bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Facial Fat Compartments Revisited: Clinical Relevance to Subcutaneous Dissection and Facial Deflation in Face Lifting
Authors: Stuzin James M. , Rohrich Rod J. , Dayan Erez 
Published: November 2019

Summary:
The facial fat compartments were described over a decade ago, but their clinical relevance to both deflation and techniques in facial rejuvenation is underappreciated. Although much of the literature following their description has focused on further anatomical elucidation of compartment anatomy, clinical relevance has focused on volumetric compartment augmentation. From the authors’ perspective, understanding compartmentalization of facial fat provides an anatomical roadmap of the facial subcutaneous plane and a patient-specific guide for the degree of skin flap dissection in facial rejuvenation. The compartmentalization of facial fat also explains the regional development of cheek deflation in aging. An individualized treatment plan to restore facial shape can be achieved with deep compartment volume augmentation and repositioning of superficial facial fat using the superficial musculoaponeurotic system.
Imaging Features of Sclerosing Angiomatoid Nodular Transformation in Spleen
Authors: Ma Jianbing , Zhang Weiqiang , Wang Lizhang , Zhu Zefeng , Wang Jia , Zhang Jingfeng , Yang Xiaofeng 
Published: November 2019

Purpose
The purpose of this study was to evaluate the features of sclerosing angiomatoid nodular transformation (SANT) in spleen on the imaging of computed tomography (CT) and magnetic resonance (MR).

Materials and Methods
From July 2006 to April 2017, 12 patients with SANT confirmed by pathology were evaluated in a retrospective study. Eight patients were with CT imaging only, 2 patients were with MR imaging only, and 2 patients were with both CT and MR. Three professional senior radiologists analyzed the imaging features on CT and MR. The main characteristic analysis included size, margin, density, signal intensity, and enhancement pattern. The significant enhancement was defined as the degree of enhancement of lesion that is higher than the surrounding spleen parenchyma, and the mild enhancement was defined as the degree of enhancement of lesion that is lower than the surrounding spleen parenchyma.

Results
All the 12 patients (5 men, 7 women; mean age, 45.8 years; age range, 21–62 years) presented as single lesion without special clinical symptoms. The range of lesions on diameter was from 25 to 80 mm. On CT images, 9 (90%) of 10 presented as hypodense in comparison with the parenchyma of spleen, 1 (10%) of 10 presented as isodense, and calcification was observed in 4 (40%) of 10 cases. On MR images, 4 (100%) of 4 manifested heterogeneous hypointensity on in-phase sequence and 3 (75%) of 4 performed as isointensity on out-of-phase sequence of T1-weighted. On the sequences of T2-weighted and diffusion-weighted image, 4 (100%) of 4 showed hypointensity. On CT and MR enhancement images, the number of significant enhancement and mild enhancement was 2 and 10, respectively. Seven (58%) of 12 showed progressive enhancement with the pattern of “spoke-wheel.”

Conclusions
Imaging features on CT and MR have a high diagnostic value for SANT, especially when CT combined with MR examination.
Application of Monochromatic Imaging and Metal Artifact Reduction Software in Computed Tomography Angiography after Treatment of Cerebral Aneurysms
Authors: Zhang Xuan , Pan Ting , Lu Shan shan , Hong Xun ning 
Published: November 2019

Purpose
This study aimed to evaluate the image quality and degree of metal artifact reduction using the new-generation gemstone spectral imaging (GSI) and metal artifact reduction software (MARs) and to demonstrate the optimal monochromatic energy level for dual-energy cerebral computed tomography angiography (CTA) in patients with intracranial aneurysm after endovascular treatment.

Material and Methods
A total of 20 patients with cerebral aneurysms treated with coils or clips underwent CTA using gemstone spectral computed tomography. Artifact index was calculated at each energy level with and without MARs. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated on all axial images with MARs; subjective evaluation was done by using a 4-point scale and a 3-point scale for assessing noise and vessel contrast, respectively, and compared between the monochromatic energy levels.

Results
The artifact index value of group GSI-MARs was significantly lower than that of group GSI at each monochromatic energy level (all, P < 0.01). Contrast-to-noise ratio and SNR of the parent arteries decreased as the energy increased from 40 to 140 keV in group GSI-MARs (all, P < 0.01). Signal-to-noise ratio and CNR between each 2 adjacent monochromatic energy level showed significant difference (all, P < 0.01). Subjective evaluation showed that a monochromatic energy level between 40 and 70 keV provided the optimal image quality.

Conclusion
Gemstone spectral imaging with MARs could reduce metal artifacts and improve the image quality of cerebral CTA after coil or clip treatment. The new generation of GSI could provide better CNR and SNR at lower energy level, and the best image quality was obtained at energy level 40 to 70 keV for GSI-MARs.
Medication-Related Osteonecrosis of the Jaw—Comparison of Bone Imaging Using Ultrashort Echo-Time Magnetic Resonance Imaging and Cone-Beam Computed Tomography
Authors: Huber Florian A. , Schumann Paul , von Spiczak Jochen , Wurnig Moritz C. , Klarhöfer Markus , Finkenstaedt Tim , Bedogni Alberto , Guggenberger Roman 
Published: November 2019

Objective
The aim of this study was to compare bone imaging between ultrashort echo-time (UTE) magnetic resonance (MR) imaging and cone-beam computed tomography (CBCT) as the reference standard in patients with medication-related osteonecrosis of the jaw (MRONJ).

Materials and Methods
A 1-year retrospective, blinded, and randomized qualitative analysis of UTE MR images and CBCT from 19 patients with clinically diagnosed MRONJ was performed by 2 independent radiologists. Medication-related osteonecrosis of the jaw imaging hallmarks such as osteolysis, periosteal thickening, and medullary osteosclerosis were rated visually (0 and 1 to 3 for normal and mild to severe changes) for defined anatomic regions of the jaw. In addition, segmentation of these regions was performed on coregistered MR/CBCT images for the following quantitative comparison of signal intensity (SI) on MR and gray values (GVs) on CBCT images. Interreader/modality agreement (Cohen kappa), standard testing for significant differences of (non)parametric values, and Pearson correlation of signal intensity/GV were used for statistical analysis.

Results
The anterior corpus of the mandible was most often affected by MRONJ (P < 0.001). Overall, interreader agreement of qualitative MRONJ hallmark scores was almost perfect (κ = 0.81) and without significant differences between modalities (κ = 0.81 vs 0.82, CBCT vs MR, respectively). Intermodality agreement for qualitative gradings was substantial for both readers (κ = 0.77 and 0.70). Signal intensity/GV in MRONJ-affected areas differed significantly from healthy bone (P < 0.001) as well as correlation significantly between modalities (r = −0.77; P < 0.001).

Conclusions
Qualitative assessment of MRONJ with radiation-free UTE MR imaging is comparable to reference standard CBCT. Quantitative measurements of both modalities significantly distinguish diseased from normal bone with strong correlations among the quantitative values in both modalities.
Head-to-Head Comparison of 18F-Prostate-Specific Membrane Antigen-1007 and 18F-Fluorocholine PET/CT in Biochemically Relapsed Prostate Cancer
Authors: Witkowska-Patena Ewa , Giżewska Agnieszka , Dziuk Mirosław , Miśko Jolanta , Budzyńska Anna , Walęcka-Mazur Agata 
Published: November 2019

Purpose of the Report
The aim of the study was to prospectively compare performance of 18F-fluorocholine (FCH) and 18F-prostate-specific membrane antigen (PSMA)-1007 PET/CT in patients with biochemical relapse (BCR) of prostate cancer and low prostate-specific antigen levels.

Methods
We prospectively enrolled 40 BCR patients after radical treatment and prostate-specific antigen levels 2.0 ng/mL or less. 18F-FCH and 18F-PSMA-1007 PET/CT imaging was performed within a mean interval of 54 ± 21 days. Scans were done 87 ± 10 and 95 ± 12 minutes after injecting 248 ± 35 and 295 ± 14 MBq of 18F-FCH and 18F-PSMA-1007, respectively. Rates of negative, equivocal, and positive scan results were compared per patient. Per lesion, findings were grouped as equivocal or highly suggestive of malignancy and then compared for their number, localization (local relapse, lymph nodes, bones), and SUVmax values.

Results
Positive, equivocal, and negative results were reported in 60%, 27.5%, and 12.5% of 18F-PSMA-1007 and in 5%, 37.5%, and 57.5% of 18F-FCH scans, respectively. In 70% of scans, 18F-PSMA-1007 PET/CT upgraded 18F-FCH PET/CT results. 18F-PSMA-1007 scans also showed significantly more lesions (184 vs 63, P = 0.0006). Local relapse, lymph node, and bone lesions accounted, respectively, for 9%, 58%, and 33% of 18F-PSMA-1007 and 5%, 89%, and 6% 18F-FCH of PET/CT findings. Highly suspicious lesions accounted for 74% of 18F-PSMA-1007 and 11% of 18F-FCH PET/CT findings. In 18F-PSMA-1007 PET/CT SUVmax values of highly suggestive lesions were significantly higher than in equivocal lesions (median, 3.6 vs 2.5; P < 0.00001).

Conclusions
In early BCR patients 18F-PSMA-1007 showed a higher detection rate than 18F-FCH PET/CT. The former also showed more lesions in total, more highly suggestive lesions and less equivocal lesions.
Renal Pelvis Urothelial Carcinoma With Bowel Metastases
Authors: Khoo Alex Cheen Hoe , Tang Weng Heng 
Published: November 2019

Abstract
Urothelial carcinoma is the fourth most common genitourinary tumor with the majority of the tumor involving the urinary bladder. Only 5% involves the renal pelvis and ureter. Metastatic urothelial carcinoma of the renal pelvis frequently involves the lymph nodes, lung, liver, bone, and peritoneum. We share rare interesting 18F-FDG PET/CT images of a 60-year-old man with metastatic urothelial carcinoma of the renal pelvis to the bowel.
99mTc-Labeled Native RBC Scintigraphy in Distinguishing Polysplenia From Abdominal Masses in a Patient With Situs Inversus Totalis
Authors: Wang Peipei , Jing Hongli , Li Fang , Wang Zhenghua , Huo Li 
Published: November 2019

Abstract
A 39-year-old previously healthy woman presented possible hematuria. An ultrasound examination showed right adrenal mass and suggested pheochromocytoma. A 99mTc-HYNIC-TOC SPECT/CT was performed, which incidentally detected situs inversus totalis and suspicion of polysplenia without definite normal spleen in the right upper abdomen. In order to differentiate the polysplenia from other etiologies, a heat-damaged 99mTc RBC scintigraphy was performed. The images showed significant activity in the multiple soft tissue nodules in the posterior right abdomen, consistent with ectopic polysplenia.
Extracorporeal Free Flap Perfusion Using Extracorporeal Membrane Oxygenation Device
Authors: Ozturk Muhammed Besir , Aksan Tolga , Ozcelik Ismail Bulent , Ertekin Cengiz , Akcakoyunlu Bahadir , Ozkanli Sidika Seyma , Tezcan Mustafa 
Published: November 2019

Abstract
Extracorporeal perfusion of organs has a wide range of clinical applications like prolonged vital storage of organs, isolated applications of drugs, bridging time to transplant, and free composite tissue transfer without anastomosis, but there are a limited number of experimental models on this topic.
This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.
Evaluating Current Scar Assessment Methods
Authors: Lipman Kelsey , Wang Maxwell , Berthiaume Emily , Holloway Janell , Da Lio Andrew , Ting Kang , Soo Chia , Zheng Zhong 
Published: November 2019

Abstract
Current scar surveys have included many questions to evaluate the physical characteristics of scars, with some expanding to include physical implications and patient opinions. This review provides an analysis of frequently used scar assessment methods to date and highlights potential areas for improvement. We build the case that a new assessment tool is necessary, specifically one that centers on psychosocial consequences of scars that influence patient decision making for treatment, allowing physicians to individualize treatment conversations with patients. We postulate that survey techniques used in consumer product marketing, such as choice-based conjoint analysis, may be effective in determining the factors strongly influencing patient decision making and spending in scar treatment; therefore, more research in this area is warranted. By incorporating these psychosocial and economic considerations driving scar treatment decisions, future scar assessment tools may accomplish much more than characterizing/documenting the clinical aspects of scars. Rather, these patient-centered, holistic tools may be implemented by plastic surgeons and other clinicians specifically to provide patients with personalized treatment options that maximize long-term patient satisfaction.
Psychological Pathologies and Sexual Orientation in Transgender Women Undergoing Gender Confirming Treatment
Authors: Papadopulos Nikolaos A. , Lellé Jean-Daniel , Zavlin Dmitry , Herschbach Peter , Henrich Gerhard , Kovacs Laszlo , Ehrenberger Benjamin , Machens Hans-Guenther , Schaff Jürgen 
Published: November 2019

Background
There are few studies evaluating depression, self-esteem, and mental health after gender confirming treatment of transgender women. Most of these studies include different surgical techniques and nonvalidated questionnaires. With our survey, we are aiming to assess psychopathologies and mental health as well as sexuality among a group of patients treated by the same surgeon performing our self-developed combined surgical technique. This vaginoplasty approach is characterized by constructing the vaginal cavity with parts of the penile and scrotal skin as well as the longitudinally incised urethra.

Materials and Methods
Forty-seven transgender women who underwent gender confirming treatment between 2007 and 2013 were included in a retrospective study. The assessment of our study group was performed by means of self-developed indication-specific questionnaires and 3 standardized questionnaires that can be compared with norm data.

Results
Preoperative psychotherapy was mostly considered as helpful by the patients, yet postoperatively, only a third of our study participants were still under therapeutic treatment. Furthermore, we could show a change in sexual preference toward a more bisexual orientation. Gender confirming treatment satisfied the expectations for most of the patients and, in their opinion, should have been performed earlier. Results of the standardized Patient Health Questionnaire 4, a short depression screening questionnaire, did not significantly differ from healthy norm data. The Freiburg Personality Inventory, Revised, revealed normal emotionality and sane self-assessment within our study group. High self-esteem and significantly higher scores than norm data were found for the Rosenberg Self-esteem Scale.

Conclusions
Gender confirming treatment with the combined technique is an important part of a multi-structured treatment of transgenders and does have effects on psychological well-being. It seems to decrease psychopathologies and implicates several ameliorations for transgender women. Findings need to be verified in prospective studies including preoperative evaluations.
Lateral Malleolar Defect Coverage Using Abductor Digiti Minimi Muscle Flap
Authors: Elfeki Bassem , Eun Seokchan 
Published: November 2019

Introduction
The lateral malleolar region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation. The abductor digiti minimi (ADM) muscle flap offers a promising treatment option for the reconstruction of small- to moderate-sized defects that have exposed bone, joint, or tendons in the lateral malleolar area.

Methods
Between 2013 and 2016, 8 patients with foot ulcers were reconstructed with ADM muscle flap. The muscle component of the flap obliterated the dead space and provided a vascularized muscle over the debrided ankle joint. When it is needed, the flap is covered with a small split-thickness skin graft.

Results
In all cases, complete healing was achieved. The muscle flap functioned well as a versatile and shock absorbent coverage without recurrence of the ulcer during a mean follow-up period of around 2 years.

Conclusions
Coverage of a soft tissue defect at the lateral side of the ankle remains a challenge for surgeons because of the limited possibilities for local transposition. Free flaps have frequently been associated with postoperative complications and higher costs. Also, not all patients are suitable candidates for free tissue transfer because of existing comorbidities. Coverage with a split-thickness skin graft will not be possible for wounds with exposed bone or neurovascular structures or in wounds involving the weight bearing surface of the foot. Using ADM muscle offers no donor site morbidity, good soft tissue coverage, and an effective healing process. Also, no limb movement affection and normal daily life are acquired.
Atypical Mycobacterial Infections After Plastic Surgery Procedures Abroad
Authors: Leto Barone Angelo A. , Grzelak Michael J. , Frost Christopher , Ngaage Ledibabari M. , Ge Shealinna , Kolegraff Keli , Chopra Karan , Tornheim Jeffrey A. , Caffrey Julie , Lifchez Scott D. , Rasko Yvonne 
Published: November 2019

Background
The recent rise in medical tourism, especially for cosmetic procedures, has been mirrored by an increase in the incidence of infections with Mycobacterium abscessus, which is an atypical mycobacterium that is ubiquitous in aquatic environments. M. abscessus soft tissue infections arise from the use of improperly sterilized water and surgical equipment during surgical procedures, and these infections have devastating consequences if not promptly treated. M. abscessus infections are notoriously difficult to diagnose and properly treat, and therefore, we illustrate a typical case presentation and provide a comprehensive diagnostic and treatment algorithm.

Methods
Of the patients who have presented to our hospital for treatment of cutaneous M. abscessus infections, a representative patient's story was included to illustrate the typical presentation and treatment timeline. The current literature on M. abscessus infections was reviewed, and this literature and the clinical experience of our plastic surgery and infectious disease teams were used in the creation of a diagnostic and treatment algorithm for M. abscessus infections.

Results

M. abscessus infections can have an incubation period of months, and the classic presenting signs include purulent drainage, violaceous nodules, and subcutaneous abscesses at the site of a recent surgery. A key finding is persistence of the infection despite debridement and empiric antibiotic treatment. Cultures grown on mycobacterial-specific growth media are considered the diagnostic criterion standard, but high clinical suspicion is enough to warrant the initiation of treatment. Treatment itself consists of surgical drainage and debridement in combination with multidrug antibiotic regimens that typically include amikacin, a macrolide, and a carbapenem or cephalosporin antibiotic, with the option for macrolide and fluoroquinolone maintenance therapy.

Conclusions

M. abscessus cutaneous infections present with unique history and physical examination findings and often require complex diagnostic workups and treatment plans. Increased provider awareness of the management and potential complications of M. abscessus is crucial to the improvement patient outcomes, as is a multidisciplinary approach that incorporates primary care providers, pathologists, plastic surgeons, and infectious disease specialists.
Suture Suspensionplasty Using Abductor Pollicis Longus and Flexor Carpi Radialis for Advanced Thumb Carpometacarpal Joint Arthritis
Authors: Lee Sang Ki , Ma Sang Beom , Choy Won Sik 
Published: November 2019

Purpose
Current operative treatment for advanced thumb carpometacarpal (CMC) joint arthritis mainly constitutes complete trapeziectomy with or without additional stabilizing procedures. However, it is unclear whether the additional procedures influence overall clinical outcomes. Therefore, the purpose of this study was to evaluate the effectiveness of our posttrapeziectomy suture suspensionplasty technique, performed using the abductor pollicis longus and flexor carpi radialis tendons, in patients with advanced thumb CMC arthritis.

Materials and Methods
We evaluated 36 thumbs of 35 patients with advanced thumb CMC arthritis treated with combined operative excision of trapezium followed by a suture suspensionplasty using flexor carpi radialis and abductor pollicis longus tendons. We used a minimal volar approach to create a sling construct with a nonabsorbable suture material, which could support the thumb metacarpal base without pin fixation or tendon transfer. For radiographic evaluation, we used the ratio of the radial metacarpal subluxation to metacarpal articular width, estimated from the bilateral stress-view radiographic images of the thumb, and calculated the trapezial space ratio by dividing the trapezial space height by the proximal phalangeal length. The clinical outcomes were evaluated using the visual analog scale and disabilities of the arm, shoulder, and hand scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery.

Results
The mean duration of follow-up was 26 months (range, 18–60 months). The average visual analog scale and disabilities of the arm, shoulder, and hand scores decreased from 5.9 to 0.4 and from 51.6 to 27.0, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 49.1 degrees to 54.1 degrees, and from 7.8 to 9.3 Kapandji score, respectively. The grip and key pinch strengths showed no significant changes from mean preoperative values of 13.3 kg and 3.8 kg to 13.2 kg and 3.2 kg, respectively, as measured at the 18-month follow-up.

Conclusions
Our suture suspensionplasty technique has several advantages including minimal invasive approach, short operative time, cost-effectiveness, and early mobilization. We suggest that it can be used as an effective, alternative stabilization method after a complete trapeziectomy.