bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pectoralis Major Median Myotomy: The Median Cut
Authors: Borenstein Amiram , Abrahami Yoav 
Published: January 2020

Summary:
Dual-plane breast augmentation offers the advantages of a subpectoral implant location with the ability to expand its use to glandular ptotic and constricted lower pole breasts. Alas, high implant position or very loose breast tissue can lead to a notorious breast shape known as the “waterfall deformity.” To prevent many of these undesired deformities, the authors introduce a novel pectoralis major median myotomy they call the “median cut.” From all of the dual-plane breast augmentations that were performed by the two authors between the years 2011 and 2017, a total of 605 included a median cut to resolve an apparent waterfall deformity. Without this procedure, a shift to subglandular augmentation would have been performed. The authors strongly believe that the median cut is a powerful and effective way to avoid intraoperative waterfall deformities and to have more women benefit from a submuscular approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
An Objective, Quantitative, Dynamic Assessment of Hyaluronic Acid Fillers That Adapt to Facial Movement
Authors: Percec Ivona , Bertucci Vince , Solish Nowell , Wagner Ted , Nogueira Alessandra , Mashburn Jay 
Published: January 2020

Background:
Objective dynamic assessments are central to the evaluation of facial rejuvenation treatments. This study used three-dimensional digital stereophotogrammetry to generate a quantitative dynamic assessment of facial strain and hyaluronic acid filler efficacy.

Methods:
Thirty women (aged 41 to 65 years) with moderate to severe bilateral nasolabial folds and marionette lines received Restylane Refyne, Restylane Defyne, or both, and were compared to a “younger” untreated group (n = 20; aged 25 to 35 years). Three-dimensional videos were collected at baseline and at day 42. Dynamic strain was analyzed at the marionette lines and nasolabial folds as subjects went from a neutral position through a series of facial expressions.

Results:
Baseline nasolabial folds and marionette lines showed statistically significant (p ≤ 0.05) differences in the level of stretch between younger and older untreated subjects, with higher stretch profiles observed in the older cohort. In the older cohort, filler treatment reduced peak strain (stretch) in the nasolabial folds and marionette lines compared with baseline across all tested expressions, resembling the youthful strain profile of the younger untreated control group. Treatment was well tolerated.

Conclusions:
Quantitative dynamic strain analysis is an innovative method for evaluating the dynamic face following dermal fillers and provides objective evidence that such treatment results in stretch levels resembling a younger phenotype in areas prone to the effects of facial aging. The strain reduction following filler treatment objectively conveys a dermal tightening effect, likely secondary to the volumization of treated areas. Additional studies will refine the technology and associated procedures to optimize quantitative dynamic strain analysis for treatment planning and patient outcome optimization.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Roles of Podoplanin-Positive/Podoplanin-Negative Cells from Adipose-Derived Stem Cells in Lymphatic Regeneration
Authors: Dai Tingting , Jiang Zhaohua , Cui Chunxiao , Sun Yiyu , Lu Bolun , Li Haibo , Cao Weigang , Chen Bin , Li Shengli , Guo Lifei 
Published: January 2020

Background:
Secondary lymphedema is a refractory disease, for which adipose-derived stem cells have shown some therapeutic potential. However, the mechanism of this action remains poorly understood.

Methods:
The authors identified podoplanin-expressing adipose-derived stem cells, which allowed them to divide adipose-derived stem cells into podoplanin-positive and podoplanin-negative groups that they characterized in vitro. The authors then used a mouse hindlimb model for lymphedema to trace the fate of podoplanin-positive, podoplanin-negative, and unsorted adipose-derived stem cells in vivo.

Results:
When induced in culture, podoplanin-positive cells were noted to up-regulate the expression of lymphatic endothelial cell markers, including LYVE-1, and assumed a cobblestone morphology. In addition, a substantial increase in lymphangiogenic cytokines was detected in the podoplanin-positive supernatant. The above findings were largely absent from the podoplanin-negative and unsorted groups. In the mouse model, the implanted cells relieved the limb lymphedema by promoting lymphangiogenesis, with the podoplanin-positive group showing the most significant effect. Immunocolocalization further revealed that the podoplanin-positive cells incorporated into lymphatic vessels were positive for LYVE-1.

Conclusions:
These data demonstrated that actions by means of both paracrine and differentiation pathways were involved in the adipose-derived stem cell–mediated therapeutic effects. The podoplanin-positive cells possessed lymphatic paracrine and differentiation abilities and may represent lymphatic endothelial cell precursor cells. The podoplanin-negative cells, which constitute a considerable proportion of the adipose-derived stem cells, may play an important paracrine role by secreting mesenchymal stem cell–related factors.
The Broad Application of Prepectoral Direct-to-Implant Breast Reconstruction with Acellular Dermal Matrix Drape and Fluorescent Imaging in a Community Setting
Authors: Bilezikian Jordan A. , Tenzel Paul L. , Bebb Gregory G. , Kays Charles R. 
Published: January 2020

Background:
Much has been written regarding the new paradigm of prepectoral direct-to-implant reconstruction, but patient selection continues to be unclear. Prepectoral direct-to-implant (PDTI) reconstruction with acellular dermal matrix drape and fluorescent imaging (ADFI) was offered to all patients.

Methods:
The PDTI with ADFI protocol is (1) fluorescent imaging following mastectomy, (2) acellular dermal matrix prepectoral drape construction, (3) direct-to-implant placement beneath drape, and (4) repeated fluorescent imaging with implant in place.

Results:
Patient ages ranged from 29 to 82 years, and body mass index ranged from 19 to 48 kg/m2. Implant size ranged from 240 to 800 cc. Two hundred thirty breasts in 131 patients were reconstructed with the PDTI with ADFI protocol between October of 2016 and June of 2018; 32 patients underwent unilateral and 99 underwent bilateral reconstruction. Twelve breasts (5 percent) received postmastectomy radiation therapy after reconstruction. Ten patients (8 percent) had previous lumpectomy and radiation therapy, with local recurrence, and underwent completion mastectomy and PDTI reconstruction with ADFI. Fifteen patients and 22 breasts (9 percent) had subpectoral reconstructions converted to PDTI with ADFI. Ten infections (4 percent) required explantation. Eight breasts (4 percent) were reconstructed with tissue expanders because of poor vascular flow. Seven breasts (3 percent) in five patients received minor cosmetic revision.

Conclusions:
SPY fluorescent imaging and expanded use of acellular dermal matrices has created an environment where PDTI reconstruction can be successful in nearly all postmastectomy patients. Tissue expansion/two-stage reconstruction has evolved to a default approach when vascular supply to skin flaps is compromised. PDTI reconstruction with ADFI has resulted in zero necroses of skin flaps, patients rarely undergoing revisions, fewer office visits, and quicker return to preoperative lifestyles.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Expression of CD40 Ligand on T Cells and Soluble CD40 Ligand in Children With Kawasaki Disease
Authors: Jindal Ankur Kumar , Rawat Amit , Goel Shubham , Shandilya Jitendra , Saikia Biman , Minz Ranjana W. , Singh Surjit 
Published: January 2020

Background/Objective
This study was done to examine the role of CD40 ligand (CD40L) in children with Kawasaki disease (KD). There is paucity of literature on this aspect of KD.

Methods
This was a case-control study of patients with KD diagnosed at the Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India. CD40L expression on activated CD3+ T cells was measured using flow cytometry, and soluble CD40L (sCD40L) was measured using enzyme-linked immunosorbent assay.

Results
We included 14 children with KD, 14 healthy controls, and 12 febrile controls for the purpose of this study. Mean percentage CD40L expression was higher in patients with KD (before administration of intravenous immunoglobulin [IVIg]) as compared with normal and febrile controls. This difference was statistically significant when compared with normal control (p = 0.00; confidence interval [CI], 8.92–20.30), but was not statistically significant when compared with febrile controls (p = 0.138; CI, −3.50 to 22.08). CD40L expression decreased after giving IVIg, but the difference was not statistically significant (p = 0.073; CI, −1.04 to 19.73). Mean sCD40L values increased significantly after giving IVIg (when repeated after a median period of 11 days; p = 0.001; CI, −0.77 to −0.29). There was no statistically significant difference between mean sCD40L in patients with KD (before giving IVIg) as compared with normal and febrile controls (p = 0.42; CI, −1.11 to −0.51 and p = 0.641; CI, −0.37 to 0.57, respectively).

Conclusions
CD40L may have important role in the pathogenesis of KD. However, these results need to be validated in larger multicenter studies.
The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain
Authors: Shafshak Tarek Saad , Elnemr Rehab 
Published: January 2020

Background
Low back pain (LBP) is a public health problem that requires accurate assessment for proper management and predicting prognosis.

Objective
This study aims to assess the agreement between visual analogue scale (VAS) and numeric rating scale (NRS) in measuring LBP severity, and investigate their ability in predicting disability.

Methods
A cross-sectional study was performed on 100 patients with chronic LBP. Pain severity assessment was performed using VAS, NRS, and pain severity scores of the Brief Pain Inventory (BPI). Disability assessment was done by BPI-Pain interference and Modified Oswestry Disability Index (MODI).

Results
There was a significant positive correlation between VAS and NRS (r = 0.92, p < 0.001) with high agreement between both as detected by Bland-Altman method (mean difference = 0.33). Moreover, there was significant (p < 0.001) positive correlation between disability scores and either VAS (r = 0.92 with BPI pain interference; r = 0.75 with MODI) or NRS (r = 0.95 with BPI pain interference; r = 0.68 with MODI). By using receiver operating characteristic curve, a score of 6 in VAS or NRS can predict severe disability, whereas VAS score higher than 4 and NRS score higher than 3 can predict moderate disability.

Conclusions
Visual analogue scale and NRS appeared reliable in assessing LBP severity with no significant difference between them. Moreover, either VAS or NRS scores can predict disability of patients with LBP.
Impact of Software Parameter Settings on Image Quality of Virtual Grid Processed Radiography Images
Authors: Gossye Tim , Smeets Peter V. , Achten Eric , Bacher Klaus 
Published: January 2020

Objectives
Mobile radiography systems are commonly used in the intensive care unit. The use of a physical antiscatter grid with these systems is uncommon because of drawbacks. In 2015, Virtual Grid (Fujifilm, Tokyo, Japan) became available for chest and abdomen examinations. In this study, we compared image quality (IQ) with a contrast-detail phantom (CDRAD 2.0; Artinis Medical Systems, Zetten, the Netherlands) of digital radiographs acquired without any grid (gridless) with those corrected for scatter by either software (SW)-based scatter correction (Virtual Grid) or a physical grid (grid). Furthermore, we determined the optimal Virtual Grid settings that lead to the best contrast-detail IQ score (inverse IQ figure).

Materials and Methods
Images were obtained with a cassette spot film device with an inserted portable flat-panel detector (Fujifilm, Tokyo, Japan). The CDRAD phantom was sandwiched between polymethylmethacrylate (PMMA) with total thicknesses of 12, 16, 21, and 26 cm to simulate patient attenuation and scatter. Tube voltages of 81, 90, 109, and 125 kVp were used to make the radiographs. In total, 12 different Virtual Grid settings (grid ratio, line pairs (lp)/cm, and type of interstitial material) were applied for every phantom thickness and tube voltage.

Results
An average increase of 32% in IQ was obtained when Virtual Grid images with a SW grid ratio 10:1 were compared with gridless images (P < 0.001). Increasing the SW grid ratio to 20:1 resulted in a further increased IQ. With a phantom thickness of 12 cm PMMA, Virtual Grid outperformed the removable physical grid presented in the cassette spot film device. The linear mixed-effects model showed that IQ is mainly affected by PMMA, tube voltage, and the SW grid ratio.

Conclusions
Virtual Grid improves images obtained without physical grid for a wide range of experimental conditions. Despite the different possible settings of the Virtual Grid SW, the most important parameter affecting IQ is the SW grid ratio.
Intense FAPI Uptake in Inflammation May Mask the Tumor Activity of Pancreatic Cancer in 68Ga-FAPI PET/CT
Authors: Luo Yaping , Pan Qingqing , Zhang Wen , Li Fang 
Published: January 2020

Abstract
Contrast CT revealed diffuse enlargement of the pancreas with a suspicious lesion in the uncinate process in a 57-year-old man who presented with jaundice. 18F-FDG PET/CT showed increased radioactivity in the enlarged pancreas with a nodular lesion with even higher uptake in the uncinate process. To differentiate autoimmune pancreatitis and pancreatic cancer, 68Ga-FAPI PET/CT was performed. It revealed intense 68Ga-FAPI uptake in the pancreas, but the FDG-avid lesion in the uncinate process was not shown. The patient was finally diagnosed with pancreatic cancer with tumor-induced pancreatitis with endoscopic ultrasonography–guided biopsy.
A Rare Presentation of Melanoma as a Retroperitoneal Mass Seen on FDG PET
Authors: Yao Yutang , Liu Wusong , Zuo Zhuo , Cheng Zhuzhong 
Published: January 2020

Abstract
A 55-year-old woman presented with intermittent fatigue and abdominal pain. Ultrasound and CT scan showed a large heterogeneous mass in the retroperitoneum, suggestive of malignancy. 18F-FDG PET/CT was performed for staging. PET/CT images showed a hypermetabolic retroperitoneal mass. Endoscopy revealed a mass infiltrating the duodenum. Eventually, the mass was pathologically proved to be malignant melanoma. Further extensive clinical, radiological, and endoscopic investigations proved the retroperitoneum to be the primary site.
Anaplastic Large Cell Lymphoma Involving 7 Different Organs in a Pediatric Patient Demonstrated by FDG PET/CT
Authors: Zhang Mingyu , Yang Xu , Wang Wei , Yang Jigang 
Published: January 2020

Abstract
An 11-year-old girl presented with vomiting, abdominal pain, nausea, and scleral icterus for 7 days. FDG PET/CT demonstrated multiple FDG-avid lesions in muscle, bone, kidney, pancreas, ovary, lymph nodes, and central nervous system. Biopsy from the lesion in the muscle of the right upper arm demonstrated ALK-positive anaplastic large cell lymphoma. The present case highlights the advantage of FDG PET/CT in better staging pediatric patients with anaplastic large cell lymphoma.
Freestyle Perforator Puzzle Flap for Posterior Trunk Reconstruction
Authors: Maruccia Michele , Di Taranto Giuseppe , Schonauer Fabrizio , D'Andrea Francesco , Losco Luigi , Ribuffo Diego , Chen Hung-Chi , Cigna Emanuele 
Published: January 2020

Background
Closure of extensive defects of posterior trunk can be challenging for reconstructive surgeons owing to the need of a large bulk of well-vascularized tissue to resurface the skin and the exposed hardware and to fill the dead spaces. We hypothesized that elevating multiple perforators flaps in various patterns would allow for reconstruction of large posterior trunk defects with tension-free primary closure and minimal donor site morbidity.

Patients and Methods
Between January 2013 and December 2016, 23 patients with large posterior trunk defects underwent reconstruction with a multiple freestyle perforator flaps approach. We experimented a freestyle perforator-based reconstruction, which consists of designing a sequence of flaps, able to adequately fit the defects, allowing for tensionless primary closure.

Results
The average age of patients was 60.2 years (range, 18–80 years). A total number of 62 perforator flaps was performed, with an average of 2.6 flaps per patient. We were able to successfully cover defects up to 27 × 29 cm. A single perforator was used in 58 flaps, whereas more than 1 perforator was applied in 4 flaps. In all cases, the donor sites were closed primarily, and patients healed uneventfully. Six patients underwent radiotherapy after surgery, but no complication occurred.

Conclusions
In this series of extensive defects of the posterior trunk, a tension-free closure was achieved by distributing the tension to multiple freestyle perforator flaps, supplying sufficient volume of tissue and reliable vascularization. This approach can be a valid tool in facing reconstruction of large and complicated defects of the posterior trunk.
Novel Three-Dimensional Coordinate System to Analyze Alveolar Molding Effects of Pre-Surgical Nasoalveolar Molding on Infants With Non-Syndromic Unilateral Cleft Lip and Palate
Authors: Zheng Jie , He Hong , Kuang Wenying , Yuan Wenjun 
Published: January 2020

Abstract
The aim of this study is to establish a stable 3-dimensional (3D) coordinate system for investigating the alveolar molding effects of pre-surgical nasoalveolar molding (PNAM) on non-syndromic unilateral cleft lip and palate (UCLP) patients, basing on the Frankfort Horizontal (FH) plane.
Twenty-one non-syndromic UCLP neonates who sought medical advice in the department of Orthodontics, from 2016.5 to 2017.10 were enrolled in the present study. All neonates were subjected to PNAM before the cleft lip repair. The treatment duration was 75.76 days. Silicone rubber models were obtained and scanned using a 3D laser scanner pre- and post-PNAM treatment. A 3D coordinate system based on the FH reference plane was built utilizing Rhino3D software to record the landmark 3D coordinates, to measure the distance, angle, and length variables. The Paired Student's t test and the Pearson correlation coefficient were used to calculate reproducibility and reliability of the landmark localization for repeated measurements. Changes of the measurement variables were analyzed by the Paired Student's t test.
This study revealed a high reproducibility and reliability for most of the landmarks. By the end of PNAM treatment, the cleft gap was reduced with the malformation of alveolar segments aligned normally and the anterior points of both alveolar segments were rotated to the cleft side.
Utilizing the FH plane to set up a rigorous and stable 3D system is meaningful. PNAM therapy is effective in reducing the severity of the maxillary deformity not only on the non-cleft side, but also on the cleft side.
The Effect of Buccal Fat Pad Graft in the Palatoplasty and the Risk Factor of Postoperative Palatal Fistula
Authors: Kim Jwa-Young , Kim Seong-Gon , Park Young-Wook , Hwang Dae Seok , Paeng Jun-Young , Seok Hyun 
Published: January 2020

Purpose:
The aim of this study was to evaluate the effect of buccal fat pad (BFP) in the palatoplasty and to investigate the risk factors associated with postoperative palatal fistula formation.

Materials and Methods:
Sixty-five cleft palate patients were enrolled for this study. Clinical data regarding sex, age, type of cleft, surgical technique, the ratio of cleft width, and BFP graft were collected. The ratio of cleft width was measured and calculated using preoperative clinical photographs. In 36 patients, the BFP was harvested and grafted on the cleft palate to prevent palatal fistula formation. The patients were followed up, the incidence of fistula formation was investigated, and the risk factors related with the fistula were evaluated.

Results:
Four patients had postoperative palatal fistula and were not BFP grafted during operation. The BFP graft and ratio of cleft width are significant factors in palatal fistula formation (P = .035, .003). There was a significant difference in the ratio of cleft width between the normal and fistula groups (P = .006). In the logistic regression analysis, there was significant association between high ratio of cleft width and palatal fistula formation in the no BFP group (odds ratio; 11.15, P = .036).

Conclusions:
The ratio of cleft width and BFP graft was a significant factor in palatal fistula formation. The BFP graft is a reliable procedure to prevent palatal fistula formation and increase the success of palatoplasty.
Application of Disposable Multifunctional Drainage Tube-Assisted Irrigation in Patients With Severe Multi-Space Infections in Oral and Maxillofacial Head and Neck Regions
Authors: Dai Tianguo , Cheng Jinqiang , Ran Hongbing , Xu Bo , Liu Yingkai , Qiu Yinxiu 
Published: January 2020

Purpose:
To compare the clinical efficacy of disposable multifunctional drainage tube (DMDT)-assisted irrigation with the traditional abscess incision rubber drainage technique in patients with severe multi-space infections in oral and maxillofacial head and neck regions.

Patients and Methods:
The data of 74 patients with severe multi-space infections in oral and maxillofacial head and neck regions, who were admitted to the Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Sichuan Province, China, between January 2015 and January 2019, were retrospectively studied. According to the treatment method, the patients were divided into 2 groups: the DMDT-assisted irrigation group and the abscess incision rubber drainage group. Cure rate, complications, length of hospitalization, days of antimicrobial use, cost of antimicrobial drugs, total hospitalization cost, number of dressing changes, and patient pain during dressing changes were compared between the 2 groups.

Results:
Of the 74 patients, 38 were treated with the DMDT-assisted irrigation, and 36 with the traditional abscess incision rubber drainage. Compared with the traditional treatment group, the total hospitalization cost of the DMDT-assisted irrigation group is not much different (P = 0.72), but the patients in the DMDT-assisted irrigation group have higher cure rate, fewer complications, less antibiotics cost, shorter hospitalization length and fewer dressing changes than the control group (P < 0.05).

Conclusions:
The DMDT-assisted irrigation technique not only improves the cure rate, reduces complications, shortens hospitalization, reduces the use of antibiotics, and alleviates patient pain during dressing changes, but also improves clinical and therapeutic efficacy by reducing the number of dressing changes.