bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Repositioning Reveals a Malignant Pleura Effusion Initially Mistaken as a Bone Metastasis on 18FDG PET/CT
Authors: Kirchner Julian , Riedl Christopher C. , Ulaner Gary A. 
Published: November 2019

Abstract
A 70-year-old woman with breast cancer underwent 18F-FDG PET/CT for restaging. An FDG-avid focus corresponding to a rib on CT images was identified and interpreted as suggestive of an osseous metastasis. A PET/CT-guided biopsy was planned with the patient in prone position. Prone images demonstrated the FDG focus “moved” to the anterior chest and corresponding to pleural fluid. The diagnosis was altered from osseous metastases to pleural malignancy, and the bone biopsy was not performed. This case not only emphasizes the sensitivity of PET in the detection of malignancy, but also highlights the difficulty localizing small, mobile, FDG-avid foci.
177Lu-PSMA and 177Lu-DOTATATE Therapy in a Patient With Metastatic Castration-Resistant Prostate Cancer and Neuroendocrine Differentiation
Authors: Assadi Majid , Pirayesh Elahe , Rekabpour Seyed Javad , Zohrabi Farshad , Jafari Esmail , Nabipour Iraj , Esmaili Abdolhamid , Amini Abdullatif , Ahmadzadehfar Hojjat 
Published: November 2019

Abstract
We presented a promising result of radionuclide therapy using 177Lu-PSMA and 177Lu-DOTATATE in a patient with prostatic adenocarcinoma and neuroendocrine differentiation. Functional imaging of somatostatin receptors in patients with metastatic castration-resistant prostate cancer may pave the way toward implementation of novel radionuclide targets for the treatment of this aggressive subtype of prostate cancer.
Revisiting the “July Effect” in Plastic Surgery
Authors: Coombs Demetrius M. , Ascha Mustafa S. , Ascha Mona , Gatherwright James , Knackstedt Rebecca , Gurunluoglu Raffi 
Published: November 2019

Background
The “July Effect” represents a topic of considerable interest across residency programs. This study investigated the frequency of postoperative complications following procedures with plastic surgery resident participation (all postgraduate year [PGY] levels) during the first (quarter 3, July–September) and last academic quarters.

Methods
The American College of Surgeons National Surgical Quality Improvement Program database was used to calculate complication rates from 2006 to 2010. Resident involvement was analyzed as a categorical variable consisting of “juniors” (PGY1–PGY3), and “seniors” (PGY4–PGY6). Outcomes from procedures during Q3 were compared with all quarters. Propensity score matching and adjustment enabled logistic regression identifying the effect of resident involvement and admission.

Results
Among all cosmetic and reconstructive procedures (n = 6625), mean operative time was not significantly greater in Q3 compared with all other quarters (P = 0.069); no significant differences in complication rates were observed between Q3 and all other quarters, though superficial surgical site infection (SSI) approached significance (3.3% of procedures in Q3 vs 2.5% in all other quarters, P = 0.063). Among reconstructive procedures only (n = 5677), mean operative time was not significantly greater in Q3 compared with all other quarters (P = 0.119); the same held true for cosmetic procedures only (P = 0.275). Surgical site infection, however, was significantly more likely to occur with reconstructive procedures only, in Q3 compared with all other quarters (3.5% of cases vs 2.3%, P = 0.024). When adjusting for PGY status and matching populations, superficial SSI and return to the operating room were not significantly more common in Q3. When adjusting for quarter of admission, however, superficial SSI was significantly more common among the overall and noncosmetic cases with participation by junior residents (P = 0.013 and 0.020, respectively).

Conclusions
This may represent the first fully reproducible, transparent National Surgical Quality Improvement Program study in plastic surgery that demonstrates the absence of a clinically significant “July Effect,” and suggests that an appropriate degree of resident autonomy may pose minimal risk during both cosmetic and reconstructive procedures in residency training. Additionally, the findings encourage the development a plastic surgery-specific database to remedy inherent difficulties with larger, more comprehensive surgical databases.
The Multifactorial Contribution of Publications in Plastic Surgery Journals in Microsurgery Education
Authors: Boczar Daniel , Sisti Andrea , Restrepo David J. , Oliver Jeremie D. , Huayllani Maria T. , Ball Colleen T. , Spaulding Aaron C. , Cochuyt Jordan J. , Rinker Brian D. , Forte Antonio J. 
Published: November 2019

Background
Microsurgery is one of the most complex operative skills. Recent restrictions on residents’ working hours challenge residency program directors to ensure skill acquisition with scant time dedicated to microsurgery practice. We aimed to summarize the contribution of plastic surgery journals in microsurgical education.

Methods
A comprehensive literature search was performed.

Results
We observed an increasing number of publications on microsurgery education over the years. This could be due to the adoption of new technologies developed in the last 2 decades, the concerns about quality of resident training in the context of reduced work hours, the well-described benefit of medical simulations in other specialties, and the pressure on trainees to be proficient before operating on patients. The variety of aspects addressed in plastic surgery publications is broad: simulators, courses, skills assessment, national surveys, and technology trends.

Conclusion
There is an upward trend in the number of publications and plastic surgery journals, demonstrating a remarkable contribution to microsurgery training.
Revisiting the Reverse Sural Artery Flap in Distal Lower Extremity Reconstruction
Authors: Daar David A. , Abdou Salma A. , David Joshua A. , Kirby David J. , Wilson Stelios C. , Saadeh Pierre B. 
Published: November 2019

Background
The reverse sural artery flap (RSAF) is a popular option for patients with distal lower extremity defects who are not ideal candidates for free flap reconstruction. This is the first systematic review and pooled analysis of surgical characteristics, risk factors, and outcomes of the RSAF.

Methods
A systematic literature review was conducted. All studies reporting on patients undergoing RSAF reconstruction and their outcomes were included. Outcomes were pooled and analyzed using Fisher exact or χ2 test.

Results
Forty-three studies (479 patients, 481 flaps) were analyzed. The majority of patients were male (70.3%), and average ± SD age was 46.9 ± 16.7 years. Rates of smoking, diabetes mellitus (DM), and peripheral vascular disease (PVD) were 34.6%, 35.4%, and 12.3%, respectively. Defect etiologies were largely traumatic (60.4%). The most common defect location was the heel (40.8%). Flap modifications were reported in 123 flaps (25.6%). The most common modification was adipofascial extension (20.3%).
Overall, the partial and total flap loss rates were 15.4% and 3.1%, respectively. Partial flap loss was significantly increased in smokers (28.9% vs 12.2% in nonsmokers, P = 0.0195). Technical modifications decreased the odds of partial necrosis by almost 3-fold compared with traditional RSAF reconstruction (7.2% vs 17.9%; odds ratio, 2.8 [1.4–5.8]; P = 0.0035). Patient age, DM, and PVD were not significantly associated with flap loss.

Conclusions
The RSAF remains a safe salvage option for patients with DM or PVD but should be used with caution in smokers. Technical modifications to minimize pedicle compression significantly reduce rates of partial necrosis.
The American College of Surgeons National Quality Improvement Program Incompletely Captures Implant-Based Breast Reconstruction Complications
Authors: Banuelos Joseph , Taslakian Editt N. , Nguyen Minh-Doan T. , Manrique Oscar J. , Tran Nho V. , Martinez-Jorge Jorys , Hieken Tina , Jakub James , Habermann Elizabeth B. , Sharaf Basel 
Published: November 2019

Background
Implant-based breast reconstruction (IBR) accounts for 70% of postmastectomy reconstructions in the United States. Improving the quality of surgical care in IBR patients through accurate measurements of outcomes is necessary. The purpose of this study is to compare the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from our institution to our complete institutional health records database.

Methods
Data were collected and recorded for all patients undergoing IBR at our institution from 2015 to 2017. The data were completely identified and compared with our institutional NSQIP database for demographics and complications.

Results
The electronic health records data search identified 768 IBR patients in 3 years and NSQIP reported on 229 (30%) patients. Demographics were reported similarly among the 2 databases. Rates of tissue expander/implant infections (5.9% vs 1.8%; P = 0.003) and wound dehiscence (3.5% vs 0.4%; P = 0.003) were not reported similarly between our database and NSQIP. However, the rates of hematoma (2.7% vs 1.8%) and skin flap necrosis (2.5% vs 1.8%) were comparable between the two databases. In our database, 43% of all complications presented after 30 days of surgery, beyond NSQIP's capture period.

Conclusions
Databases built on partial sampling, such as the NSQIP, may be useful for demographic analyses, but fall short of providing data for complications after IBR, such as infections and wound dehiscence. These results highlight the utility and importance of complete databases. National comparisons of clinical outcomes for IBR should be interpreted with caution when using partial databases.
The Utility of Diagnostic Tests for Digital Nerve Injury
Authors: Rubin Guy , Orbach Hagay , Rinat Barak , Shay Ravit , Rozen Nimrod 
Published: November 2019

Purpose
The purpose of this study was to present the sensitivity and specificity of 6 clinical tests for the diagnosis of digital nerve injury. The clinical tests are as follows: light touch, pinprick, static and dynamic 2-point discrimination (D2PD), Semmes-Weinstein monofilament, and wrinkle test.

Methods
We reviewed the charts of all the patients who were admitted to our department with hand lacerations and/or suspicions of digital nerve injury that were examined before surgery with the 6-sensation test, comparing the results to the surgical findings.

Results
The study included 70 patients with 85 injured nerves overall. Of the 85 nerves, 51 were found with full cut, 9 with partial cut, and 25 with no cut. Only 2 variables were significantly associated with the study outcome: D2PD > 4 (P = 0.0141, odds ratio = 3.9, 95% confidence interval = 1.3–11.8, sensitivity = 80.7%, specificity = 48%) and wrinkle test (P = 0.0098, odds ratio = 4.0, 95% confidence interval = 1.4–11.6, sensitivity = 69.5%, specificity = 62.5%).
Multivariable logistic regression included these variables and revealed the predictive probability for a nerve injury to be 92% if both risk factors exist and 43% if none of these risk factors exist. If one risk factor exists, the predictive probability for a cut is still very high (75%).

Conclusions
The combination of positive wrinkle test and D2PD > 4 gave a predictive probability for a nerve injury as 92% in the cases in our study and should be considered in the evaluation of patients with hand lacerations and suspicions of digital nerve injury.
Anterolateral Thigh Flap Design by Using Suprafascial Course of the Perforator
Authors: Ulas Bali Zulfükar , Keçeci Yavuz , Pabuşcu Yüksel , Yoleri Levent 
Published: November 2019

Objectives
Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative mapping to overcome these problems.

Materials and Methods
Anterolateral thigh perforator flap was planned for various soft-tissue reconstructions in 19 patients. There were 15 males and 4 female patients with ages ranging from 19 to 65 years. These patients were evaluated with preoperative multidetector computed tomographic angiography to choose and to trace the course of the perforators. Flaps were designed according to the suprafascial course of the perforators. Perforators were safely located eccentrically when needed. Pedicle length and complications, such as infection, wound dehiscence, and partial or total flap loss, were recorded.

Results
Perforators were located eccentrically in 8 patients and centrally in the other 11 patients. Eleven flaps were used in lower leg reconstruction, 2 flaps in popliteal region, and 6 flaps in head and neck. All flaps survived and any partial or total loss did not occur. There was not any infection and wound problem.

Conclusions
Multidetector computed tomographic angiography can reveal the suprafascial course of the perforator and help design anterolateral thigh perforator flap. By using this kind of mapping, perforators can be safely located eccentrically to lengthen the pedicle and partial flap loss can be prevented.
The Epidemiology of Upper Extremity Nerve Injuries and Associated Cost in the US Emergency Departments
Authors: Tapp Marion , Wenzinger Eric , Tarabishy Sami , Ricci Jerec , Herrera Fernando A. 
Published: November 2019

Background
The purpose of our study was to determine the incidence and average cost of nerve injuries in patients presenting with upper extremity trauma.

Methods
The Nationwide Emergency Department Sample database was queried using International Classification of Diseases, Ninth Revision codes specific to peripheral nerve injuries of the upper extremity. Data on the incidence, patient demographics, average number of associated diagnoses, Injury Severity Scale (ISS) score, mechanism of injury, and average cost of care were collected and analyzed.

Results
Of 1.58 million upper extremity traumatic injuries, there were 5244 nerve injuries, resulting in an annual incidence of 16.9 per 100,000 persons with an average age of 38.42 years. Ulnar nerve injuries were the most common (3.86 per 100,000) followed by digital nerve (2.96 per 100,000), radial nerve (2.90 per 100,000), and median nerve (2.01 per 100,000). Injuries to the brachial plexus had the highest average ISS score (9.79 ± 0.71) and number of presenting diagnoses (8.85 ± 0.61) while having a lower than average emergency department (ED) cost. Patients with digital nerve injuries had the highest average ED cost ($8931.01 ± $847.03), whereas their ISS score (2.82 ± 0.19) and number of presenting diagnoses (4.92 ± 0.22) were the lowest. The most commonly reported mechanism of injury in this study population was from a laceration (29.2%) followed by blunt injury, fall (14.8%), and being struck (7.20%). Males were 2.14 (2.01–2.28) times more likely to have an injury to an upper extremity nerve and 3.25 (2.79–3.79) times more likely to injure a digital nerve.

Conclusions
While there was a low incidence of upper extremity nerve injuries associated with upper extremity trauma, the ulnar nerve was most frequently injured. Males were twice as likely to sustain a traumatic upper extremity nerve injury, with laceration being the most common mechanism of injury. The average ED cost associated with upper extremity nerve injuries in the United States was determined to be approximately $5779.
Factors Affecting Healing in the Treatment of Hidradenitis Suppurativa
Authors: Worden Andrew , Yoho Daniel J. , Houin Herman , Moquin Kenneth , Hamzavi Iltefat , Saab Ihab , Siddiqui Aamir 
Published: November 2019

Background
Hidradenitis suppurativa (HS) is a chronic debilitating condition. Treatment of HS depends on disease stage, goals of care, access to care, and frequency of symptoms. We present our experience with surgical treatment for patients with HS.

Methods
Patients were followed longitudinally for at least 2 years postsurgical intervention. Demographic data, participation in a multidisciplinary program, type of surgery, healing rates, and potential factors contributing to wound healing were retrospectively reviewed in all cases using multivariate analysis.

Results
Two hundred forty-eight patients met the inclusion criteria with a total of 810 involved sites. Overall, 59% of patients had Hurley stage 3 disease at the time of surgery. Healing rates of 80% were observed in stages 1 and 2, and 74% were observed in stage 3. Hurley stage was not a significant predictor of healing (P = 0.09). Surgical treatment consisted of 38% incision and drainage, 44% excision without closure, and 17% excision with primary closure. Incisional and excisional treatments healed 78% and 79%, respectively, at 2 years. Primarily repaired defects (grafts and flaps) were 68% healed at 2 years. Observed healing rates were uniform regardless of the number of sites involved (P = 0.959). Participation in the multidisciplinary program was the strongest predictor of healing (78% vs 45%, P = 0.004). Sex, age, body mass index, tobacco use, diabetes, presurgery hemoglobin, and family history of HS were statistically not significant. Continuation of immune modulating therapy within 2 weeks of surgery was a predictor of reduced healing (odds ratio, 0.23; P = 0.004), whereas holding biologics for at least 2 weeks was not significant (odds ratio, 1.99; P = 0.146).

Conclusions
Participation in a multidisciplinary program is a strong predictor of long-term success when treating HS. Hurley score and number of involved sites did not correlate with successful healing after surgery. If taking biologics, we identified 2 weeks as an appropriate break from biologics before and after surgical intervention. Healing rates were highest with ablative procedures (incision and drainage, excision) alone.
Chest Wall Masculinization in Female-to-Male Transsexuals
Authors: Morselli Paolo G. , Summo Valeria , Pinto Valentina , Fabbri Erich , Meriggiola Maria C. 
Published: November 2019

Abstract
Esthetic masculinization of the chest wall is one of the first surgical steps in female-to-male transsexual (FTMTS) reassignment.
This surgical procedure is not a simple mastectomy: it is required for removal of breast tissue with glandular resection and skin excess revision, to reduce and replace the nipple-areola complex in the right location, minimizing chest wall scars. The creation of an esthetically pleasing male chest allows the patient to live at ease in the male gender role.
In this article, we present our series of 68 FTMTSs who underwent bilateral mastectomies for surgical sexual reassignment (a total of 136 mastectomies) according to our algorithm, in the period between January 2010 and December 2017. We selected 4 different operative procedures, classified as subcutaneous (“pull-through” and “concentric circular” techniques) and skin extended (“ultrathin vertical bipedicle” and free nipple graft).
We achieved a total complication rate of 6.6%, less than that reported in the literature; additional procedures for esthetic improvements were performed in 14.7% of cases. The mean patient satisfaction was approximately 4.57% of a maximal value of 5 (excellent).
To help surgeons in choosing the most appropriate FTMTS surgical technique and to reduce unfavorable results, we propose the use of our treatment algorithm in preoperative evaluation of the chest wall according to the breast volume, degree of glandular ptosis, and skin elasticity.
Impact of Obesity on Quality of Life After Breast Reconstruction
Authors: Koh Eugene , Watson David I. , Dean Nicola R. 
Published: November 2019

Background
There is an increasing prevalence of obesity in society, often associated with increased medical comorbidities and surgical complications. Some health providers are now placing a body mass index (BMI) limit on whom can be offered breast reconstruction. The objective of this study was to determine the impact of obesity on quality of life as measured by the BREAST-Q, in women undergoing breast reconstruction.

Methods
A review of the breast reconstruction database (n = 336) at the Flinders Breast Reconstruction Service was performed, with demographic data, complication rates, and BREAST-Q data being extracted and analyzed. Participants were divided into 2 groups: nonobese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2) for comparison.

Results
Preoperatively, obese women scored lower than nonobese women in terms of BREAST-Q scores. Mean prereconstruction scores were 51.62 versus 57.10 (psychosocial), 40.18 versus 48.14 (satisfaction with breasts), and 34.30 versus 40.72 (sexual well-being) (all P < 0.05), and 68.48 versus 72.15 (physical well-being) (P = 0.08). At 12 months post–mound reconstruction, there was a significant improvement in scores in both groups. Additionally, there were no significant differences for BREAST-Q scores between the 2 groups 12 months after surgery. While there was a significantly higher minor complication rate in the obese group compared with the nonobese group, there was no significant difference in the rate of major complications (eg, requiring revision surgery) between the 2 groups.

Conclusions
Obese participants gain a similar, if not better, improvement in quality of life after breast reconstruction, despite a higher rate of minor complications. This study did not support withholding breast reconstruction from obese women.
Segmental Corticotomy-Assisted Orthodontic Treatment With Platelet-Rich Fibrin Augmentation of Class III Anomaly
Authors: Esenlik Elçin , Günaydin Arzu , Findik Yavuz 
Published: November 2019

Abstract
This clinical report presents the outcomes of segmental corticotomy-assisted orthodontic treatment in a class III patient. A 13.5-year-old female patient presented with class III anomaly and a thin alveolus in the mandibular anterior region. After the alignment of the mandibular incisors, segmental corticotomy with platelet-rich fibrin (PRF) was performed in the mandibular incisor area to facilitate incisor retraction to ensure periodontal support after the changes in the inclination of the teeth. Lateral cephalograms were taken at the beginning (T0), precorticotomy (T1), at the end of the treatment (T2), and 2 years after the treatment (T3). Cone-beam computed tomography (CBCT) records were collected at the T1, T2, and T3 periods to evaluate the bone structures. The measurements included the inclination and the position of the mandibular incisors, symphysis width, symphysis height, B-B′ width, cervical alveolar width, the vertical alveolar bone level on the labial and the lingual sides, and the amount of labial and lingual bone at the apex in the mandibular central incisor and canine areas.
The class I molar and canine relationship was achieved in this borderline case. The amount of labial bone at the root apex and the B-B′ width increased. A vertical alveolar bone gain was observed. The facial profile was improved significantly. The treatment outcome was stable at the 2-year follow-up. The segmental anterior mandibular corticotomy provided an effective correcting inclination of the mandibular teeth with the use of class III elastics. This technique ensured the maintenance of a sufficient amount of labial bone with no periodontal side effects.