bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rupture of the Ascending Aorta Surgical Area Detected Using Isolated Cardiopulmonary Organ Computed Tomography Angiography
Authors: Tian Zhiling , Wang Zhuoqun , Wan Lei , Zhang Jianhua , Dong Hewen , Liu Ningguo , Chen Yijiu 
Published: December 2020

Abstract
We report cause of death after cardiac surgery using isolated cardiopulmonary organ computed tomography angiography (CTA) and a conventional autopsy. A 56-year-old man underwent aortic valve replacement and coronary artery bypass graft surgery under extracorporeal circulation. Massive bleeding occurred suddenly, and the patient died 25 days later. An autopsy revealed fibrinous exudate in the mediastinum and tight attachment of the pericardium to the heart; there were also clots and inflammatory exudate in the chest cavity. Separating the organs in the chest cavity was difficult, especially in the surgical area. We extracted the heart and lungs together and performed cardiovascular CTA and image reconstruction. Results showed spillage of the contrast agent from the anterior wall of the ascending aorta, approximately 4.5 cm from the replaced aortic valve. A histological examination confirmed that the site of contrast agent spillage was the sutured area of the ascending aorta, which was infected, necrotic, and had ruptured. Using the CTA approach for isolated cardiopulmonary organ imaging can accurately display the location of an aortic rupture, which further guides organ inspection and tissue sampling, and avoids irreversible damage to key regions. In conclusion, the approach we describe can provide evidence for determining cause of death.
The Pattern of Injuries Among Motorcyclists in Fatal Road Traffic Accidents
Authors: Mohd Saman Siti Asma’ , Jothee Shatishraj , Nor Faridah Mohd , Shafie Mohamed Swarhib 
Published: December 2020

Introduction
In recent years, there has been a significant increase in mortality among motorcyclists, which warrants a need to analyze the epidemiology and pattern of injuries among road users in Malaysia. Hence, prioritizing road safety in the government policy by implementing targeted actions is justified to reduce injury and fatality.

Materials and Methods
Cases of road accident deaths in motorcyclists received by UKM Medical Centre were studied over a period of 10 years, that is, between 2010 and 2019. This study was based on forensic autopsy records database and forensic autopsy.

Results
The most affected age group by road fatalities were young men. The most common injuries were intracranial hemorrhage (74%), thoracic hemorrhage (73%), and lung laceration (85.7%). About 39 (31%) fatally injured riders were positive for illicit drug and/or alcohol.

Conclusions
This study showed that men in the third decade of life are the major victims of motorcycle fatalities. Hence, urgent measures are necessary to establish road safety policy to reduce such fatalities.
Fatal Drowning Caused by A Swimming Pool Drainage System
Authors: Atilgan Mehmet , Bulgur-Kirbas Derya , Akman Refik , Deveci Cemyigit 
Published: December 2020

Abstract
In swimming pools, malfunctions in the pool water drainage system can result with severe injuries, or even death, and mostly children are affected by these accidents. In this case report, the death scene and postmortem examination findings of a 12-year-old girl, who was trapped by her feet in the pool water drainage system, are reported. The external examination revealed ecchymotic areas with abrasions on both lower legs and both feet, suggesting suction of both feet through the uncovered pool drainage system opening. To prevent such accidents, safety practices related to the water circulation system should be developed in swimming pools and similar areas; children should be supervised at all times; and emergency medical teams, as well as lifeguards, should be available for immediate intervention.
Early Spontaneous Movements of Infants With Hypoxic-Ischemic Encephalopathy
Authors: Alkan Halil , Kahraman Aysu , Mutlu Akmer 
Published: December 2020

Objective:
The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity.

Methods:
Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used.

Results:
Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS.

Conclusions:
Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.
Testing the Child PROMIS Physical Activity Measurement in Youth Attending a Large Community Event
Authors: Hooke Mary C. , Neumann Jessie , Tucker Carole A. 
Published: December 2020

Purpose:
The study's purpose was to evaluate the concurrent validity of the Child Patient-Reported Outcomes Measurement Information System (PROMIS) PA with the Youth Activity Profile (YAP) and examine its relationship to PROMIS measures of sedentary behavior and fatigue. The PROMIS Pediatric Activity (PA) measure is a newly developed, valid instrument used to collect data on children's lived experiences of short bouts of moderate to rigorous physical activity.

Methods:
Participants were ages 8 to 20 years attending a state fair. Child PROMIS measures—PA, Sedentary Behavior, and Fatigue—and the YAP were completed on an iPad.

Results:
The PROMIS PA and YAP had a positive correlation. The PROMIS PA was not associated with sedentary behavior or fatigue measurements.

Conclusion:
As expected, the PROMIS PA and YAP measure-related PA constructs, the YAP focuses on energy expended while the PROMIS PA indicates perceived response to activity.
Therapeutic Implementation of a Custom Dynamic Elbow Brace for Children With Neonatal Brachial Plexus Palsy: A Case Report
Authors: Torrey Michelle 
Published: December 2020

Purpose:
The objective of this analysis is to present the benefits and functional outcomes when using a custom dynamic elbow brace as an adjunct to therapeutic interventions for a child with neonatal brachial plexus palsy.

Summary of Key Points:
Impairments associated with neonatal brachial plexus palsy can cause lifelong limitations of mobility, dexterity, and functional use of the involved upper extremity. The functional design of the custom dynamic elbow brace provided therapeutic versatility including immobilization, active-assisted controlled movement, and resistance exercise. These features facilitated efficient and functional muscle activation patterns, negating compensatory or substitute movements.

Conclusions and Recommendations for Clinical Practice:
The brace provided opportunities for focused muscle activation and subsequent improvements in strength, development of motor control, and functional mobility. Using a custom dynamic elbow brace was an effective therapeutic tool, used in conjunction with a comprehensive treatment program, and contributed to a successful outcome.
Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study
Authors: Behrends Czarina N. , Kapadia Shashi N. , Schackman Bruce R. , Frimpong Jemima A. 
Published: December 2020

Context:
Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective.

Objective:
To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing.

Design:
We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes.

Setting:
Seven MMT programs located in 6 states in the United States.

Participants:
Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing.

Main Outcome Measure:
Themes related to integration of on-site HIV/HCV testing.

Results:
Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination.

Conclusion:
Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.
Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis
Authors: Gabriel Allen , Camardo Mark , O’Rorke Erin , Gold Rebecca , Kim Paul J. 
Published: December 2020

Background:
Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d.

Methods:
A systematic literature review and a meta-analysis of comparative studies were performed to determine the effects of NPWTi-d versus control therapy in the adjunctive management of complex wounds. Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis.

Results:
Thirteen studies comprising 720 patients were included in the analysis. Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (P = 0.01). Wounds in the NPWTi-d group were ready for closure faster than control wounds (P = 0.03). The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (P = 0.003), and percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint. There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (P = 0.03). Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (P = 0.01). Length of hospital stay was not significantly reduced for NPWTi-d patients compared with that for control patients (P = 0.06).

Conclusion:
Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.
The Diagnostic Value of Apparent Diffusion Coefficient and Proton Magnetic Resonance Spectroscopy in the Grading of Pediatric Gliomas
Authors: Yao Rong , Cheng Ailan , Liu Menglin , Zhang Zhengwei , Jin Biao , Yu Hong 
Published: December 2020

Objective
The aims of this retrospective study were to assess the value of the quantitative analysis of apparent diffusion coefficient (ADC) and proton magnetic resonance spectroscopy (1H-MRS) metabolites in differentiating grades of pediatric gliomas.

Patients and Methods
Two hundred and nine pathology-confirmed pediatric gliomas (143 low-grade gliomas [LGGs] and 66 high-grade gliomas [HGGs]) were retrospectively analyzed on preoperative diffusion-weighted magnetic resonance imaging, of which 84 also underwent 1H-MRS. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and metabolites (choline/creatine ratio [Cho/Cr], N-acetylaspartate/creatine ratio [NAA/Cr], N-acetylaspartate/choline ratio [NAA/Cho], presence of lactate and lipid peaks) between LGGs and HGGs were analyzed.

Results
There were significant negative correlations between the ADC values and glioma grade. Receiver operating characteristic analysis showed that the cutoff ADCmean value of 1.192 × 10−3 mm2/s for the differentiation between low- and high-grade pediatric gliomas provided a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 77.6%, 80.3%, 78.5%, 89.5% and 62.4%, respectively; the cutoff ADCmin value of 0.973 × 10−3 mm2/s resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 86.0%, 90.9%, 87.6%, 95.3%, and 75.0%, respectively; the cutoff ADC ratio value of 1.384 resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 73.4%, 87.9%, 78.0%, 92.9%, and 60.4%, respectively. A tendency for a positive correlation was found between Cho/Cr and glioma grade. A negative correlation was demonstrated between NAA/Cr or NAA/Cho and glioma grade. Statistical analysis demonstrated a threshold value of 2.601 for Cho/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 81.8%, 51.7%, 71.4%, 76.3%, and 60.0%, respectively, in dividing LGGs and HGGs; a threshold value of 0.705 for NAA/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 76.4%, 75.9%, 76.2%, 85.7%, and 62.9%, respectively; a threshold value of 0.349 for NAA/Cho to provide a sensitivity, specificity, accuracy, PPV, and NPV of 87.3%, 86.2%, 86.9%, 92.3%, and 78.1%, respectively.

Conclusions
The ADC values and metabolites appeared to be significantly correlated to grade in pediatric gliomas. The predictive values may be helpful for preoperative diagnostic predictions.
Patient Perspectives on the Effect of the SARS-CoV-2 Pandemic on Patients With Systemic Sclerosis
Authors: Gupta Latika , Kharbanda Rajat , Agarwal Vishwesh , Misra Durga Prasanna , Agarwal Vikas 
Published: December 2020

Background
The coronavirus disease (COVID-19) pandemic and its subsequent effects on health care systems have significantly impacted the management of chronic rheumatic diseases, including systemic sclerosis (SSc).

Methods
In this context, a 25-item anonymized e-survey was posted on the Twitter and Facebook e-groups and pages of various scleroderma organizations and patient communities to assess the problems faced by patients with SSc during the pandemic, with a focus on effects on the disease, drug procurance, continuity of medical care, and prevalent fears among patients.

Results
Of the 291 participants (median age of 55 [43.5–63] years, 93.8% females), limited systemic sclerosis was the most common diagnosis (42.3%). Many patients experienced problems attributable to the COVID-19 pandemic (119, 40.9%), of which 46 (38.7%) required an increase in medicines, and 12 (10.1%) of these needed hospitalizations for disease-related complications. More than one-third (36.4%) were on glucocorticoids or had underlying cardiovascular risks (39%) that would predispose them to severe COVID-19.
A significant proportion (38.1%) faced hurdles in procuring medicines or experienced disruption in physiotherapy sessions (24.7%). One-quarter (24.1%) felt it was difficult to contact their specialist, whereas another 7.2% were unable to do so. Contracting COVID-19 was the most prevalent fear (71.5%), followed by infection in the family (61.9%), and a flare of the disease (45.4%). Most respondents preferred teleconsultations (55.7%) over hospital visits in the pandemic period.

Conclusion
The results of the patient survey suggest that the COVID-19 pandemic has affected many patients with SSc and may translate to poorer outcomes in this population in the postpandemic period.
Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity
Authors: Choi Jong Woo , Jeong Woo Shik , Kang Min Kyu , Lee Jang Yeol , Chung Yoo Sam 
Published: December 2020

Abstract
Traditionally, maxillomandibular advancement is an orthognathic surgical procedure that has been used to manage obstructive sleep apnea in patients not able or willing to maintain adherence to continuous positive airway pressure therapy or for patient who are not able to adhere to treatment. However, maxillomandibular advancement often leads to unsatisfactory cosmetic results.
This prospective study investigated functional and esthetic outcomes using polysomnography and 3-dimensional computed tomography, after counterclockwise rotational orthognathic surgery. We enrolled 17 patients with obstructive sleep apnea, who underwent orthognathic surgery at single institution between March 2013 and December 2018.
After 12 months, the patients' mean self-rated score for facial appearance, using a 10-step visual analog scale, was 7.36. The preoperative apnea-hypopnea index and respiratory disturbance index were 34.70 and 37.45, respectively; postoperative indices were 11.60 and to 12.69, respectively (P = 0.003, 0.003). The mean posterior pharyngeal airway space increased from 5357.88 mm3 preoperatively to 8481.94 mm3 after 6 postoperative months.
Counterclockwise rotational orthognathic surgery for the correction of obstructive sleep apnea turned out to be the ideal solution not only in the correction of the sleep apnea, but also in the facial esthetics.
Endoscopy-Assisted 1-Stage Correction of the Crooked Nose Airway Function and Aesthetic Morphology
Authors: Jianfang Zhao , Lifeng Xie , Yonghuan Zhen , Li Zhu , Dong Li , Yang An 
Published: December 2020

Objectives
The aims of the study were to explore the application of endoscopy in the correction of septal deviation and nasal skeletal deviation in crooked nose deformity and, using multiple evaluation methods, to investigate the effect of endoscopy-assisted 1-stage surgery in restoring crooked nose airway function and aesthetic morphology.

Methods
From March 2015 to March 2018, 45 patients with nasal septum and skeletal deviation were treated with endoscopy-assisted septoplasty simultaneously with rhinoplasty. The follow-up period was at least 8 months. Treatment effects were evaluated both objectively and subjectively using various methods.

Results
All cases showed certain degree of airway function and nose morphology improvement. In patients with abnormal nasal ventilation, the volume and minimal cross-sectional area increased significantly after the surgery (t = 2.470 and 3.134, respectively, P < 0.05). External nose deviation distance measured on 3-dimensional models decreased significantly from 3.230 ± 1.661 mm to 1.997 ± 1.037 mm after the surgery (t = 3.772, P < 0.05). Patients visual analog scale score of nasal patency and nose morphology were significantly improved (t = 5.795 and 7.187, respectively, P < 0.05). Overall patient satisfaction was 100%, and no complication (nasal septal perforation, nasal cavity synechia, etc) was reported.

Conclusions
Septal deviation combined with external nose deflection can be corrected by endoscopy-assisted rhinoplasty and septoplasty simultaneously, to achieve 1-stage improvement of crooked nose morphology and nasal airway function. This approach has the advantages of minimal invasion, clear surgery vision, less pain, and shorter recover time. It has fewer complication and better outcomes and worth clinical promotion and application.
Reconstruction of Tibia Fracture With Soft Tissue Defect
Authors: Tsai Po-Lun , Ziegler Otto R. , Sudario-Lumague Rowena , Lin Tsan-Shiun 
Published: December 2020

Background
We aimed to compare different methods to treat lower leg soft tissue defects with tibia fracture using free flaps and pedicled flaps. We also highlighted the aesthetic outcome after using 1-stage secondary debulking procedure for tibia area.

Patients and Methods
From December 2000 to March 2017, 83 patients with lower leg defects and tibia fractures were reconstructed using 71 free flaps and 12 pedicled flaps. One-stage secondary debulking procedures were performed for 39 patients after flap reconstruction. Infection control and aesthetic outcomes using 5-point Likert scale were reviewed after a 16-month follow-up.

Results
Twenty-five myocutaneous free flaps, 45 fasciocutaneous free flaps, 1 fibula free flap, 12 pedicled flaps of which 8 were distally based sural artery flaps, and 4 medial gastrocnemius flaps were used. The flap survival rate was 100%. There was no recurrence of osteomyelitis in any patient after reconstruction with any of these flaps. Using a 5-point Likert scale, performance of a 1-stage secondary debulking procedure showed statistically significant difference in terms of contour, color, and texture compared with the group without debulking procedure.

Conclusions
The use of free flaps and pedicled flaps in the reconstruction of lower leg defects with tibia fracture is reliable and results in good infection control. A 1-stage secondary debulking procedure delivers excellent long-term aesthetic outcome after reconstruction of the tibia area.
The Newcastle Microsurgery Fellowship
Authors: Berner Juan Enrique , Magdum Ashish 
Published: December 2020

Abstract
The Newcastle upon Tyne Hospitals NHS Foundation Trust Plastic Surgery Department offers a 12-month, intense and comprehensive fellowship covering almost every aspect of reconstructive microsurgery. Across its 2 sites at The Royal Victoria Infirmary and Freeman Hospital, over 175 free flaps are performed every year, spanning the breadth of head and neck oncology, sarcoma, facial palsy, and breast and limb reconstruction. The appointed fellow is expected to be involved in at least 90 microsurgical cases, plus a reasonable number of complex nonfree flap reconstructions. An overview of this hands-on microsurgery fellowship is hereby presented based on the experience of 2 recent fellows.