bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block for lower extremity surgery
Authors: Zhao Jie , Huang Yanming , Fu Mingjie , Tao Fan 
Published: August 2020

Abstract

Rationale:
The anesthetic management of patients with severe pulmonary hypertension is different from that of normal, healthy patients, and regional nerve blocks are commonly used for them. Due to the individual variability of the course, distribution, and branching of the nerves below the inguinal ligament, the supra-inguinal fascia iliaca (SIFI) block has a wider and more stable blocking area. In combination with the sacral plexus block, they can satisfy the needs of surgical anesthesia below the hip.

Patient concerns:
A 46-year-old man with tuberculosis, chronic obstructive pulmonary disease, pulmonary heart disease, World Health Organization (WHO) class III pulmonary hypertension and right heart dysfunction, and American Society of Anesthesiologists physical status class III needed fixation of an intramedullary nail in the left lower extremity. Additionally, he had broken his left lower limb after a recent fall. Both general anesthesia and epidural anesthesia were not appropriate.

Diagnoses:
The patient had a clear history of tuberculosis, computerized tomography scan displayed destructive pneumonophthisis. Furthermore, he had chronic obstructive pulmonary disease and pulmonary heart disease.

Interventions:
An ultrasound-guided SIFI combined with a sacral plexus block was successfully performed for surgical anesthesia and avoided all hemodynamic fluctuations.

Outcomes:
We successfully performed an ultrasound-guided SIFI combined with a sacral plexus block for surgical anesthesia and avoided all hemodynamic fluctuations.

Lessons:
Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block can be suitable for anesthesia for patients with severe circulatory compromise.
Aggressive variant of splenic marginal zone lymphoma characterized using a cancer panel test and treated with rituximab-containing chemotherapy
Authors: Ishiguro Kazuya , Sasaki Yasushi , Takagi Yoshitake , Niinuma Takeshi , Suzuki Hiromu , Tokino Takashi , Hayashi Toshiaki , Takahashi Tohru , Igarashi Tetsuyuki , Matsuno Yoshihiro 
Published: August 2020

Abstract

Rationale:
Aggressive variant of splenic marginal zone lymphoma (AV-SMZL) is a very rare disease that is often associated with TP53 mutations and has a poor prognosis. On the other hand, recent advances in genome sequencing techniques enable us to understand the molecular characteristics of rare cancers such as AV-SMZL. Here we present a case of AV-SMZL analyzed using a genetic test.

Patient Concerns:
A 66-year-old woman was admitted with splenomegaly and lymphocytosis. Computed tomography revealed marked splenomegaly without lymphadenopathy in any other areas. The serum soluble interleukin-2 receptor (sIL-2R) level was significantly elevated. Peripheral and bone marrow blood tests showed an increase in abnormal lymphocytes.

Diagnosis:
A splenectomy revealed an SMZL pattern with increased numbers of large cells and mitotic cells and a high Ki-67 positivity rate, which led to a diagnosis of AV-SMZL. Although TP53 mutation was not detected, mutations in NOTCH2, NCOA4, PTEN, EPHA3, and KMT2D were identified. Among these, the mutations in NCOA4, PTEN, and EPHA3 were novel pathogenic mutations in SMZL, which suggests they may be related to the aggressiveness and persistence of the disease.

Interventions:
The patient was administered a rituximab-containing regimen and rituximab-maintenance therapy.

Outcomes:
The patient continues to exhibit a complete response.

Lessons:
This is a case of AV-SMZL in which a cancer panel test successfully detected genetic alterations that are potentially associated with its pathogenesis. These findings suggest that genetic analysis is useful for making diagnoses as well as for determining treatment strategies in AV-SMZL.
Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis
Authors: Li Ning , Wang Rui , Teng Wei , Yu Jinhua 
Published: August 2020

Abstract

Background:
The objective of this meta-analysis was to summarize and identify the available evidence from these studies to estimate which device was better for multilevel cervical spondylotic myelopathy (MCSM). And provides clinicians with evidence on which to base their clinical decision making.

Methods:
This review will include all studies comparing the new Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion (ACDF) for the treatment of MCSM. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the July, 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is operative time, blood loss, clinical function outcome, radiologic outcomes, and complications. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software.

Results:
This study will summarize current evidence to assess the efficacy and safety of Zero-profile versus cage-plate interbody fusion system in ACDF for the treatment of MCSM.

Conclusion:
The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as comparing the 2 devices in ACDF for MCSM

Registration number:
INPLASY202070095 (DOI number: 10.37766/inplasy2020.7.0095).
A Systematic Review of Nonsurgical Vulvovaginal Restoration Devices: An Evidence-Based Examination of Safety and Efficacy
Authors: Preminger B. Aviva , Kurtzman Joey S. , Dayan Erez 
Published: August 2020

Background:
The efficacy and safety of vulvovaginal restoration devices were called into question in a U.S. Food and Drug Administration statement on July 30, 2018, claiming that women are being harmed by laser and other energy-based devices. The goal of this systematic literature review was to assess existing data, determine gaps in evidence, and propose opportunities for continued investigation pertaining to laser and energy-based vaginal restoration techniques.

Methods:
A review of literature using PubMed, Cochrane Library databases, Embase, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature was conducted on January 9, 2019, and articles up to this point were considered. For inclusion, studies had to be available or translated in English and relate to clinical medicine, direct patient care, and nonsurgical energy-based vulvovaginal procedures.

Results:
The authors found five level I studies, 19 level II studies, four level III studies, and 46 level IV studies that used 15 different devices. Various degrees of improvement of symptoms were reported in all studies. Adverse events/side effects were noted in two of the 13 radiofrequency device studies, 15 of the 23 erbium:yttrium-aluminum-garnet device studies, and 17 of the 37 carbon dioxide device studies. The majority of adverse events were considered mild.

Conclusions:
The majority of studies resulted in mild to no adverse side effects. However, there is a large gap in level I evidence. As a result, the authors emphasize the necessity of supplemental data surrounding this subject and suggest that additional randomized sham-controlled studies be conducted to further investigate vulvovaginal restoration devices in an effort to address women’s health issues.
The Baker Classification for Capsular Contracture in Breast Implant Surgery Is Unreliable as a Diagnostic Tool
Authors: de Bakker Erik , Rots Mathijs , Buncamper Marlon E. , Niessen Frank B. , Smit Jan Maerten , Winters Henri A. H. , Özer Müjde , de Vet Henrica C. W. , Mullender Margriet G. 
Published: August 2020

Background:
Breast implants are frequently used in cosmetic and reconstructive breast surgery. Capsular contracture, the most common long-term complication, is usually graded using the Baker classification. Despite its widespread use, the reliability of the Baker classification has never been established. The aim of this study was to determine the interobserver reliability and agreement of the Baker classification.

Methods:
Sixty women who had undergone cosmetic breast augmentation were included. They were examined independently by two plastic surgeons from an observer pool. The Baker score was determined, along with firmness, dislocation, symmetry, and pain using four-point scales. Patients were asked to complete the BREAST-Q postaugmentation module. The interobserver reliability and agreement were calculated for all variables with a quadratic weighted kappa.

Results:
The interobserver reliability of the Baker classification was poor (kappa, 0.55; 95 percent CI, 0.37 to 0.72). Interobserver reliability of the clinical parameters firmness (0.64; 95 percent CI, 0.49 to 0.79), dislocation (0.49; 95 percent CI, 0.26 to 0.73), and symmetry (0.61; 95 percent CI, 0.34 to 0.88) was also poor. Pain scores seemed more reliable (0.72; 95 percent CI, 0.56 to 0.89); however, most patients had no pain. The interobserver agreement for the Baker score was 48 percent; in 43 percent, the observers differed one category; and in 12 percent, the difference was more than one category.

Conclusions:
Interobserver reliability and observer agreement of the Baker classification for capsular contracture were poor. Consensus about how to adequately rate the symptoms of capsular complaints is lacking. A more reliable method of measurement or description is needed, especially for scientific research purposes, to assess the long-term problems associated with breast implants.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Navigating the Insurance Landscape for Coverage of Reduction Mammaplasty
Authors: Rawes Catherine M. A. , Ngaage Ledibabari M. , Borrelli Mimi R. , Puthumana Joseph , Slezak Sheri , Rasko Yvonne M. 
Published: August 2020

Background:
Reduction mammaplasty provides symptomatic relief to patients with macromastia. Insurance companies act as gatekeepers of health care by determining the medical necessity of surgical procedures, including reduction mammaplasty. The authors sought to evaluate insurance coverage and policy criteria for reduction mammaplasty.

Methods:
The authors conducted a cross-sectional analysis of U.S. insurance policies on reduction mammaplasty. Insurance providers were selected based on their enrolment data and market share. The authors conducted telephone interviews and Web-based searches to identify the policies. Medical necessity criteria were abstracted from the publicly available policies that offered coverage.

Results:
The authors reviewed 63 insurers. One in 10 insurers had no established policy for reduction mammaplasty. Of the 48 publicly available policies, shoulder pain and backache were the most common symptoms required for preapproval (98 percent and 98 percent). A minimum resection volume was requested by 88 percent of policies. One-third of policies (31 percent) offered a choice between removal of a minimum weight per breast or a volume based on body surface area. Over half of companies (54 percent) used body surface area calculations to predict minimum resection volume. Medical necessity that extended beyond national recommendations included trial of weight loss (23 percent) and nipple position (10 percent).

Conclusions:
Insurance policy criteria for reduction mammaplasty are discordant with current national recommendations and current clinical evidence. Many policies use outdated criteria that do not correlate with symptom relief and consequently limit access to reduction mammaplasty. Here, the authors propose a comprehensive guideline to maximize coverage of reduction mammaplasty.
Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis
Authors: Retrouvey Helene , Sander Beate , von Schroeder Herbert P. , Binhammer Paul , Baltzer Heather L. 
Published: August 2020

Background:
The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective?

Methods:
A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies—(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty—were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime.

Results:
The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion.

Conclusions:
The authors’ analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.
Doxycycline-Coated Silicone Breast Implants Reduce Acute Surgical-Site Infection and Inflammation
Authors: Baker Jennifer E. , Seitz Aaron P. , Boudreau Ryan M. , Skinner Mitchell J. , Beydoun Ahmed , Kaval Necati , Caldwell Charles C. , Gulbins Erich , Edwards Michael J. , Gobble Ryan M. 
Published: August 2020

Background:
Surgical-site infection after implant-based breast reconstruction remains a leading cause of morbidity. Doxycycline is an antibiotic used to treat soft-tissue infections. The authors hypothesize that doxycycline-coated breast implants will significantly reduce biofilm formation, surgical-site infection, and inflammation after bacterial infection.

Methods:
Pieces of silicone breast implants were coated in doxycycline. In vitro studies to characterize the coating include Fourier transmission infrared spectroscopy, elution data, and toxicity assays (n = 4). To evaluate antimicrobial properties, coated implants were studied after methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa inoculation in vitro and in a mouse model at 3 and 7 days (n = 8). Studies included bacterial quantification, cytokine profiles, and histology.

Results:
Coated silicone breast implants demonstrated a color change, increased mass, and Fourier transmission infrared spectroscopy consistent with a doxycycline coating. Coated implants were nontoxic to fibroblasts and inhibited biofilm formation and bacterial adherence after MRSA and P. aeruginosa incubation in vitro, and measurable doxycycline concentrations at 24 hours were seen. In a mouse model, a significant reduction of MRSA and P. aeruginosa bacterial colonization after 3 and 7 days in the doxycycline-coated implant mice was demonstrated when compared to the control mice, control mice treated with intraperitoneal doxycycline, and control mice treated with a gentamicin/cefazolin/bacitracin wash. Decreased inflammatory cytokines and inflammatory cell infiltration were demonstrated in the doxycycline-coated mice.

Conclusions:
A method to coat silicone implants with doxycycline was developed. The authors’ doxycycline-coated silicone implants significantly reduced biofilm formation, surgical-site infections, and inflammation. Further studies are needed to evaluate the long-term implications.
Indocyanine Green Angiography Predicts Tissue Necrosis More Accurately Than Thermal Imaging and Near-Infrared Spectroscopy in a Rat Perforator Flap Model
Authors: Han Tinglu , Khavanin Nima , Wu Jinlin , Zang Mengqing , Zhu Shan , Chen Bo , Li Shanshan , Liu Yuanbo , Sacks Justin M. 
Published: August 2020

Background:
Clinical examination alone is neither sensitive nor specific for predicting flap necrosis, so several technologies, including indocyanine green angiography, thermal imaging (using the FLIR ONE), and near-infrared spectroscopy, have been developed to supplement perfusion assessment. This study aims to compare the accuracy of these three methods for intraoperatively predicting clinical flap necrosis in a rat perforator flap model. The authors hypothesized that near-infrared spectroscopy, assessing oxygenation rather than direct perfusion, would yield significantly different predictions.

Methods:
A 10 × 3-cm epigastric perforator flap was elevated in 14 adult male rats weighing 250 ± 50 g. Flap perfusion was assessed immediately after flap elevation using thermal imaging, near-infrared spectroscopy, and indocyanine green angiography. Measurements were correlated to the clinical endpoint and gold standard of flap necrosis on postoperative day 7.

Results:
All three technologies detected significant differences in perfusion along flap length (all p < 0.001), and were associated with significant differences in the odds of developing flap necrosis (all p < 0.001). The areas under the receiver operating characteristic curves were 0.948 for indocyanine green angiography as an absolute value, 0.873 for relative changes with thermal imaging, and 0.792 for tissue oxygenation. The sensitivity, specificity, and accuracy for indocyanine green angiography measured as an absolute value were the highest at 97.8, 87.5, and 92 percent, respectively.

Conclusions:
Indocyanine green angiography most accurately predicted flap necrosis in this study; however, tissue oximetry and thermal imaging were also capable of predicting necrosis and represented potentially less expensive or more readily available alternatives for objective perfusion assessment. Additional research can further delineate their roles and cost-efficacy in clinical practice.
The Medial Sural Artery Perforator Flap: Lessons Learned from 200 Consecutive Cases
Authors: Deek Nidal F. AL , Hsiao Jo-Chun , Do Nicolas T. , Kao Huang-Kai , Hsu Chung-Chen , Lin Chih-Hung , Lin Cheng-Hung 
Published: August 2020

Background:
The medial sural artery perforator flap is a versatile option in reconstructive microsurgery. However, most reports of this flap have been limited by sample size. This study reviews the experience of a single large-volume center using the medial sural artery perforator flap and its variants for a variety of reconstructive purposes.

Methods:
A retrospective review of all patients who received the medial sural artery perforator flap reconstruction between March of 2006 and July of 2014 was performed.

Results:
Two-hundred medial sural artery perforator flaps were used at three anatomical regions: head and neck (n = 129), upper extremity (n = 47), and lower extremity (n = 24). Flaps were transferred as free (n = 189) and pedicled (n = 11). Overall flap survival was 96 percent. Flap variants used included chimeric flap (n = 11) and dual skin paddle (n = 2). Plantaris tendon and saphenous/sural nerve graft were harvested in conjunction in 20 and seven patients, respectively. In 5 percent of the cases harvested in the conventional manner, a reliable perforator could not be found.

Conclusions:
The medial sural artery perforator flap is a reliable, alternative workhorse flap for nearly any small- to medium-size defect. It can be harvested as free or pedicled and the option to include multiple tissue components further expands its versatility.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Telemedicine and Plastic and Reconstructive Surgery: Lessons from the COVID-19 Pandemic and Directions for the Future
Authors: Saad Noah H. , AlQattan Husain T. , Ochoa Oscar , Chrysopoulo Minas 
Published: August 2020

Summary:
Telemedicine holds vast amounts of potential in changing the way outpatient plastic and reconstructive surgery is practiced. Before the coronavirus disease 2019 (COVID-19) pandemic, video conferencing was used by a small fraction of medical specialties. However, since the start of the pandemic, the Centers for Medicare and Medicaid Services and the largest private health insurance companies have relaxed regulations to allow the majority of specialties to use video conferencing in lieu of in-person visits. Most importantly, video conferencing minimizes patient and physician exposure in situations such as these, and decreases risk in the immunocompromised population. Video conferencing, which has been shown to be just as safe and efficacious in treating patients, offers the ability to follow up with physicians while saving travel time and travel-related expenses. This in turn correlates with increased patient satisfaction. Video conferencing also allows physicians to expand their reach to patients in rural areas seeking advanced professional advice. Incorporating video conferencing into existing practices will make for a more efficient practice, improve patient satisfaction, and decrease cost to patients and the health care system.
The Western Trauma Association at 50: Still about trauma care, friendship, family, and snow
Authors: Metzdorff Mark T. , Livingston David H. , Esrig Barry C. , Sherman Harold F. 
Published: August 2020

ABSTRACT
This article is a synopsis of a book created for the 50th anniversary meeting of the Western Trauma Association in February 2020. On the occasion of the 50th Anniversary of the Western Trauma Association, a review of the organization’s history, its contribution to trauma care and the development of leaders in the field, and its enduring unique culture reveals a vibrant association grounded in the values of its founders and well-positioned to continue successfully into the next 50 years.
Major Thromboembolic Complications in Liver Transplantation: The Role of Rotational Thromboelastometry and Cryoprecipitate Transfusion
Authors: Nguyen-Buckley Christine , Gao Wei , Agopian Vatche , Wray Christopher , Steadman Randolph H. , Xia Victor W. 
Published: August 2020

Background.
Although hemorrhage is a major concern during liver transplantation (LT), the risk for thromboembolism is well recognized. Implementation of rotational thromboelastometry (ROTEM) has been associated with the increased use of cryoprecipitate; however, the role of ROTEM-guided transfusion strategy and cryoprecipitate administration in the development of major thromboembolic complications (MTCs) has never been documented.

Methods.
We conducted a study on patients undergoing LT before and after the implementation of ROTEM. We defined MTC as intracardiac thrombus, pulmonary embolism, hepatic artery thrombosis, and ischemic stroke in 30 d after LT. We used a propensity score to match patients during the 2 study periods.

Results.
Among 2330 patients, 119 (4.9%) developed MTC. The implementation of ROTEM was significantly associated with an increase in cryoprecipitate use (1.1 ± 1.1 versus 2.9 ± 2.3 units, P < 0.001) and MTC (4.2% versus 9.5%, P < 0.001). Further analysis demonstrated that the use of cryoprecipitate was an independent risk factor for MTC (odds ratio 1.1, 95% confidence interval 1.04-1.24, P = 0.003). Patients with MTC had significantly lower 1-y survival.

Conclusions.
Our study suggests that the implementation of ROTEM and the use of cryoprecipitate play significant roles in the development of MTC in LT. The benefits and risks of cryoprecipitate transfusion should be carefully evaluated before administration.