bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Insights Into 3-Dimensional Anatomy of the Facial Mimetic Muscles Related to the Nasolabial Fold
Authors: Chen Guo Cheng , Sun Min , Yin Ningbei 
Published: November 2019

Background
This study aimed to introduce a novel approach to study the facial mimetic muscles (FMMs) related to the nasolabial fold (NLF) and realize the visualization of complex 3-dimensional (3D) structures of the FMM.

Methods
Micro–computed tomography (micro-CT) and iodine staining technique were used to obtain the 2-dimensional radiographs of the FMM. Materialise Mimics software was then used to reconstruct the 3D model of the FMM.

Results
The zygomaticus major muscle was not directly connected to the orbicularis oris muscle (OOM). The terminal fibers of the zygomaticus major muscle were located in the levator anguli oris. The surface of the FMM was covered with some unknown muscle fibers in the NLF. The terminal fibers of the zygolabialis ended in the middle of the ipsilateral OOM rather than the edge of the OOM. At the same anatomical level, the FMM fibers were so closely connected to each other that they were not separated by adipose tissue. A detailed 3D sequence of the muscle fibers in the modiolus at the corner of the mouth was determined. The muscle fibers in the modiolus were organized rather than disorganized. The terminal fibers of the levator anguli oris were located at the terminal fibers of the musculus depressor anguli oris at the corner of mouth.

Conclusions
Although the micro-CT had many disadvantages, the micro-CT combined with iodine staining technique enabled the 3D anatomical study of the FMM related to NLF. We imported the 2-dimensional images obtained by micro-CT scanning into Mimics software, successfully reconstructed the FMM related to the NLF, and finally obtained images of complex 3D structures of the FMM related to the NLF. The shapes, positions, and 3D spatial relationships between the FMM related to the NLF were clearly visualized. The novel insights into the 3D anatomy of the FMM related to NLF may help understand the formation of the NLF. Finally, the results of this study may help improve rejuvenation surgery of the NLF in the near future.
Postmastectomy Pain Syndrome
Authors: Kraft Casey T. , O'Brien Andrew L. , Skoracki Roman J. 
Published: November 2019

Abstract
Postmastectomy pain syndrome (PMPS) is defined as chronic pain after breast cancer surgery lasting greater than 3 months and has been shown to affect up to 60% of breast cancer patients. Substantial research has been performed to identify risk factors and potential treatment options, although the exact cause of PMPS remains elusive. As breast reconstruction becomes increasingly popular, plastic surgeons are likely to encounter more patients presenting with PMPS. This article summarizes current evidence on risk factors and treatment options for PMPS and highlights further areas of study.
Plastic Surgery Training and the Problematic Resident
Authors: Ovadia Steven A. , Zoghbi Yasmina , Thaller Seth R. 
Published: November 2019

Introduction
Plastic surgery resident education is a significant commitment by both programs and residents. Unfortunately, problematic resident behavior may occur and be difficult to manage. This study was designed to survey plastic surgery program directors to elucidate their experience with problematic resident behavior.

Methods
A electronic survey was prepared using the online platform, qualtrics. The survey was distributed by email to all plastic surgery program directors. Questions were designed to evaluate frequency of problematic behavior and methods to manage the behaviors. A reminder was sent 3 weeks after initial distribution. Responses were collected for an additional 3 weeks. Responses were pooled separately for integrated and independent program directors.

Results
Thirty-eight program directors responded including 10 independent and 28 integrated program directors. Integrated and independent program directors estimated prevalence of problematic behavior at 17.5 ± 14.4% and 11.8 ± 7.9%, respectively. Poor clinical skills/judgment and unprofessional behavior were the most commonly reported problematic behaviors by integrated program directors at 21% each. These were also the most commonly reported behaviors by independent program directors at 20.8% and 16.7%, respectively. Fourteen integrated program directors and 5 independent program directors reported having dismissed a resident. Only 5 integrated and 2 independent program directors reported warning signs in hindsight during the resident's initial application. Nine integrated program directors and 4 independent program directors reported at least sometimes reviewing applicant social media accounts.

Conclusions
Prevalence of problematic behavior is estimated between 10% and 20% of plastic surgery residents. Type of problematic behavior are similar between integrated and independent residents. Warning signs on initial application are uncommon. As such, understanding problematic behaviors and methods to manage them are essential.
A Critical Analysis of Prosthetic Augmentation of Autologous Microvascular Breast Reconstruction
Authors: Piper Merisa L. , Lentz Rachel , Gomez-Sanchez Clara , Withers Jacquelyn , Hu Allison , Sbitany Hani 
Published: November 2019

Introduction
The combined approach using both an implant and autologous tissue for breast reconstruction has become more common over the last 10 years. We sought to provide a systematic review and outcomes analysis of this technique.

Methods
We searched PubMed and the Cochrane Library database to identify studies that described implant augmentation of autologous flaps for breast reconstruction. The references of selected articles were also reviewed to identify any additional pertinent articles.

Results
We identified 11 articles, which included 230 patients and 378 flaps. Implants used ranged in size from 90 to 510 cc, with an average size of 198 cc. Implants were more frequently placed at the time of autologous reconstruction and in the subpectoral plane. There were no total flap losses, and partial flap loss occurred in 3 patients (1%). There were no cases of venous or arterial thrombosis and no early return to the operating room for flap compromise. Eight implants (2%) were lost because of infection or extrusion, and capsular contracture occurred in 9 breasts (3%). When stratified by the timing of implant placement (immediate vs delayed), there were no significant differences in any postoperative outcomes except the immediate group had a higher infection rate.

Conclusions
The criteria for women to be candidates for autologous tissue breast reconstruction can be expanded by adding an implant underneath the flap. We found the overall flap loss rate is comparable with standard autologous flap reconstruction, and the implant loss rate is lower than that in patients who undergo prosthetic reconstruction alone.
Analgesic Use Following Bilateral Breast Reduction
Authors: Fisher Alec H. , Powelson Ian A. , Wampler Ariel T. , Doughty Hayden , Freed Gary L. 
Published: November 2019

Abstract
The opioid epidemic in the United States resulted in 42,000 deaths in 2016, 40% of which involved a prescription opioid. It is estimated that 2 million patients become opioid-dependent after elective, ambulatory surgery each year. There has been increased interest in quantifying the need for postoperative narcotic pain medications for a variety of surgical procedures. However, studies have been limited. We sought to quantify the analgesic usage after one of the most common operations performed in plastic surgery, bilateral breast reduction.
In this prospective, observational study, sequential breast reduction patients were contacted by telephone on the evening of postoperative days 3 and 7. Patients were queried as to which analgesic medications were used on the day of the phone call. Data relating to dosage, frequency, and satisfaction with pain control were sought. Patients taking chronic narcotics, postoperative complications requiring surgical intervention, and those unable to be reached after multiple attempts were excluded.
Complete data were obtained for 40 patients. Narcotic prescriptions were written for oxycodone, hydromorphone and tramadol, with the number prescribed ranging from 0 to 20 tablets. The median total number used was 6 tablets. Eighty percent of patients used a total of 10 tablets or less. Fifty percent of patients were using only nonnarcotic analgesia by postoperative day 3. Patient-reported satisfaction with pain control was overwhelmingly positive, with 95% being either somewhat satisfied or very satisfied with postoperative pain control. Of those taking any medication on postoperative day 3, only half were using a nonsteroidal anti-inflammatory drug (NSAID) as part of their pain regimen.
The number of tablets prescribed after breast reduction surgery varies considerably, and there is no consensus regarding the appropriate number to prescribe. Currently, few patients use all the medication prescribed to them, indicating a high rate of overprescribing. The overwhelming majority are satisfied with their pain control. Most patients use less than 10 tablets of narcotic pain medication after surgery. Acetaminophen is widely used as an adjunct but NSAIDs remain underutilized. Based on these data, we recommend that breast reduction patient's pain is best managed with acetaminophen, NSAIDs, and expectation management.
Surgery of Cerebral Cavernous Angiomas With Navigational Support
Authors: Gao Yang , Zheng Hui , Hao Bin , Chen Xin , Cao Yiqun 
Published: November 2019

Objective:
Accurate localization and removal of deep-seated cavernomas through a less invasive approach is still a challenge. The aim of this study is to compare the efficacy of neuronavigation and ultrasound in guiding surgery for resection of deep-seated cavernomas by transsulcal microsurgical approach.

Methods:
A total of 38 consecutive patients who suffered from deep-seated cavernomas underwent surgery via a transsulcal microsurgical approach in our hospital between September 2016 and March 2018. Patients were randomly divided into 2 groups (20 cases in neuronavigation group and 18 cases in ultrasound group). The clinical features, character of images, and surgical outcome were analyzed.

Results:
There was no significant difference between the 2 groups in diameter (16.6 ± 2.7 mm versus 19.6 ± 2.0 mm, P > 0.05) and depth (19.2 ± 2.4 mm versus 22.0 ± 4.6 mm, P > 0.05) of lesions. The ultrasound group had a similar tumor resection rate (100% versus 80%, P = 0.11) and shorter operation time (119.7 ± 4.5 minutes versus 137.3 ± 4.9 minutes, P < 0.05) than that in the neuronavigation group. There was no significant difference between in the symptomatic improvement rate, complication, postoperative hospital stay, and period of follow-up (P > 0.05). No death and recurrence appeared in both groups.

Conclusion:
Ultrasound showed certain advantages than neuronavigation in guiding resection of deep-seated cavernomas by transsulcal microsurgical approach.
Optimal Pancreatic Surgery
Authors: Beane Joal D. , Borrebach Jeffrey D. , Zureikat Amer H. , Kilbane E. Molly , Thompson Vanessa M. , Pitt Henry A. 
Published: November 2019

Objective:
Our aims were to assess North American trends in the management of patients undergoing pancreatoduodenectomy (PD) and distal pancreatectomy (DP), and to quantify the delivery of optimal pancreatic surgery.

Background:
Morbidity after pancreatectomy remains unacceptably high. Recent literature suggests that composite measures may more accurately define surgical quality.

Methods:
The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried to identify patients undergoing PD (N = 16,222) and DP (N = 7946). Patient, process, procedure, and 30-day postoperative outcome variables were analyzed over time. Optimal pancreatic surgery was defined as the absence of postoperative mortality, serious morbidity, percutaneous drainage, and reoperation while achieving a length of stay equal to or less than the 75th percentile (12 days for PD and 7 days for DP) with no readmissions. Risk-adjusted time-trend analyses were performed using logistic regression, and the threshold for statistical significance was P ≤ 0.05.

Results:
The use of minimally invasive PD did not change over time, but robotic PD increased (2.5 to 4.2%; P < 0.001) and laparoscopic PD decreased (5.8% to 4.3%; P < 0.02). Operative times decreased (P < 0.05) and fewer transfusions were administered (P < 0.001). The percentage of patients with a drain fluid amylase checked on postoperative day 1 increased (P < 0.001), and a greater percentage of surgical drains were removed by postoperative day 3 (P < 0.001). Overall morbidity (P < 0.02), mortality (P < 0.05), and postoperative length of stay (P = 0.002) decreased. Finally, the rate of optimal pancreatic surgery increased for PD (53.7% to 56.9%; P < 0.01) and DP (53.3% to 58.5%; P < 0.001), and alspo for patients with pancreatic cancer (P < 0.01).

Conclusions:
From 2013 to 2017, pre, intra, and perioperative pancreatectomy processes have evolved, and multiple postoperative outcomes have improved. Thus, in 4 years, optimal pancreatic surgery in North America has increased by 3% to 5%.
Urinary Catheter Management Approaches Among Women Undergoing Benign Gynecologic Surgery: A Randomized Trial
Authors: Lang Patrick , Quezada Yarini , Whiteside James 
Published: November 2019

Objective
The objective of this study was to identify differences in voiding trial success rates between delayed (postoperative day 1) and day of surgery catheter removal (“fast track”) among women undergoing benign gynecologic surgery. Rates of urinary tract infection, patient satisfaction, and lower urinary tract symptoms were compared between catheter management schemes.

Methods
Women undergoing benign gynecologic surgery were randomized to either “conventional” delayed urinary catheter care removal on postoperative day 1 or day of surgery catheter removal (fast track) 4 hours after surgery. Subjects were asked to complete a brief survey recording bladder function before and during their hospitalization and satisfaction with their catheter management. Subjects were contacted by phone 2 to 3 weeks after the index surgery to survey their bladder function including symptoms (eg, dysuria) or treatment indicative of a bladder infection.

Results
The median dwell time for Foley catheters in the “fast-track” group was 8.15 hours (SD = 375 minutes), whereas the median dwell time in the conventional group was 20.6 hours (SD = 265 minutes), which was significantly different (P < 0.001). Overall, 153 (93%) patients passed their voiding trial with significantly more patients passing their voiding trial in the conventional management group (P = 0.01). There was no difference in the Urogenital Distress Inventory scores at 2 weeks between catheter management cohorts (P = 0.81).

Conclusions
Foley dwell time is significantly reduced in the fast-track cohort. Voiding trial failure is higher with same-day catheter removal but that rate of failure rate is low. Patient satisfaction, the Urogenital Distress Inventory score, and postoperative urinary tract infection rates are not significantly different between cohorts.
Determining the clinical significance of the Chest Wall Injury Society taxonomy for multiple rib fractures
Authors: Clarke Peter T.M. , Simpson Rosalind B. , Dorman Jessica R. , Hunt William J. , Edwards John G. 
Published: November 2019

BACKGROUND
The Chest Wall Injury Society (CWIS) proposals for standardized nomenclature for multiple rib fracture (MRF) classifications were derived by international expert Delphi consensus. This study aimed to validate the CWIS taxonomy using a single-instituion clinical database.

METHODS
Computed tomography (CT) scans, of 539 consecutive patients with MRFs admitted to a regional major trauma center over a 33-month period, were reviewed (blinded for clinical outcomes). Every rib fracture in every patient was assessed according to each of the CWIS criteria (the degree of displacement, characterization of the fracture line, location of each fracture, and the relationship to neighboring fractures). The clinical significance of the proposed CWIS definitions were determined from independently coded, routinely collected Hospital Episodes Statistics data.

RESULTS
The radiologic aspects of 3,944 individual rib fractures were assessed. Indicators of injury severity (severe displacement greater series length, and flail segment) were positively associated with other fractures (p < 0.001), hemopneumothorax (p < 0.001), pulmonary complications (p = 0.002), adverse outcomes (p = 0.006), mechanical ventilation (p < 0.001) and prolonged hospital and intensive therapy unit length of stay (p = 0.006, p = 0.007 respectively). Four of the CWIS-proposed definitions were correlated with pulmonary complications and adverse outcomes: the categories of displacement, the definition of individual fracture characterization, the presence of a flail segment. Two definitions for which there was CWIS consensus were not correlated with clinical outcomes: the definition of a series to describe associated fractures on neighboring ribs, the inclusion of a paravertebral sector for fracture localization.

CONCLUSION
The CWIS rib fracture taxonomy demonstrates clinical relevance. There were associations between the severity of category groups within three of the proposed definitions, based on the clinical outcomes observed. Clinical outcome assessment proved inconclusive for four agreed definitions. Comprehensive, multiinstitutional data collection would be required to provide validation for all the CWIS-proposed definitions.

LEVELS OF EVIDENCE
Level IV.
Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys
Authors: Jiang Zeying , Liang Yuling , Zhong Tingting , Yang Shicong , Chen Yanyang , Huang Gang , Wang Changxi , Chen Wenfang 
Published: November 2019

Background.
Reports about prognosis of adults receiving small pediatric-donor kidneys (PDK) as compared to those receiving elder pediatric or adult donor kidneys (ADKs) are controversial. This study aimed to examine the outcomes of adults receiving small PDK and possible prognostic factors.

Methods.
The records of adults who received kidneys from donors < 10 years old at our center from July 1, 2011 to June 30, 2018 were reviewed.

Results.
A total of 121 adults were small PDK recipients. Twenty-three patients received 29 biopsies or nephrectomy between 6 and 896 days posttransplantation days. Seven patients (30.4%) had pediatric donor glomerulopathy (PDG), which developed from 113 to 615 days posttransplantation. The incidence of proteinuria and hematuria was significantly higher in the PDG group. The characteristic pathological finding in PDG was irregular lamination and splintering of the glomerular basement membrane (GBM). Donor age, donor weight, and donor kidney volume were significantly less in PDG cases compared with the non-PDG cases. For the risk factors of PDG, increasing urinary RBC count during follow-up was an independent predictor, while increasing donor age and body weight were protective factors. PDG was not a significant risk factor for Scr increasing of PDKs.

Conclusions.
PDG is a potential cause of abnormal urinalysis in adults receiving small PDKs. The pathological characteristic change of PDG is splitting and lamination of GBM. Persistent hematuria after transplantation in recipients of PDK is a predictor of PDG development.
Consequences of past climate change and recent human persecution on mitogenomic diversity in the arctic fox
Authors: Larsson Petter , von Seth Johanna , Hagen Ingerid J. , Götherström Anders , Androsov Semyon , Germonpré Mietje , Bergfeldt Nora , Fedorov Sergey , Eide Nina E. , Sokolova Natalia , Berteaux Dominique , Angerbjörn Anders , Flagstad Øystein , Plotnikov Valeri , Norén Karin , Díez-del-Molino David , Dussex Nicolas , Stanton David W. G. , Dalén Love 
Published: November 2019

Ancient DNA provides a powerful means to investigate the timing, rate and extent of population declines caused by extrinsic factors, such as past climate change and human activities. One species probably affected by both these factors is the arctic fox, which had a large distribution during the last glaciation that subsequently contracted at the start of the Holocene. More recently, the arctic fox population in Scandinavia went through a demographic bottleneck owing to human persecution. To investigate the consequences of these processes, we generated mitogenome sequences from a temporal dataset comprising Pleistocene, historical and modern arctic fox samples. We found no evidence that Pleistocene populations in mid-latitude Europe or Russia contributed to the present-day gene pool of the Scandinavian population, suggesting that postglacial climate warming led to local population extinctions. Furthermore, during the twentieth-century bottleneck in Scandinavia, at least half of the mitogenome haplotypes were lost, consistent with a 20-fold reduction in female effective population size. In conclusion, these results suggest that the arctic fox in mainland Western Europe has lost genetic diversity as a result of both past climate change and human persecution. Consequently, it might be particularly vulnerable to the future challenges posed by climate change.This article is part of a discussion meeting issue ‘The past is a foreign country: how much can the fossil record actually inform conservation?’
Shifted distribution baselines: neglecting long-term biodiversity records risks overlooking potentially suitable habitat for conservation management
Authors: Monsarrat Sophie , Novellie Peter , Rushworth Ian , Kerley Graham 
Published: November 2019

Setting appropriate conservation measures to halt the loss of biodiversity requires a good understanding of species' habitat requirements and potential distribution. Recent (past few decades) ecological data are typically used to estimate and understand species’ ecological niches. However, historical local extinctions may have truncated species–environment relationships, resulting in a biased perception of species' habitat preferences. This may result in incorrect assessments of the area potentially available for their conservation. Incorporating long-term (centuries-old) occurrence records with recent records may provide better information on species–environment relationships and improve the modelling and understanding of habitat suitability. We test whether neglecting long-term occurrence records leads to an underestimation of species’ historical niche and potential distribution and identify which species are more vulnerable to this effect. We compare outputs of species distribution models and niche hypervolumes built using recent records only with those built using both recent and long-term (post-1500) records, for a set of 34 large mammal species in South Africa. We find that, while using recent records only is adequate for some species, adding historical records in the analyses impacts estimates of the niche and habitat suitability for 12 species (34%) in our dataset, and that this effect is significantly higher for carnivores. These results show that neglecting long-term biodiversity records in spatial analyses risks misunderstanding, and generally underestimating, species' niches, which in turn may lead to ill-informed management decisions, with significant implications for the effectiveness of conservation efforts.
This article is part of a discussion meeting issue ‘The past is a foreign country: how much can the fossil record actually inform conservation?’