P = 0.001) after NTG administration. Temporal summation threshold did not change in HC (P = 0.899). Moreover, TST reduction was more pronounced in HF-MIG with respect to LF-MIG (P = 0.002). The percentage of patients who developed a migraine-like headache after NTG was comparable in the 2 migraine groups (LF-MIG: 53.6%, HF-MIG: 52.6%, P = 0.284), whereas no subjects in the HC group developed a delayed-specific headache. Notably, the latency of headache onset was significantly shorter in the HF-MIG group when compared with the LF-MIG group (P = 0.015). Our data demonstrate a direct relationship between migraine frequency and both neurophysiological and clinical parameters, to suggest an increasing derangement of the nociceptive system control as the disease progresses, probably as a result of the interaction of genetic and environmental factors.
Extremity Mobilization After Split-Thickness Skin Graft Application
Authors: Retrouvey Helene , Adibfar Alexander , Shahrokhi Shahriar 
Published: October 2019

Purpose
To determine the current postoperative mobilization care practice patterns of burn surgeons after split-thickness skin grafting and to assess potential inconsistencies in management strategies.

Methods
A cross-sectional study of active burn surgeons was conducted with an online questionnaire (SurveyMonkey) comprising 7 demographic and 22 mobilization-related questions.

Results
Seventy-three (22%) of the 337 members of the American Burn Association mailing list consented to participate in the study, of whom 71 completed the demographic questions and 59 completed the mobilization-related questions. The majority of respondents had more than 10 years of burn care experience (68%) and practiced in an American Burn Association–verified center (70%). Standardized postoperative autograft mobilization protocols were used by 68% of respondents. Most (66%) never or rarely immobilized the upper extremity without joint involvement. When the elbow or wrist was involved, 73% always or very often immobilized. Similarly, 63% never or rarely immobilized the lower extremity without joint involvement. Most immobilized when the knee (70%) or ankle (63%) was involved. Immobilization duration was most commonly 3 or 5 days. Most respondents (71%) reported following Nedelec and colleagues' recommendation that “early postoperative ambulation protocol should be initiated immediately after lower extremity grafting,” although there was practice variability.

Conclusions
Our findings reveal that the majority of survey respondents do not immobilize the extremities after autograft without joint involvement. When grafts cross major joints, most surgeons immobilize for 3 or 5 days. Despite some practice variability, surveyed burn surgeons' current lower extremity ambulation practices generally align with the 2012 guidelines of Nedelec et al.
Current Trends in Unilateral Cleft Lip Care
Authors: Roberts John M. , Jacobs Aaron , Morrow Brad , Hauck Randy , Samson Thomas D. 
Published: October 2019

Background
The care of unilateral cleft lip (UCL) patients is extremely variable. Historical benchmarks for perioperative and intraoperative choices by cleft surgeons were produced by Sitzman et al (Plast Reconstr Surg. 2008;121:261e–270e) in 2005. However, emerging data and cleft lip repair methods around this period were not captured by this study. The aim of this study was to update the current practice patterns of cleft lip surgeons.

Methods
An electronic survey was distributed to surgeons in the American Cleft Palate Association. Demographic data about the surgeon were collected as well as their choices regarding perioperative and intraoperative cleft lip care.

Results
Eighty-six surgeons responded to the survey. Nearly 40% of surgeons have changed their technique for UCL repair with Fisher anatomical subunit repair gaining significant popularity. Nasoalveolar molding is also being used more frequently (41% vs 22%). At the time of the cleft lip repair, closure of the nasal floor is occurring in 83.1% of patients and primary cleft rhinoplasty is being performed routinely 57% of the time.

Conclusions
Over the last 10 years, there has been an increase in the use of modified rotation advancement repairs and Fisher anatomic subunit approximation technique for treatment of UCL. There continues to be a lack of evidence regarding superiority of specific repair techniques or the benefits of adjunct procedures, which results in varying practice patterns. Educating all cleft surgeons on practices that are well supported is important to improve care to cleft patients.
Nasolabial Flap Based on the Upper Lateral Lip Subunit for Large Involuted Infantile Hemangiomas of the Upper Lip
Authors: Gao Wei , Jin Yunbo , Lin Xiaoxi 
Published: October 2019

Background
Large involuted upper lip infantile hemangioma is a challenge for plastic surgeon because of high visibility of disfigurement. To achieve an optimal reconstruction with matched color and texture, nasolabial flap based on the upper lateral lip subunit is used for the upper lip reconstruction.

Methods
Records of 8 patients who underwent upper lip reconstruction from 2014 to 2018 at Shanghai Ninth People's Hospital were reviewed. After flap design according to the contralateral upper lip subunit, nasolabial flap was dissected and rotated to the defect. The donor site was subsequently closed by extensive undermining cheek skin tissue. The incisions were hidden in the border of lateral upper lip subunit.

Results
There were a few deformities observed, including scar hypertrophy (4/8), alar flaring (2/8), and lower lid bulking (1/8). Five patients received following trimming procedures because of residual scars or deformity. All the patients were satisfied with the postoperative results. No obvious complications were observed.

Conclusions
The nasolabial flap based on the upper lateral lip subunit is a safe, effective, and reliable technique for correction of severe upper lip defect caused by large involuted infantile hemangioma. Although subsequent trimming procedures are required in some complicated cases, satisfactory results can still be achieved.
The Application of Multilayer Direct Closure With a Longitudinal Relaxing Incision in Urethrocutaneous Fistula Repair
Authors: Chen Wen , Ma Ning , Wang Weixin , Ju Mengran 
Published: October 2019

Abstract
The simple closure of a urethrocutaneous fistula is technically easy, but direct suture tension is associated with a higher urethral fistula recurrence rate. We describe a multilayer direct closure with a longitudinal relaxing incision in urethrocutaneous fistula repair, avoiding the tension associated with the direct suturing of the surgical skin wound. From March 2015 to January 2018, 46 urethrocutaneous fistulas in 34 patients were repaired at the Hypospadias Center of our hospital. During the operations, after the urethral fistula closure, a longitudinal penile skin incision was created 0.5 to 1.5 cm from the edge of the surgical wound. The penile skin wound was closed, and the longitudinal penile skin incision made during the operation was used as a relaxing incision to reduce the skin tension of the closed fistula area. The urethral fistula repairs were successful, and no signs of infection or poor healing were present at the closure sites of the penile skin wounds. The relaxing incisions gradually healed within 7 to 21 days after operation, and the residual scars were soft and did not significantly differ in color from normal skin. The key to increasing the success rate of urethrocutaneous fistula repair is creating a longitudinal relaxing penile skin incision. The technique aims to avoid the direct suture tension of the penile skin wound, thereby providing a favorable environment for the normal healing of the urethral fistula suture site.
Extensive Post-Traumatic Surgical Emphysema Exacerbated by Cocaine Insufflation
Authors: Shah Nirmal , Shafi Ahad , Benech Rodolfo , Campbell Duncan 
Published: October 2019

Abstract
Surgical emphysema (SE) is characterized by air in the soft tissues causing a crackling sensation on palpation. In oral and maxillofacial surgery, it might occur using conventional air-driven dental hand pieces, as a complication of trauma and with cocaine insufflation.
The subcutaneous air may travel through tissue planes causing cervicofacial emphysema, pneumothorax, and pneumomediastinum. It may carry bacteria and potentially lead to cellulitis or necrotizing fasciitis.
The SE is usually a self-limiting entity requiring analgesia, close observation of the airway, occasionally prophylactic antibiotics, and rarely steroids. Although, the consensus on antibiotic and corticosteroid therapy is unclear.
Here presented an unusual and extensive presentation of surgical emphysema. A 29 years old male presented with emphysema following a left orbital-zygomatic complex fracture and following intranasal cocaine insufflation. It extended from the temple to the parotid region, down into the neck and into the mediastinum. No surgical intervention was required. The patient was discharged after 24 hours of observation with a week-long course of co-amoxiclav antibiotics and no corticosteroids administration.
Typical instructions following facial bone fractures are to avoid nose blowing because of the risk of SE, however, avoidance of drug habits is rarely considered. This case report highlights the importance of tailored advice to this particular patient cohort.
Applied Deep Learning in Plastic Surgery: Classifying Rhinoplasty With a Mobile App
Authors: Borsting Emily , DeSimone Robert , Ascha Mustafa , Ascha Mona 
Published: October 2019

Background:
Advances in deep learning (DL) have been transformative in computer vision and natural language processing, as well as in healthcare. The authors present a novel application of DL to plastic surgery. Here, the authors describe and demonstrate the mobile deployment of a deep neural network that predicts rhinoplasty status, assess model accuracy compared to surgeons, and describe future directions for such applications in plastic surgery.

Methods:
A deep convolutional neural network (“RhinoNet”) was developed to classify rhinoplasty images using only pixels and rhinoplasty status labels (“before”/“after”) as inputs. RhinoNet was trained using a dataset of 22,686 before and after photos which were collected from publicly available sites. Network classification was compared to that of plastic surgery attendings and residents on 2269 previously-unseen test-set images.

Results:
RhinoNet correctly predicted rhinoplasty status in 85% of the test-set images. Sensitivity and specificity of model predictions were 0.840 (0.79–0.89) and 0.826 (0.77–0.88), respectively; the corresponding values for expert consensus predictions were 0.814 (0.76–0.87) and 0.867 (0.82–0.91). RhinoNet and humans performed with effectively equivalent accuracy in this classification task.

Conclusion:
The authors describe the development of DL applications to identify the presence of superficial surgical procedures solely from images and labels. DL is especially well suited for unstructured, high-fidelity visual and auditory data that does not lend itself to classical statistical analysis, and may be deployed as mobile applications for potentially unbridled use, so the authors expect DL to play a key role in many areas of plastic surgery.
Towards a differential diagnosis of cochlear synaptopathy and outer-hair-cell deficits in mixed sensorineural hearing loss pathologies
Authors: Vasilkov Viacheslav , Verhulst Sarah 
Published: October 2019

AbstractDamage to the auditory periphery is more widespread than predicted by the gold-standard clinical audiogram. Noise exposure, ototoxicity and aging can destroy cochlear inner-hair-cell afferent synapses and result in a degraded subcortical representation of sound while leaving hearing thresholds unaffected. Damaged afferent synapses, i.e. cochlear synaptopathy, can be quantified using histology, but a differential diagnosis in living humans is difficult: histology cannot be applied and existing auditory evoked potential (AEP) metrics for synaptopathy become insensitive when other sensorineural hearing impairments co-exist (e.g., outer-hair-cell damage associated with elevated hearing thresholds). To develop a non-invasive diagnostic method which quantifies synaptopathy in humans and animals with normal or elevated hearing thresholds, we employ a computational model approach in combination with human AEP and psychoacoustics. We propose the use of a sensorineural hearing loss (SNHL) map which comprises two relative AEP-based metrics to quantify the respective degrees of synaptopathy and OHC damage and evaluate to which degree our predictions of AEP alterations can explain individual data-points in recorded SNHL maps from male and female listeners with normal or elevated audiometric thresholds. We conclude that SNHL maps can offer a more precise diagnostic tool than existing AEP methods for individual assessment of the synaptopathy and OHC-damage aspect of sensorineural hearing loss.Significance StatementHearing loss ranks fourth in global causes for disability and risk factors include noise exposure, ototoxicity and aging. The most vulnerable parts of the cochlea are the inner-hair-cell afferent synapses and their damage (cochlear synaptopathy) results in a degraded subcortical representation of sound. While synaptopathy can be estimated reliably using histology, it cannot be quantified this way in living humans. Secondly, other co-existing sensorineural hearing deficits (e.g., outer-hair-cell damage) can complicate a differential diagnosis. To quantify synaptopathy in humans and animals with normal or elevated hearing thresholds, we adopt a theoretical and interdisciplinary approach. Sensitive diagnostic metrics for synaptopathy are crucial to assess its prevalence in humans, study its impact on sound perception and yield effective hearing restoration strategies.
Trends and variation in prescribing of suboptimal statin treatment regimes: a cohort study in English primary care
Authors: Curtis Helen J , Walker Alex J , MacKenna Brian , Croker Richard , Goldacre Ben 
Published: October 2019

AbstractObjectivesWe set out to describe trends and variation in statin prescribing in England that breaches 2014 national guidance on “high-intensity” statins. We identify factors associated with breaching; and assess the feasibility of rapid prescribing behaviour change.Design, Setting and ParticipantsRetrospective cohort study in NHS primary care in England, including all 8,142 standard general practices from August 2010 to March 2019.Main Outcome MeasuresWe categorised statins as high or low/medium-intensity based on two different thresholds, and calculated the proportion prescribed below these thresholds across all practices. We plotted trends and geographical variation, carried out mixed effects logistic regression to identify practice characteristics associated with breaching guidance, and used indicator saturation to identify practices exhibiting sudden changes in prescribing.ResultsWe included all 8,142 practices across the study period. The proportion of statin prescriptions below the recommended 40% LDL-lowering threshold decreased gradually since 2012 from 80% to 45%; the proportion below a pragmatic 37% threshold decreased from 30% to 18%. The 2014 guidance had minimal impact on these trends. We found wide variation between practices (interdecile ranges 20% to 85% and 10% to 30% respectively in 2018). Mixed effects logistic regression did not identify practice characteristics strongly associated with breaching guidance. Indicator saturation identified several practices exhibiting sudden changes in prescribing towards greater guideline compliance.ConclusionsBreaches of English guidance on choice of statin remain common, with substantial variation between GP practices. Some practices and regions have implemented rapid change, indicating the feasibility of rapid prescribing behaviour change. We discuss the potential for a national strategic approach, using data and evidence to optimise care, including targeted education alongside audit and feedback to outliers through services such as OpenPrescribing.SummaryWhat is already known on this topicEnglish national guidance recommends the use of a high-intensity statin, capable of reducing LDL (low-density lipoprotein) cholesterol by 40% or more. Adherence at the time of guideline release was low, but has not been documented since.What this study addsAdherence is improving, but breaches of national guidance remain common, with 45% of prescriptions below the recommended strength, and there is very substantial variation between practices. Some practices have exhibited rapid positive change in prescribing, which indicates that better adherence could readily be achieved. We have produced a live data tool allowing anyone to explore any practice’s current statin prescribing behaviour.
Investigation of an estimate of daily resting heart rate using a consumer wearable device
Authors: Russell Allison , Heneghan Conor , Venkatraman Subbu 
Published: October 2019

AbstractResting heart rate is accepted as a valid overall indicator of cardiovascular risk and is a low-cost easy-to-measure metric that can be collected in both home and clinical settings. Wearable devices such as smartwatches and trackers can measure heart rate continuously using optical technology. This study reports initially on the agreement between the resting heart rate reported by a wearable device (Fitbit Charge HR and Fitbit Blaze) and a chest-based consumer electrocardiogram (Polar H7). In 45 subjects, the reported resting heart rates agreed within 0.89 bpm over a resting period of 5 mins. The same device and algorithm was then used in a population of 168 subjects (45.9± 15.6 yrs) who were asked to collect their resting heart rate for four days under seven different conditions and times (at wake sitting/lying down, pre-breakfast, pre-lunch, pre-dinner, and before bed sitting/lying down). The reported values were compared with the Daily Resting Heart Rate (DRHR) reported by the wearable device. The measurement lying down before wake were closest to the DRHR (mean error of 0.0 bpm with a 25-75th percentile spread of ±3.5bpm. There was a significant circadian variation in the reported resting heart rate across subjects, with the highest values reported in the middle of the day. Within individual subjects, the median standard deviation of heart rate at rest was 3-5bpm even measured under nominally similar conditions over four days.