bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients
Authors: Gabriel Allen , Sigalove Steven , Storm-Dickerson Toni L. , Sigalove Noemi M. , Pope Nicole , Rice Jami , Maxwell G. Patrick 
Published: March 2020

Background:
Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m2) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction.

Methods:
High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.

Results:
Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.

Conclusion:
Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Who, What, Where: Demographics, Severity of Presentation, and Location of Treatment Drive Delivery of Diabetic Limb Reconstructive Services within the National Inpatient Sample
Authors: Fan Kenneth L. , DeLia Derek , Black Cara K. , Zolper Elizabeth , Singh Tanvee , Wirth Peter , Luvisa Kyle , Song David H. , Attinger Christopher E. , Evans Karen K. 
Published: March 2020

Background:
Technical advances have been made in reconstructive diabetic limb salvage modalities. It is unknown whether these techniques are widely used. This study seeks to determine the role of patient- and hospital-level characteristics that affect use.

Methods:
Admissions for diabetic lower extremity complications were identified in the 2012 to 2014 National Inpatient Sample using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. The study cohort consisted of admitted patients receiving amputations, limb salvage without flap techniques, or advanced limb salvage with flap techniques. Multinomial regression analysis accounting for the complex survey design of the National Inpatient Sample was used to determine the independent contributions of factors expressed as marginal effects.

Results:
The authors’ study cohort represented 155,025 admissions nationally. White non-Hispanic patients had the highest proportion of reconstruction without and with flaps, whereas black patients had the lowest. Multinomial regression models revealed that controlling for nongas gangrene and critical limb ischemia, both of which have a much greater incidence in minorities, the effect of race against receipt of reconstructive modalities was attenuated. Access to urban teaching hospitals was the strongest protective factor against amputation (9 percent reduction; p < 0.01) and predictor of receiving limb salvage without flaps (5 percent increase; p < 0.01) and with flaps (3 percent increase; p < 0.01).

Conclusions:
This study identified multiple patient- and hospital-level factors associated with decreased access to the gamut of reconstructive limb salvage techniques. Disparity reduction will likely require a multifaceted strategy that addresses the severity of disease presentation seen in minorities and delivery system capabilities affecting access and use of reconstructive limb salvage procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Do We Publish What We Present? A Critical Analysis of Abstracts Presented at Three Plastic Surgery Meetings
Authors: Asaad Malke , Rajesh Aashish , Tarabishi Ahmad S. , Sakkal Najeeb , Banuelos Joseph , Vyas Krishna S. , Tran Nho V. 
Published: March 2020

Background:
Presentation of research at scientific conferences provides an opportunity for researchers to disseminate their work and gain peer feedback. However, much of the presented work is never published in peer-reviewed journals. The authors analyzed the conversion rate of abstracts presented at three national plastic surgery meetings.

Methods:
Abstracts presented at the American Association of Plastic Surgeons (AAPS), the American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Research Council (PSRC) annual meetings in 2014 and 2015 were identified to analyze the rates of successful conversion into full-text publications. Meeting administrators were contacted to obtain the respective acceptance rates of submitted abstracts.

Results:
A total of 1174 abstracts were analyzed. The overall conversion rate was 65 percent. The AAPS meeting had the highest conversion rate (73 percent), followed by the PSRC (66 percent) and the ASPS (61 percent). Conversely, the AAPS meeting had a lower acceptance rate (28 percent) compared with the ASPS (42 percent) and PSRC (49 percent) meetings. The conversion rate was significantly higher for abstracts from native English-speaking countries, whereas no significant differences were noted between oral and poster presentations. Plastic and Reconstructive Surgery had the highest percentage of published manuscripts (34 percent). Abstracts presented at the PSRC meeting had the highest mean impact factor for the journal of publication. First authors changed in 31 percent and last authors changed in 18 percent of publications. The overall median time to publication from the date of presentation was 13 months.

Conclusions:
Almost two-thirds of abstracts presented at AAPS, ASPS, and PSRC meetings successfully converted into full-text publications. Plastic surgery departments/divisions should follow unpublished work in their institutions to benefit both patients and the scientific community.
Calcified Adrenal Lesions: Pattern Recognition Approach on Computed Tomography With Pathologic Correlation
Authors: Consul Nikita , Venkatesan Aradhana M. , Blair Katherine J. , Morshid Ali , Menias Christine O. , Shaaban Akram M. , Elmohr Mohab M. , Gaballah Ayman H. , Elsayes Khaled M. 
Published: March 2020

Abstract
Incidental adrenal lesions are found in 2% to 10% of the population. The presence and pattern of calcifications, in conjunction with other clinical and imaging features, such as soft tissue attenuation, enhancement, and laterality, can aid in narrowing a differential diagnosis, thereby preventing unnecessary biopsies and avoiding delays in management. Calcified adrenal lesions can be categorized under the clinical and laboratory headings of normal adrenal function, hyperfunctioning adrenal tissue, and adrenal insufficiency. In this review, we provide an algorithmic approach to assessing calcified adrenal nodules with correlative radiologic findings.
Use of Spectral Detector Computed Tomography to Improve Liver Segmentation and Volumetry
Authors: Ng Yee Seng , Xi Yin , Qian Yuxiao , Ananthakrishnan Lakshmi , Soesbe Todd C. , Lewis Matthew , Lenkinski Robert , Fielding Julia R. 
Published: March 2020

Introduction
Liver segmentation and volumetry have traditionally been performed using computed tomography (CT) attenuation to discriminate liver from other tissues. In this project, we evaluated if spectral detector CT (SDCT) can improve liver segmentation over conventional CT on 2 segmentation methods.

Materials and Methods
In this Health Insurance Portability and Accountability Act–compliant institutional review board–approved retrospective study, 30 contrast-enhanced SDCT scans with healthy livers were selected. The first segmentation method is based on Gaussian mixture models of the SDCT data. The second method is a convolutional neural network–based technique called U-Net. Both methods were compared against equivalent algorithms, which used conventional CT attenuation, with hand segmentation as the reference standard. Agreement to the reference standard was assessed using Dice similarity coefficient.

Results
Dice similarity coefficients to the reference standard are 0.93 ± 0.02 for the Gaussian mixture model method and 0.90 ± 0.04 for the CNN-based method (all 2 methods applied on SDCT). These were significantly higher compared with equivalent algorithms applied on conventional CT, with Dice coefficients of 0.90 ± 0.06 (P = 0.007) and 0.86 ± 0.06 (P < 0.001), respectively.

Conclusion
On both liver segmentation methods tested, we demonstrated higher segmentation performance when the algorithms are applied on SDCT data compared with equivalent algorithms applied on conventional CT data.
Potential of Radiation Dose Reduction by Optimizing Z-Axis Coverage in Coronary Computed Tomography Angiography on a Latest-Generation 256-Slice Scanner
Authors: von Felten Elia , Messerli Michael , Giannopoulos Andreas A. , Benz Dominik C. , Schwyzer Moritz , Benetos Georgios , Rampidis Georgios , Patriki Dimitri , Kamani Christel H. , Gräni Christoph , Fuchs Tobias A. , Pazhenkottil Aju P. , Gebhard Catherine , Kaufmann Philipp A. , Buechel Ronny R. 
Published: March 2020

Objective
The purpose of this study was to quantify the reduction in radiation dose achievable by using the optimal z-axis coverage in coronary computed tomography (CT) angiography (CCTA) on a latest-generation 256-slice scanner.

Methods
A total of 408 scans were reviewed that were performed on a wide-range detector scanner allowing up to 16-cm z-axis coverage (adjustable in 2-cm increments). For each CCTA study, we assessed the radiation dose (ie, dose-length product and volume CT dose index) and measured the minimum z-axis coverage necessary to cover the complete cardiac anatomy. We calculated the potential radiation dose savings achievable through reduction of the z-axis coverage to the minimum necessary.

Results
The majority of the CCTA scans were performed with a z-axis coverage of 16 cm (n = 285, 69.9%), followed by 14 cm (n = 121, 29.7%) and 12 cm (n = 2, 0.5%). In the group that was scanned with a collimation of 16 cm, radiation dose could have been reduced by 12.5% in 55 patients, 25% in 195 patients, and 37.5% in 33 patients when using optimal z-axis coverage for CCTA. In the group that was scanned with a collimation of 14 cm, radiation dose could have been reduced by 14.3% in 90 patients, and 28.6% in 30 patients, whereas in the group that was scanned with a collimation of 12 cm, dose could have been reduced by 16.7% in 2 patients.

Conclusions
Using correct z-axis coverage in CCTA on a latest-generation 256-slice scanner yields average dose reductions of 22.0% but may be as high as 37.5%.
Liver Imaging Reporting and Data System Version 2018: What Radiologists Need to Know
Authors: Abdel Razek Ahmed Abdel Khalek , El-Serougy Lamiaa Galal , Saleh Gehad Ahmad , Shabana Walaa , Abd El-wahab Rihame 
Published: March 2020

Abstract
In this article, we aim to review Liver Imaging Reporting and Data System version 18 (LI-RADS v2018). Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Liver Imaging Reporting and Data System developed for standardizing interpreting, reporting, and data collection of HCC describes 5 major features for accurate HCC diagnosis and several ancillary features, some favoring HCC in particular or malignancy in general and others favoring benignity. Untreated hepatic lesions LI-RADS affords 8 unique categories based on imaging appearance on computed tomography and magnetic resonance imaging, which indicate the possibility of HCC or malignancy with or without tumor in vein. Furthermore, LI-RADS defines 4 treatment response categories for treated HCCs after different locoregional therapy. These continuous recent updates on LI-RADS improve the communication between the radiologists and the clinicians for better management and patient outcome.
Cranial Vault Remodeling in Children With Ventricular Shunts
Authors: Sinclair Nicholas , Ordenana Carlos , Lee Joan , Onwuzulike Kaine , Recinos Violette , Papay Francis , Rampazzo Antonio , Bassiri Gharb Bahar 
Published: March 2020

Introduction:
Cranial vault surgery in children with ventricular shunts is more complex due to the possible interference of shunt location with surgical planning and increased risk of shunt related complications. The study evaluated the management of ventricular shunts during cranial vault remodeling (CVR) and subsequent outcomes and complications following CVR.

Methods:
An IRB-approved retrospective chart review was performed including patients who underwent CVR in presence of a ventricular shunt. Measured outcomes were number of shunt revisions following CVR, 30-day complication rate, 3-month complication rate, and post-CVR Whitaker classification. Finally, a review of the literature was performed, and our results were compared to previous reports.

Results:
Eleven patients met the inclusion criteria. Ventricular shunt was not exposed in 18%; exposed and not revised in 54%; exposed and left on a bone peninsula in 18% and simultaneously exposed and revised in 18%. Two patients experienced complications within 30-days. Three additional patients experienced complications within 3-months. An average of 2.2 shunt revisions per patient were performed following CVR. Whitaker classification was I in 7 patients, II in 1 patient and III in 2 patients. Shunt revision rate for patients undergoing CVR for hydrocephalic macrocephaly was on average of 1.2 and 1.9 for shunt-induced craniosynostosis in literature.

Conclusions:
Cranial vault abnormalities in the presence of a ventricular shunt can be effectively treated with CVR. The presence of a shunt does not seem to interfere with final head shape. While leaving the shunt unexposed may appear less morbid, shunt related complications can still occur with this approach.
Application of Human Amniotic Membrane in Temporomandibular Joint Osteoarthritis
Authors: Lopez-Martos Ricardo , Martin-Lozano Guiomar , Ocete-Perez Rafael-Felix , Gonzalez-Perez Luis-Miguel , Gutierrez-Perez Jose-Luis , Infante-Cossio Pedro 
Published: March 2020

Abstract
Human amniotic membrane (HAM) has recently been used as an interpositional material to prevent ankylosis or primary re-ankylosis after temporomandibular joint (TMJ) arthroplasty. Here, the authors describe an unusual case of a 32-year-old woman who presented with a noninflammatory degenerative osteoarthritis of the TMJ in which a HAM was placed following a high condylar arthroplasty and discectomy and show the clinicoradiological results. The procedure resulted in total pain relief and significant improvement in jaw movements. On the long-term follow-up computed tomography, complete remodeling of the glenoid fossa with formation of new ectopic bone was observed. While the application of a HAM can be an alternative procedure to prevent ankylosis when performing a discectomy and arthroplasty, this clinical report highlights the possibility that it can induce ectopic bone formation at this location.
Opioid exposure after injury in United States trauma centers: A prospective, multicenter observational study
Authors: Harvin John A. , Truong Van Thi Thanh , Green Charles E. , Allen LaDonna , Murry Jason , Radosevich John J. , Bogert James N. , Murphy Patrick B. , Padilla-Jones Brandy B. , Zarzaur Ben L. , Taylor John R. , Sexton Kevin W. , Decker Cassandra , Schroeppel Thomas J. , Wade Charles E. , Kao Lillian S. 
Published: March 2020

BACKGROUND
Efforts to reduce opioid use in trauma patients are currently hampered by an incomplete understanding of the baseline opioid exposure and variation in United States. The purpose of this project was to obtain a global estimate of opioid exposure following injury and to quantify the variability of opioid exposure between and within United States trauma centers.

STUDY DESIGN
Prospective observational study was performed to calculate opioid exposure by converting all sources of opioids to oral morphine milligram equivalents (MMEs). To estimate variation, an intraclass correlation was calculated from a multilevel generalized linear model adjusting for the a priori selected variables Injury Severity Score and prior opioid use.

RESULTS
The centers enrolled 1,731 patients. The median opioid exposure among all sites was 45 MMEs per day, equivalent to 30 mg of oxycodone or 45 mg of hydrocodone per day. Variation in opioid exposure was identified both between and within trauma centers with the vast majority of variation (93%) occurring within trauma centers. Opioid exposure increased with injury severity, in male patients, and patients suffering penetrating trauma.

CONCLUSION
The overall median opioid exposure was 45 MMEs per day. Despite significant differences in opioid exposure between trauma centers, the majority of variation was actually within centers. This suggests that efforts to minimize opioid exposure after injury should focus within trauma centers and not on high-level efforts to affect all trauma centers.

LEVEL OF EVIDENCE
Epidemiological, level III.
Laparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes
Authors: Krielen Pepijn , Di Saverio Salomone , ten Broek Richard , Renzi Claudio , Zago Mauro , Popivanov Georgi , Ruscelli Paolo , Marzaioli Rinaldo , Chiarugi Massimo , Cirocchi Roberto 
Published: March 2020

BACKGROUND
Adhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consists of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although adhesiolysis was among the first surgical procedures to be approached laparoscopically, uncertainty remains about its potential advantages over open surgery. Therefore, we performed a systematic review and meta-analysis on the benefits and harms of laparoscopic surgery for ASBO.

METHODS
A systematic literature review was conducted for articles published up to May 2019. Two reviewers screened all articles and did the quality assessment. Consecutively a meta-analysis was performed. To reduce selection bias, only matched studies were used in our primary analyses. All other studies were used in a sensitivity analyses. All the outcomes were measured within the 30th postoperative day. Core outcome parameters were postoperative mortality, iatrogenic bowel perforations, length of postoperative stay [days], severe postoperative complications, and early readmissions. Secondary outcomes were operative time [min], missed iatrogenic bowel perforations, time to flatus [days], and early unplanned reoperations.

RESULTS
In our meta-analysis, 14 studies (participants = 37.007) were included: 1 randomized controlled trial, 2 matched studies, and 11 unmatched studies. Results of our primary analyses show no significant differences in core outcome parameters (postoperative mortality, iatrogenic bowel perforations, length of postoperative stay, severe postoperative complications, early readmissions). In sensitivity analyses, laparoscopic surgery favored open adhesiolysis in postoperative mortality (relative risk [RR], 0.36; 95% CI, 0.29–0.45), length of postoperative hospital stay (mean difference [MD], −4.19; 95% CI, −4.43 to −3.95), operative time (MD, −18.19; 95% CI, −20.98 to −15.40), time to flatus (MD, −0.98; 95% CI, −1.28 to −0.68), severe postoperative complications (RR, 0.51; 95% CI, 0.46–0.56) and early unplanned reoperations (RR, 0.82; 95% CI, 0.70–0.96).

CONCLUSION
Results of this systematic review indicate that laparoscopic surgery for ASBO is safe and feasible. Laparoscopic surgery is not associated with better or worse postoperative outcomes compared with open adhesiolysis. Future research should focus on the correct selection of those patients who are suitable for laparoscopic approach and may benefit from this approach.

LEVEL OF EVIDENCE
Systematic Review/Meta-analysis, Level III.
The prevention of nosocomial SARS-CoV2 transmission in endoscopy: a systematic review of recommendations within gastroenterology to identify best practice
Authors: Ong John , Cross Gail Brenda , Dan Yock Young 
Published: March 2020

ABSTRACTEndoscopy generates aerosol droplets and fomites, thereby increasing the risk of SARS-CoV2 transmission to healthcare workers and uninfected patients within endoscopy departments. Despite the sharp rise in the incidence of COVID-19, authoritative recommendations to limit the spread of SARS-CoV2 within gastrointestinal endoscopy units are lacking. Therefore, with the primary aim of identifying best practice and scrutinizing its supporting evidence, we conducted a systematic review of literature for articles published between 1 January 2002 and 15 March 2020 in five databases relating to both the current SARS-CoV2 and the previous SARS-CoV outbreaks. Official websites for gastroenterology and endoscopy societies in the 15 most affected countries were also searched. Unfortunately, a paucity of high quality data and heterogeneity of recommendations between countries was observed. Interestingly, not all countries advocated the postponement of non-urgent or elective procedures. Recommendations for patient screening and personal protective equipment were commonly featured in all recommendations but specifics varied. Only 32% (9/28) of all gastroenterology and endoscopy societies issued guidance on endoscopy in the COVID-19 pandemic. In conclusion, stronger evidence to inform current practice and robust guidelines are urgently needed to prevent the transmission of SARS-CoV2 in gastrointestinal endoscopy departments worldwide.
AAEDM: Theoretical Dynamic Epidemic Diffusion Model and Covid-19 Korea Pandemic Cases
Authors: Kim Amang (Song-Kyoo) 
Published: March 2020

AbstractThis paper deals with an advanced analytical epidemic diffusion model which is capable to predict the status of epidemic impacts. This newly propose model well describes an epidemic growth and it could be widely applied into various topics including pathology, epidemiology, business and data sciences. The Advanced Analytical Epidemic Diffusion Model (AAEDM) is a dynamic diffusion prediction model which is theoretically intuitive and its tractable closed formula could be easily adapted into versatile Bigdata driven analytics including the machine learning system. This dynamic model is still an analytical model but the periods of prediction are segmented for adapting the values from the dataset when the data is available. The epidemiologically vital parameters which effect on the AAEDM are also introduced in this paper. The evaluation of this theoretical model based on the Covid-19 data in Korea has been accomplished with relative fair future prediction accuracies. Although this analytical model has been designed from a basic exponential growth model, the performance of the AAEDM is competitive with other Bigdata based simulation models. Since the AAEDM is relatively simple and handy, anyone can use this model into analyzing outbreak situations in his daily life.