bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in Patients Receiving Neoadjuvant Chemotherapy Undergoing Immediate Breast Reconstruction: Effect of Timing, Postoperative Complications, and Delay to Radiation Therapy
Authors: Teotia Sumeet S. , Venutolo Christopher , Haddock Nicholas T. 
Published: November 2019

Background:
Neoadjuvant chemotherapy is offered to many patients with breast cancer. In patients undergoing mastectomy and immediate breast reconstruction, there is concern that this treatment could increase postoperative complications. The authors characterize which patients are at a higher risk of experiencing a postoperative complication, and assess the impact of postoperative complications on timing of radiation treatment.

Methods:
A retrospective review was performed on patients who underwent neoadjuvant chemotherapy with mastectomy and immediate breast reconstruction using tissue expanders. Multivariable binomial logistic regression analysis was used to identify risk factors for experiencing a postoperative complication. Independent samples t tests were used to compare means for neoadjuvant chemotherapy timing and time to commencement of radiation therapy between patients with and without complications.

Results:
A total of 128 patients were identified. Patients that experienced a complication had a statistically significant difference in time to commencement of radiation therapy (p = 0.021) and an elevated body mass index (p = 0.018) compared with patients who experienced no complication; there was no difference in timing interval of neoadjuvant chemotherapy (p = 0.692). Logistic regression showed an associate between body mass index and postoperative complication (OR, 1.09; 95 percent CI, 1.018 to 1.167; p = 0.013).

Conclusions:
Postoperative complications delay the commencement of radiation therapy in patients who received neoadjuvant chemotherapy and undergo mastectomy with immediate breast reconstruction. The period from the last dose of neoadjuvant chemotherapy was equivalent between those that experienced postoperative complications and those that did not. Patients with a higher body mass index are more likely to experience postoperative complications, and this should be considered when offering tissue expanders to obese patients who have received neoadjuvant chemotherapy and require adjuvant radiation treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Practical Tips to Improve Efficiency and Success in Upper Limb Replantation
Authors: Woo Sang Hyun 
Published: November 2019

Learning Objectives:After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Perform single-digit replantation after viewing the videos. 3. Recognize appropriate cases for joint salvage techniques in periarticular amputation at each joint of the digit and wrist. 4. Outline the methods of flexor and extensor tendon reconstruction in an avulsed amputation of the digit or thumb. 5. Understand the order of digital replantation and transpositional replantation for a restoration of pinch or grip in multiple-digit amputation.Summary:This article provides practical tips and caveats for the latest replantation surgical techniques for digit, hand, and upper extremity amputation. Four videos, clinical photographs, and drawings highlight important points of operative technique and outcomes of replantation.
Supermicrosurgical Lymphaticovenous Anastomosis as an Alternative Treatment Option for Patients with Lymphorrhea
Authors: Yang Johnson Chia-Shen , Yen Yuan-Hao , Wu Shao-Chun , Lin Wei-Che , Chiang Min-Hsien , Hsieh Ching-Hua 
Published: November 2019

Background:
Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive.

Methods:
From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors’ hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post–lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded.

Results:
No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green–enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent).

Conclusion:
With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Novel Approach to Quantifying Lymphatic Contractility during Indocyanine Green Lymphangiography
Authors: Granoff Melisa D. , Johnson Anna Rose , Lee Bernard T. , Padera Timothy P. , Bouta Echoe M. , Singhal Dhruv 
Published: November 2019

Summary:
Lymphedema arises from impaired lymphatic function. Quantification of lymphatic contractility has previously been shown using a custom-built near-infrared imaging system. However, to broaden the clinical use of functional lymphatic measurements, these measurements need to be performed using a standard-of-care, clinically available camera. The authors propose an objective, algorithmic, and clinically accessible approach to quantify lymphatic contractility using a 3-minute indocyanine green lymphangiograph recorded with a commercially available near-infrared camera. A retrospective review of the authors’ indocyanine green lymphangiography video repository maintained in a Research Electronic Data Capture database was performed. All patients with a newly diagnosed unilateral breast cancer undergoing preoperative indocyanine green lymphangiography were included in the analysis. Patient medical records were then analyzed for patient demographics, and videos were analyzed for contractility. Seventeen consecutive patients with unilateral breast cancers underwent video processing to quantify lymphatic contractility of the ipsilateral extremity in contractions per minute. All patients were women, with an average age of 60.5 years (range, 38 to 84 years). The average lymphatic contractility rate was 1.13 contractions per minute (range, 0.67 to 2.5 contractions per minute). Using a clinically accessible standard-of-care device for indocyanine green lymphangiography, the authors were able to determine lymphatic contractility rates of a normal extremity. The authors’ finding falls within the range of previously published data quantifying lymphatic contractility using a research device, suggesting that the authors’ technique provides a clinically accessible, time-effective means of assessing lymphatic contractility. Potential future applications include both lymphedema surveillance and evaluation of nonsurgical and surgical interventions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Unilateral Cleft Lip Nasal Deformity: Foundation-Based Approach to Primary Rhinoplasty
Authors: Tse Raymond W. , Mercan Ezgi , Fisher David M. , Hopper Richard A. , Birgfeld Craig B. , Gruss Joseph S. 
Published: November 2019

Background:
Cleft lip results in disruption of the nasal foundation and collapse of tip structures. Most approaches to primary rhinoplasty focus on correction of lower lateral cartilages; however, recurrent deformity is common, and secondary revision is frequently required. The authors describe an alternate approach that focuses on the foundation to “upright the nose,” without any nasal tip dissection. This study assessed changes with surgery and with growth. Secondary goals were to compare methods of sidewall reconstruction and septoplasty and to identify predictors of relapse.

Methods:
Consecutive patients undergoing repair (n = 102) were assessed. Images were captured preoperatively, postoperatively, and at 5 years of age (when available) using three-dimensional stereophotogrammetry. Standard anthropometric and contemporary shape-based analysis (volume ratio, dorsal deviation, and alar-cheek definition) was performed to assess longitudinal changes. Images of age-matched normal control subjects were used for comparison.

Results:
Significant changes in anthropometric and morphometric measurements occurred following surgery. Postoperative form was similar to controls immediately after surgery and at 5 years. Nasal corrections were satisfactory, and only two patients have elected to undergo revision. When subjects were grouped according to cleft type, we found the same trends. When comparing different methods of nasal sidewall reconstruction or septoplasty, we found no differences. Alveolar cleft width was a significant predictor of worse preoperative and postoperative form.

Conclusions:
Significant nasal correction can be achieved by means of reconstruction of nasal foundation, without nasal tip dissection. Preservation of tissue planes may allow for easier secondary revision, if necessary.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Association of Comorbid Depression and Anxiety Symptoms With Disability Onset in Older Adults
Authors: Dong Liming , Freedman Vicki A. , Mendes de Leon Carlos F. 
Published: November 2019

ABSTRACT

Objective
Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults.

Methods
The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups.

Results
A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild (n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe (n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20–1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45–2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07–1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94–1.79), possibly reflecting lower statistical power.

Conclusions
Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.
Multiphase Iodine Contrast-Enhanced SPECT/CT Outperforms Nonenhanced SPECT/CT for Preoperative Localization of Small Parathyroid Adenomas
Authors: Sandqvist Patricia , Nilsson Inga-Lena , Grybäck Per , Sanchez-Crespo Alejandro , Sundin Anders 
Published: November 2019

Purpose
The aim of this study was to assess the value of intravenously contrast-enhanced CT in conjunction with 99mTc-MIBI SPECT for preoperative localization of parathyroid adenoma.

Methods
One hundred ninety-two patients with primary hyperparathyroidism were enrolled in the study between May 2015 and May 2017. The patients underwent a preoperative “one-stop shop” examination with 99mTc-MIBI SPECT/CT by using dual time-point (10 and 90 minutes) protocol and both nonenhanced CT and contrast-enhanced CT acquisition in the arterial and venous phase, 35 and 75 seconds, respectively, after contrast medium injection start. For 149 patients, the imaging results could be correlated to those at surgery and histopathology.

Results
The median adenoma weight was 330 mg. The addition of contrast-enhanced CT increased the sensitivity from 81.1% to 89.9% (P = 0.003). The specificity of nonenhanced SPECT/CT was similar to contrast-enhanced CT (96.1% vs 97.9%; P = 0.077). For patients with uniglandular disease (n = 140, 94.0%), the sensitivity increased from 86.4% to 93.6% (P = 0.021) and the specificity from 96.2% to 97.9% (P = 0.118) by adding contrast-enhanced CT. In patients with multiglandular disease (n = 9, 6.0%), adding contrast-enhanced CT improved detection sensitivity from 42.1% to 63.2%. However, these patients were few and significance was not reached (P = 0.125).

Conclusions
In this cohort, with generally small parathyroid adenomas, the sensitivity in preoperative localization was greatly improved by adding contrast-enhanced CT to 99mTc-MIBI SPECT/CT.
18F-FDG PET Imaging Features of Patients With Autoimmune Lymphoproliferative Syndrome
Authors: Carrasquillo Jorge A. , Chen Clara C. , Price Susan , Whatley Millie , Avila Nilo A. , Pittaluga Stefania , Jaffe Elaine S. , Rao V. Koneti 
Published: November 2019

Introduction
Autoimmune lymphoproliferative syndrome (ALPS) is a rare immune dysregulatory condition, usually presenting in childhood with massive lymphadenopathy, splenomegaly, and an increased incidence of lymphoma. Methods to differentiate between benign ALPS adenopathy and lymphoma are needed. To this end, we evaluated the usefulness of FDG PET.

Methods
We prospectively evaluated 76 ALPS/ALPS-like patients including FS-7–associated surface antigen (FAS) germline mutation with (n = 4) and without lymphoma (n = 50), FAS-somatic (n = 6), ALPS-unknown (n = 6), and others (n = 10) who underwent FDG PET. Uptakes in 14 nodal sites, liver, and spleen were determined.

Results
In 76 ALPS patients, FDG PET showed uptake in multiple nodal sites in all but 1 patient. The highest SUVmax values in FAS mutation without lymphoma, FAS mutation with lymphoma, FAS somatic, ALPS-unknown, and other genetic mutations were a median (range) 9.2 (4.3–25), 16.2 (10.7–37.2), 7.6 (4.6–18.1), 11.5 (4.8–17.2), and 5.5 (0–15.3), respectively. Differences between uptake in the FAS group with and without lymphoma were statistically significant, but overlapped, making discrimination between individuals with/without lymphoma impossible. The spleen:liver uptake ratio was greater than 1 in 82% of patients.

Conclusions
While statistically significant differences were observed in FAS mutation ALPS with and without lymphoma, the significant overlap in FDG uptake and visual appearance in many patients prevents discrimination between patients with and without lymphoma. Similar patterns of FDG biodistribution were noted between the various ALPS subgroups.
Granulomatous Myositis Showing Fluctuating “Leopard-Man” Sign
Authors: Koyama Masamichi , Terauchi Takashi , Koizumi Mitsuru , Sugiura Yoshiya 
Published: November 2019

Abstract
A 57-year-old woman with a history of uterine endometrial carcinoma underwent PET/CT examinations for initial staging and posttreatment survey. Multiple patchy accumulations were noted in the muscles, particularly in both thighs. These accumulations resolved spontaneously 6 months after the follow-up examination. However, 3.5 years after the surgery, the multiple patchy accumulations reappeared in the muscle of the upper and lower extremities showing an increase in signal intensity from previous examination. A biopsy of the right thigh revealed epithelioid cell granuloma without necrosis. We therefore consider that this case might be “idiopathic” granulomatous myositis.
Upper Lip Fat Grafting Using the Anatomical Subunit and Fat Compartment Principles Improves Lip Cant and Symmetry in Patients With Unilateral Upper Lip Asymmetries
Authors: Denadai Rafael , Buzzo Celso Luiz , Raposo-Amaral Cesar Augusto , Raposo-Amaral Cassio Eduardo 
Published: November 2019

Background
Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. However, most surgical techniques are difficult to reproduce, and none follow anatomical principles.

Objectives
The aim of this study was to assess the clinical outcomes of upper lip contour asymmetry and lip cant correction by anatomical upper lip fat grafting using the subunit and fat compartment principles.

Methods
A prospective analysis was conducted of 113 consecutive patients who underwent anatomical upper lip fat grafting using the subunit and fat compartment principles for the management of lip cant and/or upper lip contour (volumetric) asymmetry. Quantitative photogrammetric upper lip symmetry and lip cant measurements were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment (by 8 blinded external plastic surgeons and 8 laypersons) was obtained to grade the qualitative upper lip symmetry. Bivariate and multivariate analyses were performed to identify independent variables associated with the 12-month postoperative lip cant change.

Results
There was significant (all P < 0.05) postoperative quantitative and qualitative upper lip symmetry and lip cant enhancement (preoperative < postoperative) after a single upper lip fat grafting procedure, and the outcomes were maintained (all P > 0.05) from 3 to 12 months postoperatively. Parry-Romberg syndrome was negatively associated (P < 0.05) with the 12-month postoperative lip cant change.

Conclusions
Anatomical upper lip fat grafting, using the subunit and fat compartment principles, improves lip cant and symmetry in patients with unilateral upper lip asymmetries.
Comparative Study of 2 Different Innervation Techniques in Facial Reanimation
Authors: Kim Min Ji , Kim Hyung Bae , Jeong Woo Shik , Choi Jong Woo , Kim Young Kug , Oh Tae Suk 
Published: November 2019

Abstract
Recently, 1-stage double innervation with the masseter nerve and the cross-face nerve graft (CFNG) has gained popularity owing to its outcomes of powerful and synchronous muscle contraction. In this study, we compared CFNG- and double-innervated free gracilis muscle transfer (FGMT) for facial palsy reconstruction.
A total of 49 patients with facial palsy who underwent facial reanimation surgery from August 2013 to January 2017 were enrolled. The CFNG group (18 patients) underwent 2-stage CFNG innervation, whereas the double-innervated FGMT group (31 patients) underwent dual coaptation with end-to-end masseter nerve and end-to-side CFNG. The FACEgram software was used for evaluating smile excursion, symmetry index, spontaneous smile occurrence, Terzis' score including palsy pathogenesis, and clinical progress.
In the CFNG group, the smile excursion at rest increased (P = 0.000); however, there was increased smile excursion both at rest and during smiling in the double-innervated FMGT group (rest P = 0.002, smile P = 0.028). Improvement of the symmetry index was observed only in the FMGT group (rest P = 0.001, smile P = 0.000). There was no significant difference in Terzis' scores. The average time to the first visible muscle contracture was statistically significantly shorter in the double-innervated FGMT group (P = 0.035). With respect to spontaneous smile achievement, the double-innervated FGMT group (25.8%) showed a satisfactory outcome.
Cross-face nerve graft-innervated FGMT improved only smile excursion at rest, whereas double-innervated FGMT provided improvement in both the resting and smiling postures. Furthermore, the double-innervated FGMT group showed a higher symmetry index. However, the 2 operations did not show a significant difference in functional aspects.
Photogrammetric Outcomes of Primary Nasal Correction in Unilateral Cleft Lip Patients
Authors: Nunez-Villaveiran Teresa , Fahradyan Vahe , McNinch Neil L. , Valentine Ashley , Larson Heather , Murthy Ananth S. 
Published: November 2019

Background
Concerns of nonlasting results and potential nasal growth damage precluded cleft nasal correction at the time of initial cleft lip repair. Our goal was to evaluate the outcome of primary cleft nasal correction in our patients with unilateral cleft lip.

Methods
A retrospective review of patients with complete and incomplete unilateral cleft lip who underwent primary cleft nasal correction from 2010 to 2017 by the same surgeon was performed. The cleft-to-noncleft nostril height, width, one-fourth medial part of nostril height, nasal sill height, and nostril area ratios, as well as inner nostril height-to-width ratios were determined from standard basilar view photographs taken in different time points (T1, <3 months; T2, 3–12 months; T3, 12–36 months; and T4, >36 months after surgery). A 5-point visual analog scale (1 = worst, 5 = best) was used to assess each patient's nose appearance.

Results
Seventy-two patients were identified (66.7% male, 51.3% with a complete cleft lip). Average visual analog scale scores T1–T4 were 3.88 ± 0.85, 3.72 ± 0.93, 3.54 ± 0.99, and 3.40 ± 0.71, respectively. Intraclass correlation ranged from 0.61 to 0.94. A significant decrease [mean difference (SD)] was found for cleft-to-noncleft nostril width ratio [0.15 (0.18)] from T1 to T2, and an increase for one-fourth medial height ratio [−0.09 (0.07)] and for inner nostril height-to-width ratio in the noncleft side [−0.23 (0.25)] from T1 to T3. Thirteen patients required secondary surgical revision.

Conclusion
Based on photogrammetry, primary cleft nasal correction in our patients with unilateral cleft lip achieved acceptable and stable outcomes during early childhood.