bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potential Utilization of Lymphoscintigraphy in Patients With Klippel-Trenaunay Syndrome
Authors: Wen Zhe , Tong Guansheng , Liu Yong 
Published: November 2020

Purpose
Klippel-Trenaunay syndrome (KTS) is a rare disease that was characterized by vascular malformation. Lymphatic malformation was also commonly associated with KTS. However, the application of lymphoscintigraphy in the management of patients with KTS was rarely described. The purpose of this study is to assess whether the findings of lymphoscintigraphy can aid the management of the patients with KTS.

Methods
A total of 28 patients with known KTS who underwent 99mTc-dextran lymphoscintigraphy with lower extremity tracer injection were included in this retrospective analysis. The images from lymphoscintigraphy were reviewed for any abnormalities in the body with the attention on the region of left subclavian-jugular venous angle.

Results
In addition to abnormal activity in the other regions, abnormal activity in the left subclavian-jugular venous angle was visualized in over half of the patients (53.6%, 15/28). Based on the findings of the lymphoscintigraphy, 7 patients with left subclavian-jugular venous angle activity underwent thoracic duct decompression. In 4 patients with postsurgery follow-up, 3 achieved significant, measurable symptomatic relief.

Conclusions
Lymphoscintigraphy can be used to assess potential candidates for thoracic duct decompression to alleviate the symptoms in patients with KTS.
Solitary 68Ga-PSMA–Avid Proximal Tibial Prostatic Adenocarcinoma Metastasis Mimicking Enthesopathy
Authors: Hilliar Luke , Yip Joshua Wei Liang , Le Ken , Loh Han , Mansberg Robert 
Published: November 2020

Abstract
A 76-year-old man with previously treated prostatic adenocarcinoma (Gleason 8) was referred for a 68Ga–prostate-specific membrane antigen PET/CT scan due to a rising serum PSA level. An intensely PSMA-avid focus was demonstrated in the left proximal tibia with no evidence of local recurrence or metastatic disease elsewhere. This was diagnosed and managed as enthesopathy. A 99mTc-MDP bone scan with SPECT/CT performed 9 months later confirmed an intensely osteoblastic mixed lytic/sclerotic metastasis at the left proximal tibia.
Influence of Asthma Onset on Airway Dimensions on Ultra–high-resolution Computed Tomography in Chronic Obstructive Pulmonary Disease
Authors: Tanabe Naoya , Sato Susumu , Oguma Tsuyoshi , Shima Hiroshi , Kubo Takeshi , Kozawa Satoshi , Koizumi Koji , Sato Atsuyasu , Togashi Kaori , Matsumoto Hisako , Hirai Toyohiro 
Published: November 2020

Purpose:
Asthma onset before the age of 40 years is associated with distinct clinical manifestations in chronic obstructive pulmonary disease (COPD) patients, but its morphologic features remain unestablished. This study aimed to explore airway morphology in COPD patients with asthma onset before 40 years of age using ultra–high-resolution computed tomography (U-HRCT), which allows a more accurate quantitation of the lumen and the wall in smaller airways than using conventional CT.

Materials and Methods:
Clinical data of 500 consecutive patients undergoing full inspiratory U-HRCT (1024×1024 matrix and 0.25 mm slice thickness) were retrospectively analyzed. COPD patients without asthma, COPD patients with asthma onset at age below or 40 years and above, and non-COPD smoker controls (N=137, 29, 34, and 22, respectively) were enrolled. The length, lumen area (LA), wall thickness and area (WA), and wall area percent (WA%) of the segmental (third-generation) to sub-subsegmental (fifth-generation) bronchus and the low attenuation volume percent (LAV%) were measured.

Results:
LA and WA were smaller in the fourth and fifth generation in COPD patients than in non-COPD controls, regardless of the age of asthma onset. LA was smaller and WA% was larger in the fourth-generation and fifth-generation airways in COPD with asthma onset before 40 years than COPD without asthma, whereas WA did not differ between them. In multivariate analyses, asthma onset before 40 years was associated with smaller LA in COPD patients independent of demographics, use of inhaled corticosteroids and long-acting bronchodilators, airflow limitation, and LAV%.

Conclusions:
Asthma onset before 40 years of age could be associated with greater lumen narrowing of the airways in COPD.
Orbitofrontal Reconstruction With a Three-Dimensional Titanium Patient-Specific Implant After Intraosseous Haemangioma Resection
Authors: Sesqué Alexandre , Dang Nathalie Pham , Coste Aurélien , Barthélémy Isabelle , Depeyre Arnaud 
Published: November 2020

Background:
Intraosseous hemangiomas are rare benign tumors that can develop in the skull. Orbitofrontal localization is uncommon. The complexity of orbitofrontal anatomy results in difficult reconstruction following trauma or tumoral resection.

Case presentation:
A 50-year-old woman with a right orbitofrontal intraosseous hemangioma was referred to our department. The authors decided to perform tumoral bone resection and orbitofrontal reconstruction using virtual surgical planning in collaboration with Materialize engineers (Materialise, Leuven, Belgium). Three cutting guides and a patient-specific 3-dimensional (3D) titanium implant were designed and manufactured in 3 weeks. Surgery was performed with a double surgical team composed of maxillofacial surgeons and neurosurgeons. No perioperative or post-operative complications occurred. Post-operatively, the patient was completely asymptomatic and clinical examination showed symmetrical and satisfactory facial morphology.

Conclusion:
Virtual surgical planning, design of patient-specific guides and manufacturing of implants make surgery easier and increase surgical precision. This technique is recommended for wide use in cases of oncological or complex trauma craniomaxillofacial reconstruction.
Zygoma Fractures Are Associated With Increased Morbidity and Mortality in the Pediatric Population
Authors: Elzanie Ashraf S. , Park Kitae E. , Irgebay Zhazira , Choi James , Zellner Elizabeth G. 
Published: November 2020

Background:
Trauma involving the facial bones has been shown to be associated with high severity in previous studies. Characteristics of facial fractures in adults have been well described in the adult population, less so in the pediatric literature. Our investigation aims to define these epidemiological measures and risk factors for poor outcomes using the most recent data.

Methods:
The 2016 Trauma Quality Improvement Program data bank was examined to study facial fracture pattern, mechanism of injury, and demographic descriptive data to characterize pediatric trauma patients. Multivariable regression analysis was performed to assess risk factors for morbidity and mortality in pediatric facial fracture patients.

Results:
Of 51,168 total pediatric trauma patients, 2917 (5.7%) presented with facial fractures. Motor vehicle trauma was the most common mechanism of injury. Maxillary/malar fractures was the most common fracture type overall. Mandibular fractures were most common in the 0 to 1 age category while nasal bone fractures were more common in older patients. Patients with mandible fractures experienced the highest rate of operative management. Zygoma fracture was highly associated with concomitant traumatic brain injury. Multivariable regression analysis showed that fracture of the zygoma, concomitant traumatic brain injury, and cervical spine injury were risk factors for increased mortality.

Conclusion:
Facial fractures are a rare but significant form of trauma in the pediatric population. Our data suggests a slight change in fracture patterns compared to previous studies. Zygoma fractures, traumatic brain injury, and cervical spine injury are risk factors of increased mortality that clinicians should be aware of.
Management of Unicistic Ameloblastoma in a Young Patient: Reducing Social Consequences
Authors: Mendes Bruno Coelho , Maia Rafael Alberto dos Santos , Santos Anderson Maikon de Souza , Moura Kaline da Silva , Araújo-Filho Nilton Pires de , Aburad Arlindo Tadeu Teixeira , Faverani Leonardo Perez , Borba Alexandre Meireles 
Published: November 2020

Abstract
Ameloblastoma is an odontogenic tumor of significant clinical relevance, aggressive and locally invasive. Although the posterior region of the mandible is more frequently affected, lesions observed in the maxilla should receive special attention due to the risk of expansion to the nasal, paranasal and orbital structures. This report shows a successful case of a maxillary ameloblastoma treated by combining therapies in a young patient. The treatment strategy adopted to reduce and redefine the lesion dimensions enabled enucleation in a safe way, without destruction of adjacent noble structures. It also allowed complementary approach with peripheral ostectomy and sclerosing agent, efficiently, without evidence of recurrence or complications after 2 years.
Technical Strategy Using Piezosurgery to Correct Flattened Supraorbital Rim in Unilateral Coronal Craniosynostosis
Authors: Furtado Leopoldo Mandic Ferreira , da Costa Val Filho José Aloysio , de Guimarães Mourão Rômulo Tscherbakowski Nunes , dos Santos Júnior Luiz Carlos , de Macedo Machado Filho Guaracy , Pedrosa Lucas Dantas 
Published: November 2020

Abstract
The surgical correction of orbital deformities in patients with unilateral coronal craniosynostosis is challenging. Traditional techniques have shown the persistence of orbital flattening. This study presents a new strategy for remodeling the compromised orbit, using the piezosurgery technique, which improves the orbital curvature.
Complications Due to Cranial Distraction for Craniosynostosis
Authors: Noto Mariko , Imai Keisuke , Masuoka Takeshi , Sakahara Daisuke , Kunihiro Noritsugu 
Published: November 2020

Background:
Complications of cranial distraction techniques can arise perioperatively. This study assessed long-term clinical outcomes following cranial distraction for craniosynostosis. We analyzed factors involved in those complications.

Methods:
We retrospectively assessed outcomes from 120cases treated with cranial distraction for craniosynostosis between 1997 and 2019. Age at surgery, type of craniosynostosis, length of advancement, and complications were reviewed. We analyzed cases in which clinical characteristics and medical data appeared to increase the risk of complications.

Results:
Of the 120 patients (65 males, 55 females), 79 had syndromic craniosynostosis and 41 had nonsyndromic craniosynostosis. Type of craniosynostosis was scaphocephaly in 17 patients, trigonocephaly in 4, plagiocephaly in 15, brachycephaly in 57, oxycephaly in 14, cloverleaf in 10, and others in 3. Mean age at surgery was 18.6 months (range, 3–525 months). Mean total length of advancement was 32.3 mm (range, 5.5–62.0 mm). No deaths were encountered. Complications included cerebrospinal fluid leaks in 5 patients, epidural abscess in 1, local infections in 33, device problems in 20, erosions and/or ulcers in 23 and decubitus ulcers in 8.
Comparisons of complications and factors: Local infection showed no significant correlation with type of craniosynostosis, nor with the total length of advancement. Plate displacement showed significant relationships with total length of advancement, or with age at surgery (P < 0.01)

Conclusion:
These results suggested that local infection occurred independent of the type of craniosynostosis. Plate displacement and ulcers appear to occur more easily among patients with longer lengths of advancement or with surgery at a younger age, due to the weakness of the cranial bones.
Defining Microbiome Readiness for Surgery: Dietary Prehabilitation and Stool Biomarkers as Predictive Tools to Improve Outcome
Authors: Keskey Robert , Papazian Emily , Lam Adam , Toni Tiffany , Hyoju Sanjiv , Thewissen Renee , Zaborin Alexander , Zaborina Olga , Alverdy John C. 
Published: November 2020

Objectives:
Determine whether preoperative dietary prehabilitation with a low-fat, high-fiber diet reverses the impact of Western diet (WD) on the intestinal microbiota and improves postoperative survival

Background:
We have previously demonstrated that WD fed mice subjected to an otherwise recoverable surgical injury (30% hepatectomy), antibiotics, and a short period of starvation demonstrate reduced survival (29%) compared to mice fed a low-fat, high-fiber standard chow (SD) (100%).

Methods:
Mice were subjected to 6 weeks of a WD and underwent dietary pre-habilitation (3 days vs 7 days) with a SD prior to exposure to antibiotics, starvation, and surgery. 16S rRNA gene sequencing was utilized to determine microbiota composition. Mass spectrometry measured short chain fatty acids and functional prediction from 16S gene amplicons were utilized to determine microbiota function.

Results:
As early as 24 hours, dietary prehabilitation of WD mice resulted in restoration of bacterial composition of the stool microbiota, transitioning from Firmicutes dominant to Bacteroidetes dominant. However, during this early pre-habilitation (ie, 3 days), stool butyrate per microbial biomass remained low and postoperative mortality remained unchanged from WD. Microbiota function demonstrated reduced butyrate contributing taxa as potentially responsible for failed recovery. In contrast, after 7 days of prehabilitation (7DP), there was greater restoration of butyrate producing taxa and survival after surgery improved (29% vs 79% vs 100%: WD vs 7DP vs SD, P < 0.001).

Conclusions:
The deleterious effects of WD on the gut microbiota can be restored after 7 days of dietary prehabilitation. Moreover, stool markers may define the readiness of the microbiome to withstand the process of surgery including exposure to antibiotics and short periods of starvation.
Risk of Acquiring Perioperative COVID-19 During the Initial Pandemic Peak: A Retrospective Cohort Study
Authors: Axiotakis Lucas G. , Youngerman Brett E. , Casals Randy K. , Cooke Tyler S. , Winston Graham M. , Chang Cory L. , Boyett Deborah M. , Lalwani Anil K. , McKhann Guy M. 
Published: November 2020

Objective:
To determine the risk of acquiring perioperative COVID-19 infection in previously COVID-19 negative patients.

Summary of Background Data:
During the initial peak of the COVID-19 pandemic, there was significant concern of hospital acquired COVID-19 infections. Medical centers rapidly implemented systems to minimize perioperative transmission, including routine preoperative testing, patient isolation, and enhanced cleaning.

Methods:
In this retrospective cohort study, medical records of all adult patients who underwent surgery at our quaternary, acute care hospital between March 15 and May 15, 2020 were reviewed. The risk of preoperatively negative patients developing symptomatic COVID-19 within 2–14 days postoperatively was determined. Surgical characteristics, outcomes, and complications were compared between those with and without acquired perioperative COVID-19 infection.

Results:
Among 501 negative patients undergoing index surgeries, 9 (1.8%) developed symptomatic COVID-19 in the postoperative period; all occurred before implementation of routine preoperative testing [9/243, 3.7% vs 0/258, 0%, odds ratio (OR): 0.048, P = 0.036]. No patient who was polymerase-chain-reaction negative on the day of surgery (n = 170) developed postoperative infection. Perioperative infection was associated with preoperative diabetes (OR: 3.70, P = 0.042), cardiovascular disease (OR: 3.69, P = 0.043), angiotensin receptor blocker use (OR: 6.58, P = 0.004), and transplant surgery (OR: 11.00, P = 0.002), and multiple complications, readmission (OR: 5.50, P = 0.029) and death (OR: 12.81, P = 0.001).

Conclusions:
During the initial peak of the COVID-19 pandemic, there was minimal risk of acquiring symptomatic perioperative COVID-19 infection, especially after the implementation of routine preoperative testing. However, perioperative COVID-19 infection was associated with poor postoperative outcome.
A Single Institution Multi-disciplinary Approach to Power-assisted Liposuction for the Management of Lymphedema
Authors: Granoff Melisa D. , Johnson Anna Rose , Shillue Kathy , Fleishman Aaron , Tsai Leo , Carroll Brett , Donohoe Kevin , Lee Bernard T. , Singhal Dhruv 
Published: November 2020

Objective:
To implement and evaluate outcomes from a comprehensive, multi-disciplinary debulking program in the United States.

Summary of Background Data:
Interest in and access to surgical treatment for chronic lymphedema (LE) in the United States have increased in recent years, yet there remains little attention on liposuction, or debulking, as an effective treatment option. In some other countries, debulking is a common procedure for the surgical treatment of LE, is covered by insurance, and has demonstrated excellent, reproducible outcomes. In this study we describe our experience implementing a debulking technique from Sweden in the United States.

Methods:
Patients who presented with chronic LE followed a systematic multi-disciplinary work-up. For debulking with power assisted liposuction, the surgical protocol was modeled after that developed by Håkan Brorson. A retrospective review of consecutive patients who underwent debulking at our institution was conducted.

Results:
Between December 2017 and January 2020, 39 patients underwent 41 debulking procedures with power assisted liposuction, including 23 upper and 18 lower extremities. Mean patient age was 58 years and 85% of patients had LE secondary to cancer, the majority of which (64%) was breast cancer. Patients experienced excess volume reductions of 116% and 115% in the upper and lower extremities, respectively, at 1 year postoperatively. Overall quality of life (LYMQOL) improved by a mean of 33%. Finally, patients reported a decreased incidence of cellulitis and decreased reliance on conservative therapy modalities postoperatively.

Conclusions:
Debulking with power assisted liposuction is an effective treatment for patients with chronic extremity LE. The operation addresses patient goals and improves quality of life, and additionally reduces extremity volumes, infection rates and reliance on outpatient therapy. A comprehensive, multi-disciplinary debulking program can be successfully implemented in the United States healthcare system.
Utilization of MEG Among the US Epilepsy Centers: A Survey-Based Appraisal
Authors: Bagić Anto I. , Burgess Richard C. 
Published: November 2020

Purpose:
The purported underutilization of magnetoencephalography (MEG) among the USA epilepsy centers has never been studied, and any evidence-based understanding of its magnitude is lacking.

Methods:
Two hundred twenty-five National Association of Epilepsy Centers centers (2016) were invited to participate anonymously in a 13-question web-based survey of clinical practice focused on MEG use.

Results:
On average, centers (N = 70; 61 of which were level 4) reported <6 epileptologists, >7 dedicated epilepsy monitoring unit beds, 206 phase 1 studies, 15 phase 2 studies, 10 direct resections, and 9 indirect resections; 27% owned MEG. On average, 11.2 MEGs per year were ordered for epilepsy localization and 7.6 for any presurgical mapping modalities. Wada test aka the intracarotid sodium amobarbital procedure (ISAP) (43%) and functional MRI (29%) were preferred over MEG (4%) for language mapping. The number of epileptologists and the number of epilepsy monitoring unit beds correlated positively with the most clinical volumes. The centers who own a MEG had surgical volumes significantly higher than those without. The number and complexity of patients as well as the proximity of a MEG were perceived as significant contributors/obstacles to increased MEG use.

Conclusions:
Only the centers with larger surgical volumes incorporate MEG regularly in presurgical evaluation of patients with drug-resistant epilepsy. A reversal of the pervasive underutilization of epilepsy surgery can benefit from MEG, but this requires a sustained concerted promotion by the epilepsy and MEG communities.
The 10 Common Evidence-Supported Indications for MEG in Epilepsy Surgery: An Illustrated Compendium
Authors: Bagić Anto I. , Funke Michael E. , Kirsch Heidi E. , Tenney Jeffrey R. , Zillgitt Andrew J. , Burgess Richard C. 
Published: November 2020

Summary:Unfamiliarity with the indications for and benefits of magnetoencephalography (MEG) persists, even in the epilepsy community, and hinders its acceptance to clinical practice, despite the evidence. The wide treatment gap for patients with drug-resistant epilepsy and immense underutilization of epilepsy surgery had similar effects. Thus, educating referring physicians (epileptologists, neurologists, and neurosurgeons) both about the value of epilepsy surgery and about the potential benefits of MEG can achieve synergy and greatly improve the process of selecting surgical candidates. As a practical step toward a comprehensive educational process to benefit potential MEG users, current MEG referrers, and newcomers to MEG, the authors have elected to provide an illustrated guide to 10 everyday situations where MEG can help in the evaluation of people with drug-resistant epilepsy. They are as follows: (1) lacking or imprecise hypothesis regarding a seizure onset; (2) negative MRI with a mesial temporal onset suspected; (3) multiple lesions on MRI; (4) large lesion on MRI; (5) diagnostic or therapeutic reoperation; (6) ambiguous EEG findings suggestive of “bilateral” or “generalized” pattern; (7) intrasylvian onset suspected; (8) interhemispheric onset suspected; (9) insular onset suspected; and (10) negative (i.e., spikeless) EEG. Only their practical implementation and furtherance of personal and collective education will lead to the potentially impactful synergy of the two—MEG and epilepsy surgery. Thus, while fulfilling our mission as physicians, we must not forget that ignoring the wealth of evidence about the vast underutilization of epilepsy surgery - and about the usefulness and value of MEG in selecting surgical candidates - is far from benign neglect.