bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Cartoons as a Distraction Technique for Children Undergoing Suture of Facial Lacerations in the Emergency Department
Authors: Choi Hyo Jeong , Kim Ho Jung 
Published: March 2020

Purpose
To show the efficacy of cartoon as a distraction technique in suturing a child patient in the emergency room.

Methods
We studied children aged 2 to 8 years who had sustained a facial laceration 3 cm or less that required suturing from September 2015 to November 2016. We used local anesthesia and attempted to place the sutures without sedation while showing the children cartoons instead. If the first attempt failed, 1 more attempt was made. The patients were divided into 3 groups: success, success on second attempt, and failure. Age, location and size of the wound, and scores on the FACES Pain Rating Scale (FPS) before and after local anesthesia were recorded.

Results
The study included 106 children. Cartoon distraction was most effective for those aged 3 to 6 years (4.6 ± 1.9 years). The second-attempt group tended to be older, whereas the failure group was much younger (mean age, 7.4 ± 1.0 vs 2.7 ± 1.8 years). The FPS-R score differed widely among the groups. The success group tended to have a low score before and after local anesthetic injection (4.1 ± 2.0 and 3.1 ± 1.3), whereas the second-attempt and failure groups had much higher scores after injection (8.0 ± 1.7 and 8.8 ± 0.8; 5.2 ± 2.6 and 9.3 ± 0.8).

Conclusions
Cartoon distraction techniques can reduce the treatment duration and number of assistants, which also makes it appropriate for the emergency room. In addition, our results indicate that the pre–/post–local injection FPS score is a good predictor of success.
Prevalence of Abuse and Additional Injury in Young Children With Rib Fractures as Their Presenting Injury
Authors: Brennan Brian , Henry M. Katherine , Altaffer Ana , Wood Joanne N. 
Published: March 2020

Objective
The primary objective of this study was to determine the prevalence of (a) additional injuries, (b) abuse as determined by a standardized scale, and (c) reports to child protective services (CPS) among children younger than 5 years in whom a rib fracture was the first presenting injury concerning for abuse.

Methods
A retrospective study of children younger than 5 years diagnosed with rib fractures at a tertiary pediatric hospital between 2007 and 2018 was performed. Children in motor vehicle crashes, hospitalized after birth, or with previously diagnosed metabolic bone disease were excluded. We included only those children whose rib fractures were the first presenting injury. Demographic and clinical information was abstracted from the records. Prevalence of additional injuries, a diagnosis of abuse, and a report to CPS were calculated. Associations between patient demographic and clinical characteristics and the outcomes of interest were examined.

Results
Of the 67 cases included, additional injuries concerning for abuse were identified in 40 (60%), and 58% were deemed likely or definite abuse. Reports to CPS were filed in 72% of cases. Posterior rib fractures, multiple rib fractures, and presence of rib fractures of multiple ages were all associated with presence of additional injuries and classification as definite or likely abuse (all P ≤ 0.05).

Conclusions
The presence of a rib fracture in young children is associated with a high likelihood of additional concerning injuries and should prompt a thorough evaluation for child abuse.
Factors Associated With Increased Risk of Pediatric Orbital Cellulitis—Who Should Be Scanned?
Authors: Ohana-Sarna-Cahan Lea , Hurvitz Noa , Gross Itai , Cohen Adi , Hashavya Saar 
Published: March 2020

Background
Evaluation of a child with POC/OC is complicated due difficulties in physical examination and risks of imaging by computed tomography.

Method
Retrospective review of children 0–16 years admitted to the pediatric emergency department for POC/OC from 2009 to 2019.

Results
Ten years study period, 243 children younger than 16 years presented to the pediatric emergency department with a diagnosis of POC/OC. OC was documented in 51 (20.6%) patients. The mean age was 7.8 years (±4.3 years). Fever (80.4%), upper respiratory tract infection (43%), swelling of both eyelids (96%), proptosis (33.3%), and tenderness on percussion (24.5%) were more common in comparison to POC (P = 0.0001, 0.03, 0.0001, 0.0001, 0.0001 respectively). All children with suspected diagnosis of OC underwent computed tomography scan. POC accounted for 196 patients. Mean age was 4.6 (±4.3) years. Twenty percent of the cases were recorded as local trauma or insect bite in the infected eye.
Mean leukocyte count in the OC group had higher mean of 15.2 (109/L) versus 13.4(109/L) (P = 0.05), absolute neutrophil count was significantly higher in the OC 11.3(109/L) versus 7.2(109/L) (P = 0.0001) whereas the lymphocyte count was higher in the POC 4.5(109/L) versus 2.4(109/L) (P = 0.0001), NLR of 0.318 correlates with orbital cellulitis with sensitivity of 75.5% and specificity of 77.4%.
Patients with OC had mean C-reactive protein levels of 11.7 (mg/dL) versus 4.9(mg/dL) (P = 0.0001), erythrocyte sedimentation rate was elevated in the OC 53.6 (cm/h) versus 36.4 (cm/h) (P = 0.02).
Based on the aforementioned study a risk calculator for OC was formulated with 6 major variables.

Conclusions
Differentiation between POC/OC is cardinal. This study highlights the importance of ancillary laboratory tests especially C-reactive protein in the assessment of infections of the eye.
Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial
Authors: Garcia Edgard S. , Veiga Daniela F. , Veiga-Filho Joel , Cabral Isaías V. , Pinto Natália L. L. , Novo Neil F. , Sabino-Neto Miguel , Ferreira Lydia M. 
Published: March 2020

Background:
Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty.

Methods:
The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted.

Results:
There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003).

Conclusion:
The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.
Syndrome of the Trephined: Quantitative Functional Improvement after Large Cranial Vault Reconstruction
Authors: Tarr Joseph T. , Hagan Matthew , Zhang Ben , Tanna Neil , Andrews Brian T. , Lee Justine C. , Bradley James P. 
Published: March 2020

Background:
Large decompressive craniectomies may be life-saving; however, they may also result in syndrome of the trephined. This postrecovery sequela is characterized by dizziness, fatigue, depression, weakness, speech slowing, gait disturbance, and impaired mentation. Because this entity is poorly understood, the authors attempted to quantify the functional improvement in patients with syndrome of the trephined after cranial vault reconstruction.

Methods:
Patients with cranial vault defects (>50 cm2) from trauma, meningioma, and hemorrhage were studied preoperatively and postoperatively (6 months) after cranial vault reconstruction using (1) the Cognistat Active Form and (2) the Functional Independence Measure instrument (n = 40). Cranial vault reconstructive techniques varied from split cranial bone to alloplastic implants (polyetheretherketone or titanium mesh).

Results:
Of the 143 patients treated with decompressive craniectomies, 28 percent (n = 40) developed symptoms of syndrome of the trephined. A larger craniectomy defect size correlated with development of syndrome of the trephined. Time from craniectomy to presentation of symptoms was 4.5 months. Time from craniectomy to cranial vault reconstruction was 6.1 months. Time from cranial vault reconstruction to symptom improvement was 4.3 days. Complete functional recovery of syndrome of the trephined was seen in 70 percent. Type of cranial vault reconstruction included polyetheretherketone implant (57.5 percent), split calvarial graft (22.5 percent), and titanium mesh (20 percent), and was not a determinant of functional improvement. Cognistat assessment score noted improvement (from 38 to 69); likewise, the Functional Independence Measure measurement tool showed improvement (from 38 to 98).

Conclusions:
Syndrome of the trephined occurs more frequently than previously described in posttraumatic patients with large cranial vault defects. Cranial vault reconstruction leads to significant, quantifiable functional improvement in a large number of patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Transforming the Culture of Peer Review: Implementation Across Three Departments in an Academic Health Center
Authors: Lossius Michele N. , Rosenberg Eric I. , Thompson Lindsay A. , Gerner Janet , Holland Carolyn K. 
Published: March 2020

Objectives
Although many health care institutions believe that clinical peer review is vital for identifying and improving quality of care, peer review is perceived by many clinicians as variable and inherently punitive. Successful peer review requires institutional leadership and adoption of a just culture approach to investigating and determining accountability for medical errors that result in harm.

Methods
We describe how an academic medical center implemented and adapted its clinical peer review processes to be consistent with just culture theory and provide a roadmap that other institutions may follow. Specific examples of peer review are highlighted to show how the process improved patient safety in the departments of emergency medicine, internal medicine, and pediatrics.

Results
The most significant process improvement was shifting from a tradition of assigning letter grades of “A,” “B,” or “C” to determine whether preventable adverse events were caused by “human error,” “at-risk behavior,” or “reckless behavior.” This categorization of human behaviors enabled patient safety officers within 3 departments to develop specific interventions to protect patients and enlist physician support for improving clinical systems.

Conclusions
Each department’s success was due to recognition of different patient and provider cultures that offer unique challenges. The transformation of peer review was a crucial first step to shift perceptions of peer review from a punitive to a constructive process intended to improve patient safety. Our experience with reengineering clinical peer review shows the importance of focusing on just culture as a key method to prevent patient harm.
Mother-to-Child HIV Transmission With In Utero Dolutegravir vs. Efavirenz in Botswana
Authors: Davey Sonya , Ajibola Gbolahan , Maswabi Kenneth , Sakoi Maureen , Bennett Kara , Hughes Michael D. , Isaacson Arielle , Diseko Modiegi , Zash Rebecca , Batlang Oganne , Moyo Sikhulile , Lockman Shahin , Lichterfeld Mathias , Kuritzkes Daniel R. , Makhema Joseph , Shapiro Roger 
Published: March 2020

Background:
A large-scale evaluation of mother-to-child transmission (MTCT) with dolutegravir (DTG)-based antiretroviral treatment (ART) has not been conducted previously.

Setting:
Botswana was the first African country to change from efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC) to DTG/TDF/FTC first-line ART.

Methods:
From April 2015 to July 2018, the Early Infant Treatment Study offered HIV DNA testing at <96 hours of life. Maternal ART regimen was available for screened infants who could be linked to the separate Tsepamo surveillance study database. We evaluated characteristics of HIV-positive infants, and compared MTCT rates by ART regimen for linked infants.

Results:
Of 10,622 HIV-exposed infants screened, 42 (0.40%) were HIV-positive. In total, 5064 screened infants could be linked to the surveillance database, including 1235 (24.4%) exposed to DTG/TDF/FTC and 2411 (47.6%) exposed to EFV/TDF/FTC. MTCT was rare when either regimen was started before conception: 0/213 [0.00%, 95% confidence interval (CI): 0.00% to 1.72%] on DTG, 1/1497 (0.07%, 95% CI: 0.00% to 0.37%) on EFV. MTCT was similar for women starting each ART regimen in pregnancy: 8/999 (0.80%, 95% CI: 0.35% to 1.57%) for DTG and 8/883 (0.91%, 95% CI: 0.39% to 1.78%) for EFV (risk difference 0.11%, 95% CI: −0.79% to 1.06%). Most MTCT events (4/8 with DTG, 6/9 with EFV) occurred when ART was started <90 days before delivery. Infants exposed to DTG in utero had lower baseline HIV RNA compared with other HIV-infected infants.

Conclusion:
In utero MTCT in Botswana remains rare in the DTG era. No significant MTCT differences were observed between DTG/TDF/FTC and EFV/TDF/FTC. Risk was highest for both groups when ART was started in the third trimester.
Imaging of Fulminant Demyelinating Disorders of the Central Nervous System
Authors: Razek Ahmed Abdel Khalek Abdel , Elsebaie Nermeen A. 
Published: March 2020

AbstractWe aim to review the imaging appearance of fulminant demyelinating disorders of central nervous system that have different pathological features, clinical course, clinical features, and imaging findings different from classic multiple sclerosis. Routine magnetic resonance imaging (MRI) can help in accurate localization of the lesions, detection of associated lesions, and monitoring of these patients. Advanced MRI combined with routine MRI can aid in differentiation fulminant demyelinating lesions from simulating malignancy. Tumefactive demyelination lesions are located in supratentorial white matter mainly frontal and parietal regions with incomplete rim enhancement. Baló concentric sclerosis shows characteristic concentric onion skin appearance. Schilder disease is subacute or acute demyelinating disorders with one or more lesions commonly involving the centrum semiovale. Marburg disease is the most severe demyelinating disorder with diffuse infiltrative lesions and massive edema involving both the cerebral hemisphere and brain stem.
Diagnostic Yield of Computed Tomography–Guided Percutaneous Lung Biopsy in Patients With Prior Nondiagnostic Transbronchial Biopsy
Authors: Li Quan-Kui , Ding Yuan-Kun , Liu Yi , Xia Feng-Fei , Li Lin , Fu Yu-Fei 
Published: March 2020

Purpose
The purpose of this study was to assess the diagnostic yield of computed tomography (CT)–guided core needle biopsy (CNB) for initial transbronchial biopsy (TBB)–based nondiagnostic lung lesions.

Methods
From January 2014 to December 2017, 101 consecutive patients with initial TBB-based nondiagnostic lung lesions underwent CT-guided CNB. All procedures were performed with an 18G core needle by a chest radiologist with more than 5 years of experience. The CT-guided CNB was performed within 30 days after the initial TBB. In total, 90 and 11 central and peripheral lung lesions were observed, respectively. The mean ± SD diameter of these lesions was 58.8 ± 21.8 mm. The diagnostic yield of CT-guided CNB was assessed.

Results
Computed tomography–guided CNB provided a definite diagnosis for 63 (62.4%) of the 101 lesions. The 63 CNB-based lesion diagnoses included malignant (n = 57) and specific benign (n = 6) lesions. The remaining 38 CNB-based nondiagnostic lesions included nonspecific benign (n = 35) and suspected malignant (n = 3) lesions. The 38 CNB-based nondiagnostic lesions were confirmed by surgery (n = 5), repeat CNB (n = 5), or CT follow-up (n = 28). The mean ± SD follow-up was 9.9 ± 7.3 months. Based on the final diagnosis, 67 lesions were malignant and 34 lesions were benign. The sensitivity, specificity, and accuracy of CT-guided CNB were 89.6% (60/67), 100% (34/34), and 93.1% (94/101), respectively.

Conclusions
Computed tomography–guided CNB is a useful diagnostic modality for accurate diagnosis of lung lesions with inconclusive pathologic results after initial TBB.
Diagnostic Performance of Abnormal Nulling on Cardiac Magnetic Resonance Imaging Look Locker Inversion Time Sequence in Differentiating Cardiac Amyloidosis Types
Authors: Tavoosi Anahita , Yu Boxin , Aghel Nazanin , Karur Gauri R. , Pakkal Mini , Wald Rachel , Wintersperger Bernd J. , Delgado Diego H. , Hanneman Kate 
Published: March 2020

Purpose:
To evaluate the diagnostic utility of the Look Locker inversion time (TI) sequence on cardiac magnetic resonance imaging in patients with suspected cardiac amyloidosis and to evaluate whether there are differences in the nulling pattern between amyloid types.

Materials and Methods:
A total of 144 patients with suspected cardiac amyloidosis who had undergone cardiac magnetic resonance imaging were included in this retrospective study. Sixty-four had cardiac amyloidosis (62.1±9.2 y, 70.3% male, 68.8% had light chain amyloid [AL], 18.8% had familial transthyretin amyloid caused by mutant genes [ATTRm], and 12.5% had wild-type transthyretin amyloid [ATTRwt]) and 80 did not have cardiac amyloidosis (61.3±13.3 y, 58.8% male). Time to myocardial and blood pool nulling on the Look Locker TI sequence was classified as normal if blood pool nulled before myocardium or abnormal if blood pool nulling was coincident with or after myocardial nulling.

Results:
The nulling pattern was abnormal in 26 patients with cardiac amyloidosis compared with none of the patients without cardiac amyloidosis (40.6% vs. 0.0%, P<0.0001). Abnormal nulling had 40.6% sensitivity and 100% specificity for cardiac amyloidosis (area under the receiver operating characteristic curve: 0.703, 95% confidence interval: 0.642-0.764). All patients with cardiac amyloidosis with an abnormal nulling pattern demonstrated late gadolinium enhancement. Among patients with cardiac amyloidosis, there was no significant difference in abnormal nulling between AL, ATTRm, and ATTRwt amyloid types (31.8%, 58.3%, 62.5%, respectively, P=0.10).

Conclusions:
An abnormal nulling pattern on the Look Locker TI sequence is highly specific for cardiac amyloidosis when present. However, abnormal nulling is a late finding with low sensitivity and does not differentiate between amyloid types.
Neonatal Mandibular Distraction Osteogenesis in Infants With Pierre Robin Sequence
Authors: Diep Gustave K. , Eisemann Bradley S. , Flores Roberto L. 
Published: March 2020

Abstract
Pierre Robin sequence is the constellation of micrognathia, glossoptosis, and tongue-based airway obstruction. When airway obstruction is severe, feeding, growth, and respiratory demise are at risk. Neonatal mandibular distraction osteogenesis is a technique which improves tongue-based airway obstruction and avoids tracheostomy in patients with severe expressions of Pierre Robin sequence. Its efficacy in relieving airway obstruction is well documented, and it has become the surgical intervention of choice at many craniofacial centers. However, this is an uncommon procedure which can be performed within the first weeks of life, offering little space for a learning curve. The success of neonatal distraction and avoidance of complications is highly dependent on proper surgical technique. This report provides a brief overview of the disease, details the technique of the senior surgeon with captioned videos, describes the protocol used at our institution and reports long-term outcomes with a case description.
Terminology and Etymology in Oculoplastic Surgery
Authors: Mohammad Syed , Hussain Ahsen 
Published: March 2020

Purpose:
To provide a collection of important terms in oculoplastic surgery, their etymology, current usage, and clarification of terms with overlapping or often misconstrued definitions.

Methods:
Commonly employed terms in oculoplastic surgery were collected, and their etymologies were determined. The authors then examined how these terms are being currently used in the published literature to determine how closely their usage matched the origin of the terms, if any terms had developed multiple meanings, or if multiple terms were being used to describe the same concept.

Results:
This article assembles in one area much of the important terms in oculoplastic surgery, highlighting how the etymology of the terms both links to their meanings as well as clarifies the appropriate usage of terms that have evolved to develop several different definitions. Special attention is placed on clarifying the correct definitions of closely related but distinct terms.

Conclusions:
Most terms in ophthalmology are used in a uniform manner across the literature with definitions closely matching their etymology, but some terms in oculoplastic surgery are being used in a potentially confusing overlapping manner and warrant clarification.
Dental Topics for Plastic Surgeons, Part One: Normal Anatomy, Growth and Development
Authors: Zajac Jocelyn C. , Abbate Olivia , Oh Albert K. , Mantilla-Rivas Esperanza , Aivaz Marudeen , Wang Raymond , Talbet Joseph , Manrique Monica , Tate Anupama R. , Rogers Gary F. 
Published: March 2020

Abstract
Normal and abnormal conditions affecting the dentition and the periodontal structures receive sparse coverage in the plastic surgery literature, textbooks, and training programs. Nevertheless, a working knowledge of this subject matter is important in certain areas of clinical practice, and a fundamental understanding is often part of plastic surgery competency tested for in the In-service and written board examinations. This four-part series is written to provide plastic surgeons with a working knowledge of relevant dental topics. Part 1 covers fundamental aspects of normal dental embryology, growth and anatomy.