bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock*
Authors: Starr Michelle C. , Banks Russell , Reeder Ron W. , Fitzgerald Julie C. , Pollack Murray M. , Meert Kathleen L. , McQuillen Patrick S. , Mourani Peter M. , Chima Ranjit S. , Sorenson Samuel , Varni James W. , Hingorani Sangeeta , Zimmerman Jerry J. ,   for the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Published: June 2020

Objectives:
Acute kidney injury is common in critically ill children; however, the frequency of septic shock–associated acute kidney injury and impact on functional status are unknown. We evaluated functional outcomes of children with septic shock–associated acute kidney injury.

Design:
Secondary analysis of patients with septic shock from the prospective Life after Pediatric Sepsis Evaluation study. We defined acute kidney injury using Kidney Disease Improving Global Outcomes criteria, comparing patients with absent/Stage 1 acute kidney injury to those with Stage 2/3 acute kidney injury (severe acute kidney injury). Our primary outcome was a composite of mortality or new functional morbidity at day 28 of hospitalization or discharge. We also assessed poor long-term outcome, defined as mortality or a persistent, serious deterioration in health-related quality of life at 3 months.

Setting:
Twelve academic PICUs in the United States.

Patients:
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.

Interventions:
None.

Measurements and Main Results:
More than 50% of patients (176/348) developed severe acute kidney injury; of those, 21.6% (38/176) required renal replacement therapy. Twice as many patients with severe acute kidney injury died or developed new substantive functional morbidity (38.6 vs 16.3%; p < 0.001). After adjustment for age, malignancy, and initial illness severity, severe acute kidney injury was independently associated with mortality or new substantive morbidity (adjusted odds ratio, 2.78; 95% CI, 1.63–4.81; p < 0.001). Children with severe acute kidney injury had poorer health-related quality of life at 3 months (adjusted effect size 2.46; 95% CI, 1.44–4.20; p = 0.002). Children with severe acute kidney injury required longer duration of mechanical ventilation (11.0 vs 7.0 d; p < 0.001) and PICU stay (11.7 vs 7.1 d; p < 0.001).

Conclusions:
Among children with septic shock, severe acute kidney injury was independently associated with increased risk of death or new substantive functional morbidity. Survivors of sepsis with severe acute kidney injury were more likely to have persistent, serious health-related quality of life deterioration at 3 months.
Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI
Authors: Ajam Amna A. , Tahir Sana , Makary Mina S. , Longworth Sandra , Lang Elvira V. , Krishna Nidhi G. , Mayr Nina A. , Nguyen Xuan V. 
Published: June 2020

Abstract
Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients’ awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients’ motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.
Aesthetic and Anatomic Reconstruction of Polysyndactyly of the Fifth Toe Fused With the Fourth Toe
Authors: Chen Wei , Chen Lu , Huang Wei , Tian Xiaofei 
Published: June 2020

Background
The aim of the study was to present a new operative technique for aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe.

Methods
Surgery was performed in 86 feet in 73 patients with polysyndactyly of the fifth toe fused with the fourth toe. The operation involved polydactyly excision, syndactyly release using an improved dorsal asymmetric gullwing flap for web space reconstruction without skin grafting, and simultaneous correction of valgus deformity and brachydactyly of the toes. The web shape (height and width),scar contracture, and aesthetic outcomes (foot contour and morphology of the reconstructed fifth toe) were assessed using the criterion of D‘Arcangelo, Vancouver Scar Scale score, and older children and parent–based satisfactory questionnaire, respectively.

Results
The patients were followed up for 12 to 36 months. The reconstructed web spaces were slightly deeper than normal, with an hourglass shape and a physiological slope. Valgus deformity was completely corrected without recurrence. The reconstructed fifth toes appeared to be visually lengthened. On the basis of the criterion of D‘Arcangelo, the height and width of the webs were good in 76, fair in 10, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.5. All parents and patients were satisfied with the appearance and function.

Conclusions
Our new operative procedure could achieve aesthetic and anatomic reconstruction of polysyndactyly of the fifth toe fused with the fourth toe with good shape of the reconstructed web space without skin grafting, favorable appearance and axis alignment of the reconstructed fifth toes, and good foot contour.
Standardized Schematics for Facial Trauma Planning: A Clinical Education Tool
Authors: De Ruiter Brandon J. , Lesko Robert P. , Davidson Edward H. 
Published: June 2020

Introduction:
Learning facial fracture management principles can be challenging for surgical trainees. Residents must assimilate nuances of fixation techniques, skeletal biomechanics, and hardware use while managing acute work-flow limitations. This study aims to design a standardized-schematic for teaching facial fracture management and evaluate its performance improving resident operative planning.

Methods:
Printable schematics of the facial skeleton with soft-tissue overlay were developed. Instructions on depicting fracture pattern, incisions, plating sequence, loadbearing/sharing plates, locking/nonlocking screws, and mono/bicortical screws were given. Senior residents (n=5) evaluated computed tomography of 3 mandibular fractures and submitted 3 operative plans per case: first without guidance, then with written instruction, and finally using the schematic (n=45). Performance was graded on content and conceptual correctness. Data on time to completion was obtained. Likert-scale surveys assessing understanding, communication, and operative planning were given

Results:
Schematic use improved operative plan content and facilitated communication of resident operative schemes. Of 7 content domains spanning approach, plating strategy, and screw selection, a mean of 2.3, 3.7, and 6.5 were included with no guidance, written instruction, and schematic use respectively. Information on approach (P=0.001), plating type (P=0.02), screw location (P<0.000), screw depth (P=0.000), and screw locking status (P=0.000) were improved when comparing pre- and postintervention plans. Mean time to completion was 8 minutes and 54 seconds. All subjects “agreed” (n=2) or “strongly agreed” (n=3) that schematic use aided planning and communication.

Conclusions:
Simple, guided interventions can enhance surgical training by identifying knowledge gaps, improving visuospatial conceptualization, and facilitating targeted discussions with attendings.
Dental Topics for Plastic Surgeons, Part Two: Abnormal Tooth Development, Conditions, and Treatment
Authors: Zajac Jocelyn C. , Mantilla-Rivas Esperanza , Manrique Monica , Aivaz Marudeen , Ramirez-Suarez Karen I. , Wang Raymond , Oh Albert K. , Tate Anupama R. , Rogers Gary F. 
Published: June 2020

Abstract
Conditions that affect dental and periodontal structures receive sparse coverage in the plastic surgery literature, yet a working knowledge of this subject matter is important in certain areas of clinical practice and a fundamental understanding is part of plastic surgery competency tested on the in-service and written board examinations. This four-part series written to provide plastic surgeons with a working knowledge of dental topics that may be relevant to their clinical practice. This section, Part II, covers abnormal tooth development and related conditions.
Cleft Palate Repair: Predictive Factors of Difficulty and Planned Strategies to Solve It
Authors: Bennun Ricardo D. 
Published: June 2020

Introduction:
A cleft of the primary and/or secondary palate involve almost every function of the face except vision. Today, an isolate cleft palate or a complete cleft lip/palate should not be considered as an adverse condition because surgical repair has reached a highly satisfactory level. Nevertheless, for the average cleft surgeon palatoplasty still remains an enigma.

Planning the Strategy:
Having an observational and an anatomical measurement methodology of some pre op parameters, it would make possible to predict a complicate repair. In that way, the surgeon can select the best closure strategy, minimize surgical aggression, and even prevent the presence of sequels. Palates must be reviewed just before the operation, under general anesthesia, with the patient and the Dingman retractor in place. By using a precision caliper at least 4 parameters should to be considered to select the right strategy.

Conclusions:
Since 2009, author has selected the alveolar extension palatoplasty with complete muscle dissection and retro positioning, plus posterior pillars elongation with a hemi-uvula rotation and reconstruction as the procedure of choice for complete primary cleft palate repair. The utilization of the pre op mentioned parameters to identify cleft palate diversity and severity seems to be useful to select the correct strategy to perform cautious surgical procedures.
Myxoid Liposarcoma Metastasizing to the Parotid Gland
Authors: Daralioti Theodora , Petruzzi Gerardo , Zocchi Jacopo , Moretto Silvia , Pichi Barbara , Pellini Raul , De Virgilio Armando , Covello Renato 
Published: June 2020

Abstract
Localization of metastases into the parotid gland is a very uncommon event. Usually they arise from primary tumors located in the head and neck, mainly melanoma or epidermoid carcinoma of the skin, while other histotypes, from others anatomical districts, hardly have a metastatic spread to the parotid. Myxoid liposarcoma (MLS) is a rare malignant tumor of the soft tissue that mainly occurs in the extremities, representing the second most common subtype of liposarcoma. Although it is typical for liposarcomas to metastasize to the lungs, it is known that MLS can spread also to extra pulmonary sites. The authors report a case of myxoid liposarcoma of the left thigh in a 64-year-old man, with an unusual metastatic double presentation to the contralateral forearm first and to the parotid gland then. MLS with metastatic disease to the parotid gland is an extremely rare event with very few cases reported in the English literature.
Simple Approach for Internal Fixation of Repositioned Fat Pedicles in Transconjunctival Lower Eyelid Blepharoplasty
Authors: Wang Rongrong , Sun Jiaming , Guo Nengqiang 
Published: June 2020

Purpose:
To introduce an easy and effective approach for internal fixation of repositioned fat pedicles in transconjunctival lower eyelid blepharoplasty.

Methods:
Thirty-six consecutive patients underwent fat repositioning transconjunctival lower blepharoplasty from August 2016 to January 2018. After release of the orbicularis oculi muscle and exposure of the intraorbital fat pedicles, a supraperiosteal pocket was dissected. A 6-0 nylon suture was passed through the shaft of a hypodermic needle from the sharp tip, then the hypodermic needle was pierced through the cheek skin about 5 to 8 mm below the orbital rim into the dissected pocket, the hypodermic needle was next pull out and pierced through the same pinhole but different pathways into the dissection pocket again. The hypodermic needle was curved accordingly and passed through the lower surface tissue of the pocket, the needle was then taken out. Two ends of the 6-0 nylon suture were both brought out through the transconjunctival incison. One end of the 6-0 nylon suture was sewed through the free margin of the fat pedicle and tied tightly with the other end. The fat pads were transferred and blended well with midface fat. The severity of tear trough deformity were evaluated according to Barton's grading system by two independent plastic surgeons pre and post-operatively.

Results:
Tear trough deformity was improved in most cases. There were significant differences in preoperative and post-operative tear trough deformity grades (P < 0.5). All patients recover very well without significant complications. Three patients had transient mild to moderate lumpiness over the tear trough area, which were all resolved spontaneously eventually. One patient complained of retained fat tissue, and a revision surgery was given.

Conclusions:
In summary, The authors offered a new, simple, and effective approach to help fix the repositioned fat pads in transconjunctival lower lid blepharoplasty.
Risk Factors for Mandibular Fracture After Marginal Mandibular Resection
Authors: Sukegawa Shintaro , Saika Masato , Tamamura Ryo , Yamamoto Norio , Nakano Keisuke , Nagatsuka Hitoshi , Furuki Yoshihiko 
Published: June 2020

Purpose:
This study aimed to examine the relationship between post-operative mandibular fractures and its predictable risk factors in patients with marginal mandibular resection. Additionally, the timing of post-operative mandibular fractures was assessed.

Patients and methods:
Records of 37 patients with mandibular gingival carcinoma who underwent marginal mandibular resection at the Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, from April 2011 to March 2019 were retrospectively analyzed. The following variables were investigated: age, sex, location of carcinoma, tumor size, mandibular height on the surgical and healthy sides, surgical approach, number of residual teeth, post-operative radiotherapy, chemotherapy, and the presence or absence of diabetes and osteoporosis. Various risk factors for post-operative mandibular fractures were statistically investigated.

Results:
Post-operative mandibular fracture was observed in 5 (13.5%) of the 37 mandibular marginal resection cases. The average residual mandibular height in patients with post-operative mandibular fracture was 8.5 mm. A significant difference in residual mandibular height (P = 0.013) was observed between patients with post-operative mandibular fracture and those with no fracture. The average time to post-operative fracture of the mandible was 305.4 days, and it was found to be correlated to the remaining height of the mandibular body.

Conclusions:
A decrease in mandibular height below 9 mm results in post-operative mandibular fracture. Furthermore, a correlation between the height of the mandibular bone and the period until the post-operative mandibular fracture was noted in this study. These findings contribute to the prediction and management of mandibular fractures after mandibular margin resection.
Reconstruction of Full Thickness Calvarial Defect With Dermal Regeneration Template and Full Thickness Skin Graft After Encephaloduroarteriosynangiosis
Authors: Soteropulos Carol E. , Christie Brian M. , Afifi Ahmed M. 
Published: June 2020

Abstract
Full-thickness defects of the calvarium often present reconstructive challenges, necessitating large rotational flaps or microsurgical free tissue transfer. Although the vascularity of the scalp is robust, there is an increased risk of wound healing complications after both direct and indirect intracranial revascularization procedures as compared to routine craniotomies, as these procedures utilize extracranial scalp vasculature to supply the ischemic brain. Patients presenting with wound healing complications following intracranial revascularization surgeries may not be candidates for extensive reconstructive procedures, as they are often medically comorbid with cardiac disease, diabetes, and a paucity of recipient vessels for free tissue transfer due to underlying vascular disease that prompts initial revascularization surgery. We present a case of full-thickness calvarial reconstruction using dermal regeneration template and full-thickness skin grafting to the dura in a patient with a full thickness calvarial defect due to wound breakdown and exposed hardware following indirect intracranial revascularization with encephaloduroarteriosynangiosis.
Optimizing Reconstruction in Craniosynostosis: Review of Nonsyndromic Patients Treated With a Novel Technique
Authors: Rudy Hayeem L. , Herman Sean , Stern Carrie S. , Staffenberg David A. , Dowling Kamilah , Goodrich James T. , Tepper Oren M. 
Published: June 2020

Purpose:
Open cranial vault remodeling (CVR) with autologous split calvarial bone grafts redistributes and recontours an abnormal calvarium to create an expanded cranial vault in patients with craniosynostosis. We report a 12-year retrospective review of 162 nonsyndromic patients who underwent operative repair using our previously-described technique which portends excellent surgical outcomes and can be applied to patients of any age group and with any variety of suture fusion.

Methods:
Data was gathered on patients who underwent CVR from 2005 to 2016. Surgical records for each patient were analyzed and included operative time, estimated blood loss, and intraoperative transfusion volumes. Intraoperative and postoperative complications, the need for revision surgery, postoperative length of stay, and follow-up records were also reviewed. Syndromic patients were excluded, as well as patients with incomplete data sets. Patients who underwent either anterior or posterior vault remodeling were compared.

Results:
A total of 162 patients were included in this case series. Patients undergoing anterior CVR were significantly older than those undergoing posterior CVR (13.3 versus 11.0 months, P < 0.015) and also had significantly greater intraoperative red blood transfusion volumes (20.3 versus 15.3cc/kg, P < 0.0207) and longer operative time than posterior CVR patients (274.9 versus 216.7 minutes, P < 0.0001). No patients required reoperation for resorption or recurrence or persistent contour irregularities. There were no visual or neurological complications. Calvarial bone was successfully split in 100% of cases.

Conclusions:
This surgical approach to CVR results in good surgical outcomes with a low recurrence rate, while also maximizing operative efficiency, and minimizing total blood loss and transfusion volume. This technique can be applied to any affected suture in a patient with craniosynostosis and in patients of any age group.
Validation of the Adapted Clavien-Dindo in Trauma (ACDiT) Classifications in Medical and Surgical Management of Acute Diverticulitis
Authors: Wei Shuyan , Radwan Aiat , Mueck Krislynn M. , Wan Charlie , Wan David Q. , Millas Stefanos G. , Ko Tien C. , Holcomb John B. , Wade Charles E. , Naumann David N. , Kao Lillian S. 
Published: June 2020

Objectives:
To validate the adapted Clavien-Dindo in trauma (ACDiT) tool as a novel outcome measure for patients with acute diverticulitis managed both operatively and nonoperatively.

Background:
Complications following diverticulitis are difficult to classify because no traditional tools address patients managed both operatively and nonoperatively. The ACDiT grading system—graded from 0 to 5b—is applied in this manner but has not yet been validated for this patient group.

Methods:
We performed a 5-year observational study of patients with acute diverticulitis at a safety-net hospital. Baseline demographics and hospitalization data were collected. ACDiT scores were assigned, and validation was undertaken by comparing scores with hospital-free days, and verifying that higher scores were associated with known risk factors for poor outcomes. Inverse probability weighted propensity scores were assigned for surgical management, and inverse probability weighted regression analysis was used to determine factors associated with ACDiT ≥ grade 2.

Results:
Of 260 patients, 188 (72%) were managed nonoperatively. Eighty (31%) developed a complication; 73 (91%) were grades 1 to 3b. Higher grades correlated inversely with hospital-free days (rs = −0.67, P < 0.0001) for all patients and for nonoperative (rs = −0.63, P < 0.0001) and operative (rs = −0.62, P < 0.0001) patients. Hinchey 2 to 3 and initial operative management had higher odds of having a complication of ACDiT ≥ grade 2.

Conclusion:
The ACDiT tool was successfully applied to acute diverticulitis patients managed operatively and nonoperatively, is associated with known risk factors for adverse outcomes. ACDiT may be considered a meaningful outcome measure for comparing strategies for acute diverticulitis.
A Prospective Audit of 805 Consecutive Patients With Penetrating Abdominal Trauma
Authors: Sander Anthony , Spence Richard T. , McPherson Deidre , Edu Sorin , Nicol Andrew , Navsaria Pradeep 
Published: June 2020

Background:
Global trends of penetrating abdominal trauma (PAT) have seen a shift toward a selectively conservative management strategy. However, its widespread adoption for gunshot injuries has been sluggish. The purpose of this study is to compare the injury mechanisms of gunshot (GSW) and stab wounds (SW) to the abdomen in presentation, management, and outcomes.

Methods:
Prospective cohort study, set in Cape Town, South Africa, over 2 years. All patients presenting to the center with PAT during this time were included. Presentation, management, and outcomes were compared by injury mechanism, with a focus on the operative strategy (operative vs nonoperative).

Results:
During the study period, 805 patients (SW 37.6%; GSW 62.4%) with PAT were managed. Immediate laparotomies were performed in 119 (39.3%) SW and 355 (70.7%) GSW, with a therapeutic laparotomy rate of 85.7% and 91.8% for SW and GSW, respectively. Nonoperative management (NOM) was implemented in 184 SW (60.7%) and 147 GSW (29.3%) (P < 0.001), with a 92.9% and 92.5% success rate for SW and GSW, respectively. The therapeutic laparotomy rate for the delayed laparotomies (DOM) was 69.2% for SW, and 90.9% for GSW. The accuracy of clinical assessment (with adjuncts) in determining the need for laparotomy was: GSW—92% and SW—91%. Univariate analysis revealed the mechanism not to be associated with DOM. The overall mortality rate was 7.2%, and nonfatal morbidities 22.2%.

Conclusion:
Although GSW is a more morbid and often fatal injury, the general principles of selective conservatism hold true for both GSW and SW, equally.