bluuebunny/crossref_metadata_2025_split huggingface dataset:
Translational Studies on Biologic Fusion of a Vertebral Segment as a Novel Treatment Modality for Low Back Pain
Authors: Olmarker Kjell , Gerward Andreas , Isberg Bengt , Lehmann Anders , Berg Svante 
Published: September 2020

Study Design.
Preclinical studies: Efficacy and toxicological studies on lactic acid (LA)-induced sclerozation in pig lumbar discs. Clinical study: Prospective, randomized, double-blinded, placebo-controlled, single ascending dose study investigating the safety and local tolerability of LA.

Objective.
To determine if LA produces sclerozation of the porcine nucleus pulposus (NP) followed by a phase Ib study to evaluate preliminary safety, tolerability, and efficacy of LA in patients with chronic discogenic low back pain.

Summary of Background Data.
Surgical stabilization of a motion segment harboring a painful degenerated disc often affords symptomatic relief. In the present study, the hypothesis was tested that LA can produce sclerozation and stabilization of the NP.

Methods.
LA (0.2 mL; 60, 120, or 240 mg/mL) or vehicle was injected into the NP or close to the extra spinal region of spinal nerves of young female pigs. The size of the NP, MRI changes, flexural stiffness, and histology of the disc was studied after up to 84 days of survival. Fifteen patients injected intra discally with placebo (iohexol, 1.5 mL, n = 6) or iohexol plus LA (30, 60, or 120 mg/mL; three patients in each group) were followed for up to 12 months.

Results.
Injection of LA in the pig reproducibly induced sclerozation of the NP and increased flexural rigidity. Histological changes included generation of connective tissue and increased expression of collagen I. No safety concerns were raised. Adverse events in patients were limited to transiently increased low back pain with no obvious difference between treatment groups. There was indication of lower water content of NP injected with the two highest doses of LA.

Conclusion.
LA has a sclerozing effect on the NP in pigs and patients and is therefore a candidate for further clinical studies powered to determine its potential as a treatment of chronic discogenic low back pain.

Level of Evidence: 2
Availability, Use, and Satisfaction of Personal Protective Equipment Among Healthcare Workers
Authors: Sarfraz Azza , Sarfraz Zouina , Anwer Ammar , Sarfraz Muzna , Siddiq Javaria 
Published: September 2020

Objective:
To assess the discrepancy among and within low- and middle-income countries (LMICs) regarding PPE availability, use, and satisfaction.

Methods:
The study population consisted of healthcare workers from LMICs who partook in the questionnaire survey from March 1, 2020, until April 15, 2020.

Results:
In the bivariate analysis, gender (P = 0.05), HCWs (P < 0.01), and level of care (P < 0.01) were associated with the public or private sector (P < 0.05). Using multivariate analysis, PPE factors were associated with the health sector (p < 0.05). The multivariate logistic regression model determined a Pearson's χ2 value of 706.736 (df = 726, P = −0.689) and a c-statistic of 0.592, indicating a good model.

Conclusion:
In LMICs, huge discrepancies are present in PPE provision to HCWs, especially among the public healthcare sectors. Efforts at national and international levels ought to be addressed to protect frontline HCWs at higher risk of contracting COVID-19.
Endoscopic ultrasound-guided liver biopsy using a 20-gauge fine needle biopsy needle with the wet-heparinized suction technique
Authors: Sisman Gurhan , Barbur Erol , Saka Didem , Piyade Betul , Besli Sevval , Boynukara Can , Kirimlioglu Hale 
Published: September 2020

Objectives
The primary aim of this study was to evaluate the histological adequacy of the liver tissue specimens obtained with a 20-gauge fine-needle biopsy needle and the secondary aim was to test the safety endoscopic ultrasound-guided liver biopsy with a 20-gauge fine-needle biopsy needle with the wet-heparinized suction technique.

Methods
Forty patients who underwent endoscopic ultrasound-guided liver biopsy were included in the study. A 20-gauge fine-needle biopsy needle was used with the wet-heparinized suction technique to make one pass each from the left and the right lobe. Histologic characteristics of the specimens were evaluated, and patients were observed after the procedure in order to intervene in case of an adverse event.

Results
The median longest core fragment was 22 mm from the left lobe [first quartile–third quartile 20–25 mm, interquartile range (IQR) 5 mm], and 20 mm (first quartile–third quartile 17–22 mm, IQR 5 mm) from the right lobe. The median cumulative core length per patient was 103 mm (91–108 mm, IQR 17 mm). The median cumulative number of complete portal triads per patient was 69.50 (52.25–82.25, IQR 30). The rate of diagnostic yield was 100%. Post-biopsy self-limiting abdominal pain was reported in two patients (5%). The most common histologic diagnosis was fatty liver disease (25%).

Conclusion
Endoscopic ultrasound-guided liver biopsy with the wet-heparinized suction technique using a 20-gauge fine-needle biopsy needle is a safe alternative method in clinical practice.
Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest to the Traditional Open Approach in Breast Reconstruction
Authors: Winocour Sebastian , Tarassoli Sam , Chu Carrie K. , Liu Jun , Clemens Mark W. , Selber Jesse C. 
Published: September 2020

Background:
Robotically assisted latissimus dorsi harvest permits harvest of the latissimus dorsi muscle without a back incision, as compared to the traditional open technique. The authors hypothesized that robotic harvest has lower donor-site complication rates, decreased opioid requirements, and a shorter length of stay than the traditional open technique.

Methods:
A retrospective review was performed of all consecutive pedicled latissimus dorsi flaps for breast reconstruction between 2011 and 2015. All procedures were conducted by two surgeons who performed both robotic and open cases.

Results:
Fifty-two patients were identified; 25 underwent robotically assisted latissimus dorsi harvest and 27 underwent the open technique. Demographic data between the two groups were similar. Median length of stay for robotic harvest was shorter than that for the traditional technique (2 days versus 3 days; p = 0.031). Postoperative morphine requirement was less in the robotic compared to the traditional technique, but the difference was not significant (158 mg versus 184 mg; p = 0.826). Seroma rate was higher in the robotic group (16 percent versus 0 percent; p = 0.034). The mean duration of surgery was longer in the robotic cohort (388 minutes versus 311 minutes; p = 0.002).

Conclusions:
This study demonstrates robotically assisted latissimus dorsi harvest as an effective alternative to the traditional open technique in select patients. Advantages of robotic harvest include no back scar, a shorter length of stay, and lower opioid requirements, although the difference was not significant; disadvantages include longer operative time and a higher seroma rate.

Clinical Question/Level of Evidence:
Therapeutic, III.
Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty
Authors: Rohrich Rod J. , Savetsky Ira L. , Suszynski Thomas M. , Mohan Raja , Avashia Yash J. 
Published: September 2020

Summary:
In an era with smartphone photography and social media (specifically, “selfies”), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis. The authors continue by describing idealized basal view aesthetics and provide a treatment algorithm for common deformities that include alar flaring and a wide nasal base. The authors attempt to provide a comprehensive approach to the treatment of the nasal base by discussing the implications of treating columellar deformities, tip positioning, or alar-columellar discrepancies on the overall aesthetics of the lower third of the nose. Furthermore, technical considerations are given for common surgical maneuvers addressing the alar base to help guide treatment and prevent complications such as poor scarring, notching, nostril asymmetry or stenosis (external valve obstruction), and alar deformities (“parenthesis” or “bowling pin”), to name a few.
Comparison of Superb Microvascular Imaging With Other Doppler Methods in Assessment of Testicular Vascularity in Cryptorchidism
Authors: Keçeli Merter , Keskin Zeynep , Keskin Suat 
Published: September 2020

Abstract
Superb microvascular imaging (SMI) is a new Doppler technique. Superb microvascular imaging can observe microvascular and low-velocity blood flow. Superb microvascular imaging is available in 2 modes: color SMI (cSMI) and monochrome SMI (mSMI). To evaluate testicular flow, we have compared color Doppler ultrasound (CDUS), power Doppler ultrasound (PDUS), Advanced Dynamic Flow (ADF), cSMI, and mSMI techniques.
Fifty-six participants less than 36 months of age were included in the study (mean age, 18.21 ± 1.5 months). One of the testes examined was in the scrotal sac, and the other was undescended testis (UT), and its location was at the level of the lower/middle inguinal canal. Testicular vascularization was evaluated with the CDUS, PDUS, ADF, and SMI techniques. Spot and linear signal encoding detected in the parenchyma were recorded between 0 and III for each technique. At the level of the testicle hilus, the outer boundary of the testicle was drawn manually along the long axis of each testis, and the vascularity index (VI) was automatically calculated from this area on the cSMI method.
There was no significant relationship between normal and undescended testicles in terms of age, weight, height, testicle volume, and VI. Superb microvascular imaging was found to be superior in showing testicular vascularity, especially UT. The power of detecting Doppler signal in mSMI is significantly higher than in other methods (P < 0.001). The most valuable method according to the power of detecting testicular vascularity was mSMI. Next were cSMI, ADF, PDUS, and CDUS.
In conclusion, the SMI technique should be included in vascular examination in pediatric patients with UT. The SMI technique can play an important role in assessing vascularization of UT.
Speech Outcomes Comparison Between Adult Velopharyngeal Insufficiency and Patients With Unrepaired Cleft Palate
Authors: Lou Qun , Wang Xudong , Chen Yang 
Published: September 2020

Objective:
This study compared the speech outcomes of adult velopharyngeal insufficiency patients and adult cleft palate (ACP) patients, and explored whether there was any difference in the phonological level of these 2 types of patients.

Methods:
Perceptual evaluation was used to assess speech intelligibility, hypernasality and compensatory articulation in 89 adult patients with velopharyngeal insufficiency and 35 adult patients with unrepaired cleft palate. Each group was divided into complete cleft palate and incomplete cleft palate (including submucous cleft palate). The phonological differences were compared between the 2 groups of patients and 2 types of cleft palate.

Results:
The mean speech intelligibility was 43.04% in velopharyngeal insufficiency group and 32.87% in ACP group. There was a significant difference in speech intelligibility between the 2 groups by T test, t = 2.916 (P < 0.01), speech intelligibility between 2 types of cleft palate was no significant difference. Also, there was a significant difference between the 2 groups in the constitution of hypernasality degree by Chi-Square test,
x

2 = 31.650 (P < 0.01), compensatory articulation were present in 74.3% ACP patients (26/35) and 47.2% velopharyngeal insufficiency patients (42/89),
x

2 = 7.446 (P < 0.01), there was a significant difference in incidence of compensatory articulation between the 2 groups.

Conclusions:
Adult patients with unpaired cleft palate present an even worse speech intelligibility and hypernasality degree than velopharyngeal insufficiency patients after cleft palate repair, regardless of the cleft type. Additionally, patients in ACP group have a higher incidence of compensatory articulation than that in incomplete cleft palate group. In sequenced treatments of cleft lip and palate, evaluation and treatment of speech disorders cannot be ignored.
Cleft Lip Repair in Premature Infants With Cardiac Risk Factors
Authors: Kalmar Christopher L. , Patel Vijay A. , Taylor Jesse A. 
Published: September 2020

Abstract
Despite cleft lip repair having demonstrated safety when performed in the outpatient setting, patients with comorbidities are significantly more likely to be hospitalized overnight. There are several comorbidities overrepresented with inpatient admission, but only cardiac risk has any association with adverse outcomes in premature patients. The severity of cardiac risk is significantly associated with adverse events at all degrees of prematurity (P all ≤0.002). In premature patients with major cardiac risk factors, adverse events are significantly associated with younger age (P = 0.016) and lower weight (P = 0.013). Performing cleft lip repair on children older than 125 days (P < 0.001, before cutoff: 50.0% vs after cutoff: 6.4%) and weight greater than 10 lbs (P < 0.001, before cutoff: 56.4% vs after cutoff: 6.1%) provides a significant reduction in postoperative adverse events in premature patients with major cardiac risk factors.
Pattern of Maxillofacial Trauma and Associated Factors in Traffic Accident Victims
Authors: Porto Damião Edgleys , Araújo Jéssica Maria do Nascimento , Júnior Cledinaldo Lira , Andrade Emanuel Savio de Souza 
Published: September 2020

Introduction:
Maxillofacial trauma (MFT) due to road traffic accidents are responsible for part of care provided at trauma centers.

Purpose:
This research aimed to analyze the pattern of MFTs and associated factors in victims of road traffic accidents.

Methods:
A total of 873 medical records of patients with MFTs in 2 reference hospitals for trauma in Northeastern Brazil during the period from January 2011 to December 2018 were analyzed. Data were included in the Tweedie multiple regression analysis to estimate the prevalence ratio (PR), with 95% confidence interval (95%CI) and P < 0.05.

Results:
Motorcycle accidents were the most prevalent (76.4%). Higher hospital costs were the result of patients victims of motorcycle accidents (PR = 1.56; 95%CI = 1.29–1.88; P < 0.001), diagnosed with mandible fracture (PR = 1.41; 95%CI = 1.07–1.86; P = 0.001) who had consumed alcoholic beverages (PR = 1.12; 95%CI = 1.00–1.25; P = 0.04) and did not use personal protective equipment (PPE) (PR = 1.29; 95%CI = 1.10–1.50; P = 0.001). Patients victims of motorcycle accidents remained in hospital longer than other etiologies (PR = 1.47; 95%CI = 1.23–1.76; P < 0.001). The consumption of alcoholic beverages resulted in more severe MFTs (PR = 2.05; 95%CI = 1.34–3.14; P = 0.001).

Conclusion:
Victims of motorcycle accidents remained hospitalized longer and resulted in higher hospital costs compared to other etiologies. Alcohol consumption increases hospital costs and the severity of MFTs. Higher hospital costs were also observed in patients who did not use PPE. Strategies need to be adopted to understand associated factors in MFTs such as the reallocation of resources to fund, implement and improve services and the surveillance in roads and highways, as well as prevention programs aimed at this health problem.
A Novel Classification of Relationship Between Nasal Septum and Inferior Turbinate Associated With Nasal Airway Obstruction in Patients With Unilateral Alveolar Cleft
Authors: Yan Huixin , Xu Yanbin , Wei Shuaishuai , Pan Yong-Chu , Wan Lin-Zhong , Du Yifei , Wang Yuli 
Published: September 2020

Objective:
This study aims to investigate nasal morphologies associated with nasal airway obstruction in unilateral alveolar cleft patients.

Methods:
A total of 234 unilateral alveolar cleft cases were performed cone beam computed tomography scans. The digital imaging and communication in medicine data were imported into Simplant Pro software. The radiographic features including nasal septum deviation and inferior turbinate hypertrophy as well as nasal airway volume and sinusitis were analyzed.

Results:
A new radiographic classification of relationship between nasal septum and inferior turbinate (NS-IT) on the cleft side was proposed and three types of NS-IT relationship (type I, II and III) were identified in 234 cases. The statistical analysis revealed that the nasal airway volume on non-cleft side was significantly higher than that on cleft side in each of three types (P
< 0.0001), while no difference of nasal airway volume on non-cleft side was found among three types. In addition, the nasal airway volume on non-cleft side in type I and II was significantly higher than that in type III (P < 0.0001). Also, type III presented higher rate of maxillary sinusitis (P = 0.0154) and ethmoid sinusitis on cleft side (P = 0.0490) than type I and II. The other indexes including clinical variances were not significant among three types.

Conclusions:
Unilateral alveolar cleft patients with type III NS-IT relationship could have nasal airway obstruction and higher rate of maxillary and ethmoid sinusitis on cleft side, which may be taken into account at primary cleft repair and alveolar bone grafting treatment.
Quantifying Upper Airway Changes Following Mandibular Orthognathic Surgery
Authors: Sahoo Nanda Kishore , Agarwal Shiv Shankar , Datana Sanjeev , Bhandari Sujit Kumar 
Published: September 2020

Abstract
The aim of this study was to quantify upper airway changes following mandibular orthognathic surgery. Treatment records of 50 patients who underwent mandibular orthognathic surgery were divided into 2 groups, that is, Group 1: Cases treated with Mandibular Advancement Surgery and Group 2: Cases treated with Mandibular Setback Surgery with 25 patients in each group. The Lateral Cephalogram and Acoustic Pharyngometry records of both groups were studied at T0 (01 week before surgery) and T1 (01 year postsurgery) for changes in linear airway measurements (Nasopharyngeal Airway Space - NAS, Superior Airway Space - SAS, Posterior Airway Space - PAS and Hypopharyngeal Airway Space (HAS)), hyoid bone position (Mandibular Plane Hyoid distance), mean area and mean volume. The percentage change and change in these parameters per millimeter advancement or setback of mandible at T1 was calculated. A significant increase in linear airway parameters (SAS and PAS); decrease in hyoid distance; and increase in volume and area of upper airway was observed at T1 in Group 1 and reverse was observed in Group 2. The change in airway parameters (SAS, PAS, mean volume and area) was more significant in Group 1 as compared to Group 2. In the current airway centric approach, meticulous assessment and prediction of long-term airway changes post surgery should be an integral part of ortho-surgical diagnosis and treatment planning and suitable modifications in the treatment plan must be made to cater for any potential adverse effects on airway.
The Impact of Palatal Fistulae on the Success of Alveolar Bone Grafting
Authors: Bradford Perry S. , Shaffrey Ellen C. , Le Paulina , Hoard Martin , Black Jonathan S. 
Published: September 2020

Abstract
Palatal fistulae are common complications of cleft palate surgery with a frequency of 5% to 29% and are challenging to repair. Optimal timing to repair palatal fistulae, in a staged fashion before alveolar bone grafting, or at the same time, still remains controversial. The primary aim of this study is to compare outcomes of 2 groups with regard to successful alveolar bone grafting in patients with cleft lip and palate and palatal fistulae. We describe a review of 85 consecutive patients identified as undergoing bone grafting from a single institution craniofacial team during 2003 to 2018. Twenty-eight required palatal fistula repair. All patients had a diagnosis of unilateral or bilateral complete cleft lip and palate. Patients with cleft lip and palate repairs were stratified based on preoperative or simultaneous palatal fistula repair. Panoramic radiographs were reviewed by 2 physicians to evaluate success of bone grafting. Comparison between cohorts was made by statistical analysis. Of the 28 that required palatal fistula repair, 15 (53.6%) patients underwent prebone grafting palatal fistula repair and 13 (46.4%) patients underwent simultaneous bone grafting with palatal fistula repair. Mean age at time of bone grafting and palatal fistula repair were 10.60 years old and 9.39 years old, respectively. Length to follow-up was 54.82 months. The average height of the healed alveolar cleft site for patients in the prebone grafting or simultaneous groups was 10.57 mm and 11.46 mm, respectively. Patients who underwent palatal fistula repair and simultaneous bone grafting had similar outcomes as those with palatal fistula repair preoperatively.
Insights from evolutionarily relevant models for human ageing
Authors: Emery Thompson Melissa , Rosati Alexandra G. , Snyder-Mackler Noah 
Published: September 2020

As the world confronts the health challenges of an ageing population, there has been dramatically increased interest in the science of ageing. This research has overwhelmingly focused on age-related disease, particularly in industrialized human populations and short-lived laboratory animal models. However, it has become clear that humans and long-lived primates age differently than many typical model organisms, and that many of the diseases causing death and disability in the developed world are greatly exacerbated by modern lifestyles. As such, research on how the human ageing process evolved is vital to understanding the origins of prolonged human lifespan and factors increasing vulnerability to degenerative disease. In this issue, we highlight emerging comparative research on primates, highlighting the physical, physiological, behavioural and cognitive processes of ageing. This work comprises data and theory on non-human primates, as well as under-represented data on humans living in small-scale societies, which help elucidate how environment shapes senescence. Component papers address (i) the critical processes that comprise senescence in long-lived primates; (ii) the social, ecological or individual characteristics that predict variation in the pace of ageing; and (iii) the complicated relationship between ageing trajectories and disease outcomes. Collectively, this work provides essential comparative, evolutionary data on ageing and demonstrates its unique potential to inform our understanding of the human ageing process.This article is part of the theme issue ‘Evolution of the primate ageing process’.