bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care
Authors: Moffitt Joseph K. , Cepeda Alfredo , Ekeoduru Rhashedah A. , Teichgraeber John F. , Nguyen Phuong D. , Greives Matthew R. 
Published: September 2020

Background:
Enhanced recovery after surgery (ERAS) protocols have been adopted for many types of surgery. Postoperative pain following palatoplasty may cause feeding and swallowing difficulty. Our study evaluated the use of ERAS protocols to improve the management of pain following primary palatoplasty as well as in the transition of care from inpatient to outpatient.

Methods:
An Institutional Review Board approved retrospective analysis was performed for patients who previously underwent primary palatoplasty before ERAS implementation. Separately, an Institutional Review Board approved prospective trial of patients undergoing primary palatoplasty was performed and these patients were managed with ERAS protocols. Data were obtained for length of stay, pain scale scores, milligrams of morphine administered, and inpatient readmissions/emergency department visits. Outpatient medication logs were used to follow pain medicine usage, and a satisfaction survey was administered at the first postoperative visit.

Results:
Data were obtained retrospectively for 56 patients and prospectively for 57 patients who underwent primary palatoplasty. Patients in the ERAS protocol received significantly less milligrams of morphine on postoperative day 1 through day 4 than those patients in the usual care group P < 0.05. No significant difference was observed for length of stay, oral intake prior to discharge, or inpatient face, legs, activity, cry, consolability pain scale scores. Outpatient medication logs showed a continued decrease in narcotic usage at home with no spike post discharge day 1. Parents reported high satisfaction levels for inpatient pain management (4.66 ± 0.49) and even higher satisfaction levels for understanding (5.0 ± 0) and management of pain at home (4.92 ± 0.29). Return visits to the hospital for pain management following primary palatoplasty decreased from 7.1% (4) following the previous protocol to 0% with the new ERAS protocol (P = 0.057).

Conclusion:
The ERAS protocols provide improved inpatient pain management following primary palatoplasty as evidence by decreased total narcotic pain medication usage. The use of multimodality therapy and increased patient education regarding non-narcotic medications can improve the transition of care from inpatient to outpatient, without sacrificing patient/parent satisfaction. The results of this study merit future study into more restricted use of opioid pain medications with greater emphasis on the use of multimodal therapeutics as primary agents as opposed to adjuncts.
Advantages of Small Bone-Window Craniotomy Under Microscope Combined Postoperative Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage
Authors: Men Donghai , Huang Zixiong , Yin Yanqing , Wu Weichuan , Li Wensheng , Liu Huanqiang , Xu Chengjie 
Published: September 2020

Objective:
The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients.

Methods:
One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed.

Results:
The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn’t significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn’t significant (P > 0.05).

Conclusion:
Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.
Concurrent High Condylectomy and Orthognathic Surgery for Treatment of Patients With Unilateral Condylar Hyperplasia
Authors: Maniskas Seija A. , Ly Catherine L. , Pourtaheri Navid , Parsaei Yassmin , Steinbacher Derek M. 
Published: September 2020

Background:
Facial asymmetry from unilateral condylar hyperplasia (UCH) may be definitively treated in the presence of active disease (with high condylectomy and concurrent orthognathic surgery) or after waiting for disease inactivity (orthognathic surgery alone). There is currently no consensus on the standard of care. In this study, we sought to compare functional and esthetic outcomes, as well as treatment duration, between these 2 management options.

Methods:
Patients who underwent treatment for UCH were identified through retrospective review. Pre- and postoperative 3-dimensional (3D) images were obtained. Short- and long-term operative outcomes of those treated during the active (group 1) were compared to those treated in the inactive phase (group 2). Total treatment time, operative time, and length of hospital stay were evaluated. Facial asymmetry was also assessed by laypersons using a Likert scale.

Results:
Fifteen patients (mean 25.6 years, range 14–56) were included: 6 in group 1 and 9 in group 2. All surgical outcomes were statistically independent of procedure type. Treatment time was significantly longer in the group 2 (P = 0.03). Both groups demonstrated significant improvement in facial asymmetry scores postoperatively with no significant difference in pre- or postoperative asymmetry between groups (P = 0.64).

Conclusions:
In patients with active UCH, high condylectomy and orthognathic surgery is a procedure that restores facial symmetry and improves jaw function while halting mandibular growth. Good esthetic and functional outcomes, as well as reduced treatment time and disease burden, support the use of this treatment option for this population.
Open Reduction, Internal Fixation, or Maxillo-Mandibular Fixation for Isolated, Unilateral, Tooth-Bearing, Mandibular Body Fractures in Children
Authors: Lopez Joseph , Reategui Alvaro , Yesantharao Pooja S. , Yang Robin , Redett Richard J. , Manson Paul N. , Dorafshar Amir 
Published: September 2020

Background:
Mandibular body fractures can cause severe and long-term morbidity in the pediatric population. Nonetheless, there is insufficient data on the treatment and management of this specific fracture type in children. This study aimed to investigate the etiology, treatment, and outcomes of pediatric mandibular body fractures by analyzing our institution's experience managing these uncommon injuries

Methods:
This was a 30-year retrospective, longitudinal cohort study of pediatric patients presenting to a single institution with isolated, unilateral, mandibular body fractures. Patient data was extracted from electronic medical records, while subgroup analysis was completed by dentition stage.

Results:
A total of 14 patients met inclusion criteria, of whom 8 (57.1%) had deciduous, 3 (21.4%) had mixed, and 3 (21.4%) had permanent dentition. Deciduous dentition patients with displaced, mobile or comminuted fractures underwent open reduction and internal fixation (ORIF), while those with nondisplaced and/or nonmobile fractures received soft diet or closed treatment with maxillomandibular fixation. For the mixed dentition cohort, all patients (100%) received closed treatment with maxillomandibular fixation. Among permanent dentition patients, most patients (66.6%) underwent ORIF regardless of fracture severity. The post-ORIF complication rate was 20% (dental maleruption).

Conclusions:
Isolated, unilateral mandible body fractures are relatively uncommon in the pediatric population, and management differs by dentition stage and injury pattern. While isolated body fractures had considerable associated morbidity, this fracture pattern did not result in major growth restrictions or malformations.
Can the Bone Density Estimated by CBCT Predict the Primary Stability of Dental Implants? A New Measurement Protocol
Authors: Al-Jamal Mustafa Faisal J. , Al-Jumaily Hassanien A. 
Published: September 2020

Background:
The use of dental implants to restore edentulous parts of the jaws is a common and well-documented treatment method. Effective dental implant treatment is known to be affected by both the quality and the quantity of bone required for implant placement, bone quality is a critical factor to consider when predicting stability of implants. Thus, stability of the initial implant and the possibility of early loading could be predicated using cone-beam computed tomography (CBCT) scans and primary stability parameters before implant placement.

Objectives:
The aim of this study was to objectively assess bone density obtained by CBCT and the correlations with primary stability of dental implants using implant stability meter IST device.

Methods:
A total of 40 implants were placed in 16 patients (9 males and 7 females with a range of 22 to 61 years (mean age 40.44 ± 12.3 years). The bone densities of implant recipient sites were preoperatively recorded using CBCT. The maximum insertion torque value of each implant was measured by engine during implant placement and compared to the primary stability for every implant using implant stability meter device (IST).

Results:
A statistically significant correlation was found between bone density value from CBCT with the primary implant stability and insertion torque.

Conclusion:
Although the small samples size, the study shown bone density assessment using CBCT is an efficient method and significantly correlated with primary stability using implant stability meter device IST and insertion torque.
Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach
Authors: Aksoyler Dicle , Doğan Fatih , Bolletta Alberto , Sengenc Esma , Sönmez Taha , Yavan Mehmet Ali 
Published: September 2020

Abstract
The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.
Effect of Operative Timing and Bone Grafting on Postoperative Cephalometric Indices in Nonsyndromic Sagittal Synostosis
Authors: Varman Rahul M. , Van Spronsen Nicole , Nagy Laszlo , Demke Joshua 
Published: September 2020

Abstract
Surgical repair of sagittal suture craniosynostosis is highly variable, and optimal timing/use of bone grafts remains a subset of parameters that continue to be studied. We sought to compare cephalometric outcomes of early surgical intervention without bone grafting compared to later intervention with bone grafting. Patients undergoing primary surgical repair of nonsyndromic sagittal suture craniosynostosis between 2015 and 2019 were followed with preoperative measurements of cephalic index along with postoperative measurements at 6 months to 1 year, respectively. Nineteen patients undergoing cranial vault reconstruction were studied in 2 groups, namely those younger than 6 months who did not have bone grafting performed during primary repair (31.6%) and patients 6 months and older who underwent cranial vault reconstruction with bone grafting during primary repair (68.4%). Mean 6-month to 1-year postoperative cranial index was significantly increased in both groups (P < 0.001). The average cephalic index change for both groups (younger than 6 months without bone grafting, CI value change 9; 6 months and older with bone grafting; CI value change 6) was not significantly different with regards to 95% confidence interval (P = 0.30). Patients older than 6 months of age undergoing cranial vault reconstruction with bone grafting have similar cephalometric outcomes as their younger counterparts undergoing cranial vault remodeling without bone grafting. Bone grafting in the appropriate cohort may improve functional and esthetic outcomes without compromising primary surgical goals of improving cranial vault cephalometric indices.
Defining Benchmark Outcomes for Pancreatoduodenectomy With Portomesenteric Venous Resection
Authors: Raptis Dimitri A. , Sánchez-Velázquez Patricia , Machairas Nikolaos , Sauvanet Alain , Rueda de Leon Alexandra , Oba Atsushi , Groot Koerkamp Bas , Lovasik Brendan , Chan Carlos , Yeo Charles J. , Bassi Claudio , Ferrone Cristina R. , Kooby David , Moskal David , Tamburrino Domenico , Yoon Dong-Sup , Barroso Eduardo , de Santibañes Eduardo , Kauffmann Emanuele F. , Vigia Emanuel , Robin Fabien , Casciani Fabio , Burdío Fernando , Belfiori Giulio , Malleo Giuseppe , Lavu Harish , Hartog Hermien , Hwang Ho Kyuong , Han Ho-Seong , Poves Ignasi , Rosado Ismael Domínguez , Park Joon-Seong , Lillemoe Keith D. , Roberts Keith J. , Sulpice Laurent , Besselink Marc G. , Abuawwad Mahmoud , Del Chiaro Marco , de Santibañes Martin , Falconi Massimo , D'Silva Mizelle , Silva Michael , Abu Hilal Mohammed , Qadan Motaz , Sell Naomi M. , Beghdadi Nassiba , Napoli Niccolò , Busch Olivier R. C. , Mazza Oscar , Muiesan Paolo , Müller Philip C. , Ravikumar Reena , Schulick Richard , Powell-Brett Sarah , Abbas Syed Hussain , Mackay Tara M. , Stoop Thomas F. , Gallagher Tom K. , Boggi Ugo , van Eijck Casper , Clavien Pierre-Alain , Conlon Kevin C. P. , Fusai Giuseppe Kito 
Published: September 2020

Objective:
The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers.

Summary Background Data:
PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection.

Methods:
This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998).

Results:
Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%.

Conclusion:
These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.
mTOR Inhibition Is Most Beneficial After Liver Transplantation for Hepatocellular Carcinoma in Patients With Active Tumors
Authors: Schnitzbauer Andreas A. , Filmann Natalie , Adam René , Bachellier Philippe , Bechstein Wolf O. , Becker Thomas , Bhoori Sherrie , Bilbao Itxarone , Brockmann Jens , Burra Patrizia , Chazoullières Olivier , Cillo Umberto , Colledan Michele , Duvoux Christoph , Ganten Tom M. , Gugenheim Jean , Heise Michael , van Hoek Bart , Jamieson Neville , de Jong Koert P. , Klein Christian G. , Klempnauer Jürgen , Kneteman Norman , Lerut Jan , Mäkisalo Heikki , Mazzaferro Vincenzo , Mirza Darius F. , Nadalin Silvio , Neuhaus Peter , Pageaux George-Philippe , Pinna Antonio D. , Pirenne Jaques , Pratschke Johann , Powel James , Rentsch Markus , Rizell Magnus , Rossi Giorgio , Rostaing Lionel , Roy André , Scholz Tim , Settmacher Utz , Soliman Thomas , Strasser Simone , Söderdahl Gunnar , Troisi Roberto I. , Turrión Victor Sánchez , Schlitt Hans J. , Geissler Edward K. 
Published: September 2020

Objective:The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial).Summary and Background Data:Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data.Patients and Methods:Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence.Results:Sirolimus use for ≥3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52–0.96,P= 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) ≥10 ng/mL and having used sirolimus for ≥3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49–0.59,P= 0.0079–0.0245).Conclusions:mTOR-inhibitor treatment with sirolimus for ≥3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients.Clinical Trial Registration:EudraCT: 2005-005362-36Clinicaltrials.gov:NCT00355862.
The Impact of Hospital Volume on Failure to Rescue after Liver Resection for Hepatocellular Carcinoma
Authors: Ardito Francesco , Famularo Simone , Aldrighetti Luca , Grazi Gian Luca , DallaValle Raffaele , Maestri Marcello , Jovine Elio , Ruzzenente Andrea , Baiocchi Gian Luca , Ercolani Giorgio , Griseri Guido , Frena Antonio , Zanus Giacomo , Zimmitti Giuseppe , Antonucci Adelmo , Crespi Michele , Memeo Riccardo , Romano Fabrizio , Giuliante Felice 
Published: September 2020

Objective:
The aim of this study was to evaluate correlation between centers’ volume and incidence of failure to rescue (FTR) following liver resection for hepatocellular carcinoma (HCC).

Summary Background Data:
FTR, defined as the probability of postoperative death among patients with major complication, has been proposed to assess quality of care during hospitalization. Perioperative management is challenging in cirrhotic patients and the ability to recognize and treat a complication may be fundamental to rescue patients from the risk of death.

Methods:
Patients undergoing liver resection for HCC between 2008 and 2018 in 18 Centers enrolled in the He.Rc.O.Le.S. Italian register. Early results included major complications (Clavien ≥3), 90-day mortality, and FTR and were analyzed according to center's volume.

Results:
Among 1935 included patients, major complication rate was 9.4% (8.6%, 12.3%, and 7.0% for low-, intermediate- and high-volume centers, respectively, P = 0.001). Ninety-day mortality rate was 2.6% (3.7%, 4.2% and 0.9% for low-, intermediate- and high-volume centers, respectively, P < 0.001). FTR was significantly higher at low- and intermediate-volume centers (28.6% and 26.5%, respectively) than at high-volume centers (6.1%, P = 0.002). Independent predictors for major complications were American Society of Anesthesiologists (ASA) >2, portal hypertension, intraoperative blood transfusions, and center's volume. Independent predictors for 90-day mortality were ASA >2, Child-Pugh score B, BCLC stage B-C, and center's volume. Center's volume and BCLC stage were strongly associated with FTR.

Conclusions:
Risk of major complications and mortality was related with comorbidities, cirrhosis severity, and complexity of surgery. These factors were not correlated with FTR. Center's volume was the only independent predictor related with severe complications, mortality, and FTR.