bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Adjunctive Pain Medications on Postoperative Inpatient Opioid Use in Abdominally Based Microsurgical Breast Reconstruction
Authors: Yan Chen , Wink Jason D. , Ligh Cassandra A. , Kanchwala Suhail 
Published: February 2020

Background
The purposes of this study were to quantify the amount of opioid medication used postoperatively in the hospital setting after abdominally based microsurgical breast reconstruction, to determine factors that are associated with increased opioid use, and to identify other adjunctive medications that may contribute to decreased opioid use.

Methods
An electronic medical record data pull was performed at the University of Pennsylvania from November 2016 to October 2018. Cases were identified using Current Procedural Terminology code 19364. Only traditional recovery after surgery protocol patients were included. Patient comorbidities, surgical details, and pain scores were captured. Postoperative medications including non–patient-controlled analgesia opioid use and adjunctive nonopioid pain medications were recorded. Non–patient-controlled analgesia total opioid use was calculated and converted to oral morphine milligram equivalents (mme). Statistical analysis was performed using t test analyses and linear regression.

Results
A total of 328 patients satisfied our inclusion criteria. Five hundred forty free flaps were performed (212 bilateral vs 116 unilateral, 239 immediate vs 89 delayed). Bilateral patients used on average 115.2 mme (95% confidence interval [CI], 103.4–127.0 mme) compared with 89.0 mme in unilateral patients (95% CI, 70.0–108.0 mme; P = 0.015). Patients with abdominal mesh placement (n = 249) required 113.0 mme (95% CI, 100.5–125.5 mme) compared with 83.8 mme (95% CI, 68.8–98.7 mme) for patients without mesh (n = 79; P = 0.016). Each additional hour of surgery increased postoperative mme by 9.4 (P < 0.01). Patients with a nonzero preoperative pain score required 100.3 mme (95% CI, 90.2–110.4 mme) compared with 141.1 mme (95% CI, 102.7–179.7 mme) for patients with preoperative pain score greater than 0/10 (P < 0.01). Patients with postoperative index pain score ≤5/10 required 89.2 mme (95% CI, 78.6–99.8 mme) compared with 141.1 mme (95% CI, 119.9–162.2 mme) for patients with postoperative index pain score >5/10 (P < 0.01). After regression analysis, a dose of intravenous acetaminophen 1000 mg was found to decrease postoperative mme by 11.7 (P = 0.024). A dose of oral ibuprofen 600 mg was found to decrease postoperative mme by 8.3 (P < 0.01).

Conclusions
Bilateral reconstruction and longer surgery resulted in increased postoperative mme. Patients with no preoperative pain required less opioids than did patients with preexisting pain. Patients with good initial postoperative pain control required less opioids than did patients with poor initial postoperative pain control. Intravenous acetaminophen and oral ibuprofen were found to significantly decrease postoperative mme.
Cadaver Nerve Grafts
Authors: Puente-Espel Jordi , Chang Jeremy , Liu Xiangxia , Riccio Charles A. , Konofaos Petros 
Published: February 2020

Abstract
Nerve grafts represent an invaluable tool, when reconstructing nerve defects of more than 1 cm. Historically, the criterion standard use of autografts has relied on the premise of using nonessential sensory nerves to fulfill the principle of replacing “like with like,” while simultaneously minimizing the infliction of undue morbidity on the patient. The reconstructive surgeon thus faces a dilemma when extensive nerve damage requires reconstruction, or when donor nerves are not available or limited such as in the pediatric population. Cadaver nerve grafts (CNG) uniquely allow for reconstruction of large nerve lesions without the presence of host morbidity. The following article reviews the use of CNG, its indications, advantages, and disadvantages, as well as provides some case studies of real-world application. In addition, an insight into the future perspectives of CNG is provided.
The Feasibility of a Sensate Profunda Artery Perforator Flap in Autologous Breast Reconstruction
Authors: Song Bin , Kumbla Pallavi Archana , Boyd Carter , de la Torre Jorge I. , Fix Jobe 
Published: February 2020

Background
The profunda artery perforator (PAP) flap has been demonstrated to be an effective method of autologous breast reconstruction, particularly when the abdominal donor site is contraindicated. However, there are no current reports regarding the use of a sensate PAP flap in this type of reconstruction. The objective of this study is to describe the feasibility and anatomic location of the sensory nerves supplying the PAP flap in relation to surface landmarks for use in autologous breast reconstruction.

Methods
In this anatomic study, 10 cadaver lower limbs were microsurgically dissected. We investigated the posterior femoral cutaneous nerve (PFCN), which supplies sensation to the skin of the posterior thigh and distribution of the PAP flap. The midline of the posterior thigh and gluteal crease were used for surface landmarks. The diameter and length of the nerve branches were documented.

Results
There were between 2 and 5 PFCN branches, with an average of 3 branches, that were found within the distribution of the PAP flap. Measurements were taken from the gluteal crease and midline to the nerve branches. The average distance caudal to the gluteal crease was 2.4 cm (0 to 7 cm). The average distance medial to the midline was 4.3 cm (0.2 to 8.1 cm). The average diameter of the nerve branches was 1.8 mm (1 to 2.5 mm). The average length of nerve branches from the flap to the fascia was 2.0 cm (1.5 to 2.4 cm). The maximum length of the nerve branches from the flap to the main trunk of the PFCN was 7.8 cm when tracing the nerve branches intramuscularly.

Conclusions
The findings from this study provide an anatomic basis for the sensate PAP flap that would potentially provide an additional dimension to the use of this perforator flap in autologous breast reconstruction. These preliminary results are promising, and further physiological studies are warranted to validate the use of this sensate flap.
Long-Term Outcomes of Arm Replantation
Authors: Wang Chunyang , Askari Morad , Zhang Feng , Lineaweaver William C. 
Published: February 2020

Background
Advances in microsurgery have improved the survival rate of arm replantation. However, the functional outcome of the replanted arms remains unpredictable. The authors performed a systematic review to evaluate the long-term outcome of arm replantation and the secondary reconstructive procedures after replantation.

Methods
All available English literature in the PubMed, Embase, and CENTRAL databases was searched for articles reporting functional outcome of successful arm replantation with follow-up period more than 1 yr. Clinical data were extracted including study characteristics, patient demographic information, functional outcome, and the numbers, types, and timing of secondary surgery. Among these, factors identified to influence overall outcome were reviewed and analyzed.

Results
Twenty-nine studies representing 79 arm replantations met the inclusion criteria. A total of 111 secondary procedures were recorded in 23 studies. The average number of secondary surgical procedures was 2.6 per patient. The most common procedures were nerve repair (23.4%), followed by functioning muscle transfer (19.8%), tendon transfer (17.1%), wound coverage (11.7%), contracture release (10.8%), bone repair (9.9%), arthrodesis (5.4%), and others (1.8%). Procedures involving wound coverage and nerve repair were mainly conducted in the early stage within 4 mos after replantation, whereas functioning muscle transfer, tendon transfer, and arthrodesis were mostly performed after 1 yr postoperatively. The satisfied (Chen I and II) functional outcome was achieved in 49.4% patients. The level of amputation and the type of injury have significant impact on final outcomes, whereas patients' age and timing of nerve repair do not. Patients with amputation at the distal third of the arms had a better outcome than those at the proximal and middle third of the arms (P < 0.05), and patients injured by sharp-cut recovered better than those by crush and avulsion (P < 0.05).

Conclusions
Optimal outcomes could be achieved in nearly half of patients with arm replantation, although multiple secondary surgical interventions and long periods of recovery are often required.
Clinical Factors Affecting Survival in Pediatric Vascular Tumors of the Head and Neck
Authors: Cheng Jeffrey , Jung Sin-Ho , Gao Junheng 
Published: February 2020

Abstract
Clinical factors associated with the behavior and outcomes of nonbenign, head, and neck vascular tumors in children are not well described. Our aim is to provide descriptive information and identify prognostic factors associated with lower overall survival for children with these types of tumors. A retrospective cohort study was performed using the SEER database (years 1973–2015). Children aged 18 years and under with the diagnosis of a vascular tumor with locally aggressive or borderline and malignant behavior, classified by ICD-O-3, within the head and neck were included. Vascular tumors with benign behavior as classified by ISSVA were excluded. One hundred forty-eight children were identified. Mean age was 9.9 years (SD = 6.4). A gender predilection was noted with more males affected, female (37.8%) and male (62.2%), P = 0.0031. Majority of the children were white (79.4%) and angiosarcoma was the most common histologic subtype (68.2%). Children had a significantly better overall survival than adults with head and neck vascular tumors, P < 0.0001. Univariate and multivariate analysis did not reveal any factors with significant association to overall survival. Vascular tumors in the head and neck in children most commonly affect males and white children, with angiosarcoma as the most common histologic subtype. Children seem to have a more favorable overall survival compared to adults.
Effectiveness and Satisfaction Degree of Transconjunctival-Approach Lower Blepharoplasty Combined With Pinch Skin Excision Technique
Authors: Choi Boyoon , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun 
Published: February 2020

Abstract
The purpose of this study was to evaluate and compare the effectiveness and satisfaction of transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique between young patients (younger than 60 years of age) and elderly patients (older than 60 years of age) in Korea. The medical records of 69 patients who underwent transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique from January 2003 to February 2018 were reviewed. Success rate postoperative complications, and degree of satisfaction with the surgical technique were evaluated and statistically compared between the 2 different age groups. All 69 patients were satisfied with the final result. The average success rate of surgery was 96.7% in the young patients (group A) and 97.4% in the elderly patients (group B) during the mean follow-up period of 6 months. There were 3 cases reported as having persistent complications (2 cases in group A and 1 patient in group B). The satisfaction rating between groups A and B showed no statistically significant difference (P = 0.430). We confirmed lower-eyelid fat prolapse and dermatochalasis can be effectively corrected using transconjunctival lower blepharoplasty with a pinch skin excision technique in patients regardless of age.
Congenital Total Eversion of Upper Eyelids in a Normal Newborn
Authors: Güdeloğlu Elif , Altan Emir Volkan 
Published: February 2020

Abstract
Here, the authors report a rare case of congenital bilateral upper eyelid eversion with severe chemosis that was successfully managed by nonsurgical ways. A 2-hour-old male newborn with bilateral congenital upper eyelid eversion and severe chemosis was properly treated with conservative management consisting of the application of the antibiotic, steroid, and artificial tear drops and ointments in combination with padding the exposed conjunctiva with normal saline-soaked gauzes. The management was resulted in prompt and satisfactory resolution on the 14th day. Congenital upper eyelid eversion being typically a rare clinical entity is reported more frequently in African population. Although this unfavorable condition could end up with destructive complications like loss of vision, a reasonable anatomical outcome with good cosmetic results can be effectively achieved by conventional methods. Therefore, a thorough ocular examination should be carried out to exclude other ocular or systemic complications.
Rhino-Orbito-Cerebral Mucormycosis in Diabetic Disease Mucormycosis in Diabetic Disease
Authors: Galletti Bruno , Freni Francesco , Meduri Alessandro , Oliverio Giovanni William , Signorino Giuseppe Alberto , Perroni Pietro , Galletti Cosimo , Aragona Pasquale , Galletti Francesco 
Published: February 2020

Abstract
The authors present their experience about clinical evidences that include patients with an untreated diabetes who developed rhino-orbito-cerebral mucormycosis (ROCM). They were treated with endoscopic sinus surgery and medical treatment with intravenous, intradural therapy, and sinus washes with amphotericin B. The ROCM is a disease with a rapid evolution and an increase in mortality rate, especially if the fungus enters the cranial cavity. Therefore, it would be necessary in all diabetic patients with sinus symptoms, headaches, visual changes, suspect a mucormycosis, and perform a careful radiology assessment and a nasal endoscopy. Often, despite an early diagnosis and rapid treatment for ROCM, it is not possible to stem the disease, which ends with the patient's death.
Quantifying the Severity of Metopic Craniosynostosis: A Pilot Study Application of Machine Learning in Craniofacial Surgery
Authors: Bhalodia Riddhish , Dvoracek Lucas A. , Ayyash Ali M. , Kavan Ladislav , Whitaker Ross , Goldstein Jesse A. 
Published: February 2020

Abstract
The standard for diagnosing metopic craniosynostosis (CS) utilizes computed tomography (CT) imaging and physical exam, but there is no standardized method for determining disease severity. Previous studies using interfrontal angles have evaluated differences in specific skull landmarks; however, these measurements are difficult to readily ascertain in clinical practice and fail to assess the complete skull contour. This pilot project employs machine learning algorithms to combine statistical shape information with expert ratings to generate a novel objective method of measuring the severity of metopic CS.
Expert ratings of normal and metopic skull CT images were collected. Skull-shape analysis was conducted using ShapeWorks software. Machine-learning was used to combine the expert ratings with our shape analysis model to predict the severity of metopic CS using CT images. Our model was then compared to the gold standard using interfrontal angles.
Seventeen metopic skull CT images of patients 5 to 15 months old were assigned a severity by 18 craniofacial surgeons, and 65 nonaffected controls were included with a 0 severity. Our model accurately correlated the level of skull deformity with severity (P < 0.10) and predicted the severity of metopic CS more often than models using interfrontal angles (χ
2 = 5.46, P = 0.019).
This is the first study that combines shape information with expert ratings to generate an objective measure of severity for metopic CS. This method may help clinicians easily quantify the severity and perform robust longitudinal assessments of the condition.
Improvement of Periorbital Appearance in Apert Syndrome After Subcranial Le Fort III With Bipartition and Distraction
Authors: Chetty Vaneshri , Haber Samer E. , Khonsari Roman Hossein , Arnaud Eric 
Published: February 2020

Aim and Scope:
Children with Apert syndrome have a characteristic inversion of the orientation of the palpebral fissures, an increase of the inter-orbital distance, telecanthus, and exorbitism. Here, Le Fort III osteotomy with subcranial bipartition and distraction osteogenesis was evaluated as a tool to improve the position of the palpebral fissures in Apert syndrome.

Material and Methods:
All patients with Apert syndrome who underwent Le Fort 3 osteotomy with subcranial bipartition and distraction osteogenesis using an external device, with canthopexy, between 2009 and 2014, with available preoperative and postoperative frontal photographs, were included into the study. Palpebral fissure inclination was measured. Ratios of the intercanthal distance (ICD) to the outer-canthal distance (OCD) and the interpupillary distance to the OCD were computed. Preoperative and postoperative values were compared using the Wilcoxon signed-ranks test.

Results:
The authors included 15 patients with Apert syndrome. The mean age at surgery was 10 ± 3.4 years and the average follow-up was 7.3 ± 2.9 years. We found normalization of the negative inclination of the palpebral fissures (right eye: 10.7 ± 2.4 degrees preoperatively versus 7.0 ± 3.1 degrees postoperatively, P < 0.001; left eye: 12.4 ± 3.9 degrees preoperatively versus 8.7 ± 4.1 degrees postoperatively, P = 0.01) and a significant reduction of the inter-pupillary distance: OCD ratio (0.717 ± 0.027 preoperatively versus 0.699 ± 0.030 postoperatively, P = 0.03). These modifications were stable on the long term. There was no significant change of the inter-canthal distance:OCD ratio.

Conclusions:
Le Fort III facial advancement with subcranial bipartition and distraction improves the position and orientation of the orbital region in children with Apert syndrome
Inhibition of PAR-2 Attenuates Neuroinflammation and Improves Short-Term Neurocognitive Functions Via ERK1/2 Signaling Following Asphyxia-Induced Cardiac Arrest in Rats
Authors: Ocak Umut , Ocak Pinar Eser , Huang Lei , Zuo Gang , Yan Jun , Hu Xin , Song Zhijun , Zhang John H. 
Published: February 2020

ABSTRACT

Objective:
Global cerebral ischemia-induced neuroinflammation causes neurofunctional impairment following cardiac arrest. Previous studies have demonstrated that the activation of protease-activated receptor-2 (PAR-2) contributes to neuroinflammation. In the present study, we aimed to determine the potential treatment effect of PAR-2 inhibition against neuroinflammation in the setting of asphyxial CA (ACA) in rats.

Methods:
A total of 116 adult, male Sprague-Dawley rats were randomly divided into Sham (n = 18) and ACA (n = 98) groups. Time course, short-term outcome, and mechanism studies were conducted. All drugs were delivered intranasally. The effect of PAR-2 inhibitor FSLLRY-NH2 on neurocognitive functions was assessed by neurologic deficit score, number of seizures, and T-maze test, while hippocampal neuronal degeneration was evaluated by Fluoro-Jade C staining after ACA. Western blotting was performed for the mechanism study at 24 h following ACA. Selective PAR-2 agonist (AC55541) and ERK1/2 inhibitor (PD98059) were used for intervention.

Results:
Inhibition of PAR-2 decreased neuroinflammation, reduced the number of degenerating hippocampal neurons and improved neurocognitive functions following ACA. PAR-2 activator alone exerted opposite effects to PAR-2 inhibitor. PAR-2 mediated the augmented brain levels of proinflammatory cytokines by promoting the phosphorylation of ERK1/2.

Conclusions:
PAR-2 inhibition diminished neuroinflammation and thereby reduced hippocampal neuronal degeneration and neurocognitive impairment following ACA. This effect was at least partly mediated via the PAR-2/ERK1/2 signaling.
Inverse Association Between the Quantity of Human Peripheral Blood CXCR5+IFN-γ+CD8+ T Cells With De Novo DSA Production in the First Year After Kidney Transplant
Authors: Zimmerer Jason M. , Basinger Matthew W. , Ringwald Bryce A. , Abdel-Rasoul Mahmoud , Pelletier Ronald P. , Rajab Amer , El-Hinnawi Ashraf , Parekh Hemant , Washburn Kenneth , Bumgardner Ginny L. 
Published: February 2020

Background.
We recently reported that a novel CXCR5+IFN-γ+CD8+ T-cell subset significantly inhibits posttransplant alloantibody production in a murine transplant model. These findings prompted the current study to investigate the association of human CD8+ T cells with the same phenotype with the development of de novo donor-specific antibody (DSA) after kidney transplantation.

Methods.
In the current studies, we prospectively and serially analyzed peripheral blood CD8+ and CD4+ T-cell subsets and monitored for the development of de novo DSA in kidney transplant recipients during the first-year posttransplant. We report results on 95 first-time human kidney transplant recipients with 1-year follow-up.

Results.
Twenty-three recipients (24.2%) developed de novo DSA within 1-year posttransplant. Recipients who developed DSA had significantly lower quantities of peripheral CXCR5+IFN-γ+CD8+ T cells (P = 0.01) and significantly lower ratios of CXCR5+IFN-γ+CD8+ T cell to combined CD4+ Th1/Th2 cell subsets (IFN-γ+CD4+ and IL-4+CD4+ cells; P = 0.0001) compared to recipients who remained DSA-negative over the first-year posttransplant.

Conclusions.
Our data raise the possibility that human CXCR5+IFN-γ+CD8+ T cells are a homolog to murine CXCR5+IFN-γ+CD8+ T cells (termed antibody-suppressor CD8+ T cells) and that the quantity of CXCR5+IFN-γ+CD8+ T cells (or the ratio of CXCR5+IFN-γ+CD8+ T cells to Th1/Th2 CD4+ T cells) may identify recipients at risk for development of DSA.
Prevalence and Patterns of Opioid Use Before and After Liver Transplantation
Authors: Cron David C. , Tincopa Monica A. , Lee Jay S. , Waljee Akbar K. , Hammoud Ali , Brummett Chad M. , Waljee Jennifer F. , Englesbe Michael J. , Sonnenday Christopher J. 
Published: February 2020

Background.
Opioid use in liver transplantation is poorly understood and has potential associated morbidity.

Methods.
Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid-naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant.

Results.
Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Posttransplant, 61% of patients filled an opioid prescription 0–2 months after discharge, and 21% filled an opioid between 10–12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use posttransplant. Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pretransplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased posttransplant opioid use.

Conclusions.
Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.