bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region
Authors: Li Bo , Chang Shi-Min , Du Shou-Chao , Zhuang Lei , Hu Sun-Jun 
Published: November 2019

Backgrounds
Distally based perforator propeller flap from the lower leg region is a versatile local reconstructive technique for the foot and ankle defects. However, flap venous congestion remains a tough nut to crack. We hypothesize that raising an adipofascial flap with turnover mode of transposition can improve venous drainage and enhance flap safety.

Methods
Based on the 2 rows of septocutaneous perforators in the posterior distal third of the lower leg, distally based adipofascial flap was raised from medial sural region nourished by 1 perforator bundle from the posterior tibial artery or from the lateral sural region from the peroneal artery. The superficial dissection was performed in subdermal plane and deep in to the subfascial space. The flap was nourished by perforator-plus-adipofascial pedicle and turned over 180 degrees upside down to reach the distal wounds. One week later, a split-skin graft was used to cover the exposed fascial flap. Postoperatively, flap survival, complications, and patient functional recovery were evaluated.

Results
Distally based sural turnover adipofascial flaps were used in 12 cases with complicated wounds of the distal third lower leg, foot, and ankle region. All wounds were caused by trauma and experienced fracture implants fixation and 5 with osteomyelitis. The comorbidities include diabetes in 9 cases and smoking in 7. There were 8 medial ural flaps and 4 lateral sural flaps. The adipofiscial flaps measured from 6.0 cm × 5.0 cm to 17.0 cm × 6.0 cm (mean, 61.3 cm2). Postoperatively, all flaps survived uneventfully without any complication such as flap ischemia and/or necrosis. Two minor donor site complications were encountered, one was postoperative hematoma, and another was hyperproliferative scar. After a mean of 14.6 months of follow-up, the adipofascial flap plus skin graft showed a durable esthetic coverage, with normal shoe wearing and walking.

Conclusions
Distally based sural adipofascial turnover flap is a simple and reliable wound coverage technique. It avoids venous congestion as usually seen in distally based fasciocutaneous flaps.
Cosmetic Tourism in Northern Ireland
Authors: Martin Serena , Long Rebekah , Hill Christopher , Sinclair Stephen 
Published: November 2019

Aim
Over the new year period, we recognized a high number of admissions with postoperative complications following cosmetic surgery abroad. We aimed to determine the driving forces behind this and financial impact on the National Health Service (NHS).

Methods
Cases of all patients attending the regional plastic surgery unit with complications following surgery abroad were reviewed. Patients completed a survey on the perioperative period abroad and driving forces. In addition, the costing department was contacted to determine the financial burden associated with cosmetic tourism.

Results
Six patients were admitted to the regional unit after independently organizing surgery abroad. Countries visited included Turkey, Belgium, Poland, Estonia, and India. Reasons included cost and access to procedures not recommended by UK surgeon. Type of surgery included breast (5), abdominoplasty (2), liposuction (2), and labiaplasty (1), and 50% had multiple procedures. Complications included necrotic wounds (33%), infected breast implant (33%), venous thromboembolism investigated (33%), and wound infection (17%). Overall, 67% required surgery on the NHS. The total cost was £23,976.82, with an average of £4000/patient (range, £1294–£6291).

Discussion/Conclusions
This surge in cosmetic complications occurred in the New Year period. Complications were seen after a wide range of surgical procedures. All patients required an inpatient stay, and two-thirds required surgery with a significant cost burden to the NHS. Patients are unaware of the risks involved, highlighted by the lack of preoperative counseling and follow-up. In addition, this series has highlighted the risks associated with traveling in the perioperative period, with 2 patients investigated for pulmonary embolus.
Nasolabial Changes Following Double Jaw Surgery
Authors: Allar Michelle L. , Movahed Reza , Wolford Larry M. , Oliver Donald R. , Harrison Steve D. , Thiesen Guilherme , Kim Ki Beom 
Published: November 2019

Background:
This study aimed to analyze 3-dimensional nasolabial soft tissue changes following double jaw surgery with Le Fort I maxillary advancement and relate them to underlying surgical movements.

Methods:
Pre- and post-surgical cone-beam computed tomography images of 37 maxillomandibular surgery patients with ≥2 mm of advancement at A-point were analyzed. Lateral cephalograms were constructed to determine horizontal and vertical surgical movements and 3-dimensional facial images were created from the CBCTs to calculate linear and angular changes.

Results:
Alar base width increased 1.9 mm, nasal tip protrusion decreased 0.74 mm, the upper lip flattened 7.71 degree and increased 0.9 mm in length, nasal tip was displaced 2.47 mm superiorly causing an increased concavity of 5.52 degree for the overall dorsal surface and 3.99 degree at the supratip break angle (SBA), nasal tip angle decreased 2.16 degree and nasolabial angle decreased 7.37 degree. Correlations were found between underlying surgical movements and nasal tip protrusion, SBA, nasolabial angle (NLA), and nasal tip elevation (NTE). Multiple linear regression equations were calculated to predict changes in SBA from horizontal change at A-point, NLA from horizontal change at B-point, and NTE from the change at A-point horizontally and U1-tip vertically.

Conclusion:
Double jaw surgery with maxillary advancement has significant effects on nasolabial anatomy.
Symptom and Quality of Life Improvements After Pelvic Floor Physical Therapy in a Clinical Population of Women With Pelvic Pain and Other Symptoms
Authors: Killinger Kim A. , Henrichsen Jacob L. , Han Esther , Dai Yi Ling , Nguyen Laura , Gilleran Jason , Odabachian Lisa , Boura Judith A. , Peters Kenneth M. , Sirls Larry T. 
Published: November 2019

Objectives
This study aimed to evaluate changes in validated symptom scores at intake and discharge in women undergoing pelvic floor physical therapy (PFPT) for pain and other pelvic floor symptoms.

Methods
Consecutive women starting PFPT during 1 year were reviewed. History, demographics, and Pelvic Floor Distress Inventory Questionnaire – Short Form 20 (PFDI) total and domain scores (Pelvic Organ Prolapse Distress Inventory-6, Urogenital Distress Inventory-6, Colorectal-Anal Distress Inventory-8), Pelvic Floor Impact Questionnaire (PFIQ-7), and pain levels on a numeric rating scale (NRS) were collected at intake and discharge. Data were analyzed with descriptive statistics and sign tests.

Results
Of 474 women, mean age was 50.3 ± 16.7 years (range, 18–87 years) and the most common indication for PFPT was pelvic pain (208/474; 43.9%). In women with complete data, pretreatment to posttreatment median scores improved on the PFDI (77.3 vs 41.8; P < 0.0001), Urogenital Distress Inventory (37.5 vs 16.0; P < 0.0001), and PFIQ (58.0 vs 19.0; P < 0.0001), and the minimal clinically important difference was met for the PFDI, PFIQ, and Colorectal-Anal Distress Inventory. Women with primarily pelvic pain (n = 208) achieved significant improvements in PFDI, PFIQ, and NRS scores (P < 0.0001 for all) as well as the minimal clinically important difference for these measures. Pain patients with a history of pelvic surgery (n = 50) also had significant improvements in PFIQ and NRS but not PFDI scores.

Conclusions
Most women referred to PFPT demonstrated symptom improvements as measured by validated instruments.
Consequences of pre-injury utilization of direct oral anticoagulants in patients with traumatic brain injury: A systematic review and meta-analysis
Authors: Nederpelt Charlie J. , van der Aalst Stefano J.M. , Rosenthal Martin G. , Krijnen Pieta , Huisman Menno V. , Peul Wilco C. , Schipper Inger B. 
Published: November 2019

BACKGROUND
The rapid adoption and widespread use of direct oral anticoagulants (DOACs) has outpaced research efforts to establish their effects in bleeding trauma patients. In patients with complicated traumatic brain injury (TBI) caused by intracranial hemorrhage, DOAC use may be associated with higher bleeding volume and potentially more disastrous sequelae than use of vitamin K antagonists (VKAs). In the current systematic review and meta-analysis we set out to evaluate the literature on the relationship between preinjury DOAC use and course of the intracranial hemorrhage. (ICH), its treatment and mortality rates in TBI patients, and to compare these outcomes to those of patients with preinjury VKA use.

METHODS
PubMed, Embase, Web of Science, and the Cochrane Library were searched using a search strategy including three main terms: “traumatic brain injury,” “direct oral anticoagulants,” and “vitamin K antagonists.” There were 1,446 abstracts screened, and ultimately, six included articles. Random effects modeling meta-analysis was performed on in-hospital mortality, ICH progression and neurosurgical intervention rate.

RESULTS
All cohorts had similar baseline and emergency department parameters. Within individual studies surgery rate, reversal agents used, ICH progression and in-hospital mortality differed significantly between DOAC and VKA cohorts. Meta-analysis showed no significant difference in in-hospital mortality (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.23–4.06; I
2 = 76%; p = 0.97), neurosurgical interventions (OR, 0.48; 95% CI, 0.14–1.63; p = 0.24), or ICH progression rates (OR, 1.86; 95% CI, 0.32–10.66; p = 0.49) between patients that used preinjury DOACs versus patients that used VKAs.

CONCLUSION
Direct oral anticoagulant-using mild TBI patients do not appear to be at an increased risk of in-hospital mortality, nor of increased ICH progression or surgery rates, compared with those taking VKAs.

LEVEL OF EVIDENCE
Systematic review, level III.
Rotational thromboelastometry predicts transfusion and disability in pediatric trauma
Authors: Cunningham Aaron J. , Condron Mary , Schreiber Martin A. , Azarow Kenneth , Hamilton Nicholas A. , Downie Katie , Long William B. , Maxwell Bryan G. , Jafri Mubeen A. 
Published: November 2019

BACKGROUND
Trauma-induced coagulopathy seen on rotational thromboelastometry (ROTEM) is associated with poor outcomes in adults; however, this relationship is poorly understood in the pediatric population. We sought to define thresholds for product-specific transfusion and evaluate the prognostic efficacy of ROTEM in injured children.

METHODS
Demographics, ROTEM, and clinical outcomes from severely injured children (age, < 18 years) admitted to a Level I trauma center between 2014 and 2018 were retrospectively analyzed. Receiver operating characteristic curves were plotted and Youden indexes were calculated against the endpoint of packed red blood cell transfusion to identify thresholds for intervention. The ROTEM parameters were compared against the clinical outcomes of mortality or disability at discharge.

RESULTS
Ninety subjects were reviewed. Increased tissue factor-triggered extrinsic pathway (EXTEM) clotting time (CT) >84.5 sec (p = 0.049), decreased EXTEM amplitude at 10 minutes (A10) <43.5 mm (p = 0.025), and decreased EXTEM maximal clot firmness (MCF) <64.5 mm (p = 0.026) were associated with need for blood product transfusion. Additionally, EXTEM CT longer than 68.5 seconds was associated with mortality or disability at discharge.

CONCLUSION
Coagulation dysregulation on thromboelastometry is associated with disability and mortality in children. Based on our findings, we propose ROTEM thresholds: plasma transfusion for EXTEM CT longer than 84.5 seconds, fibrinogen replacement for EXTEM A10 less than 43.5 mm, and platelet transfusion for EXTEM MCF less than 64.5 mm.

LEVEL OF EVIDENCE
Prognostic, Level III; Therapeutic, Level IV.
Venous thromboembolism chemoprophylaxis regimens in trauma and surgery patients with obesity: A systematic review
Authors: Shaikh Saamia , Boneva Dessy , Hai Shaikh , McKenney Mark , Elkbuli Adel 
Published: November 2019

BACKGROUND
Venous thromboembolism (VTE) continues to be a devastating source of morbidity and mortality in obese patients who suffer traumatic injuries or obese surgery patients. High incidence rates in VTE despite adherence to prevention protocols have stirred interest in new dosing regimens. The purpose of this study was to systematically review the literature and present the existing VTE chemoprophylaxis regimens for obese trauma and surgical patients in terms of efficacy and safety as measured by the incidence of VTE, anti-factor Xa levels, and the occurrence of bleeding events.

METHODS
An online search of seven literature databases including PubMed, Excerpta Medica Database, GoogleScholar, JAMA Network, CINAHL, Cochrane, and SAGE Journals was performed for original studies evaluating the safety and efficacy of VTE chemoprophylaxis dosing regimens according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Cochrane Risk of Bias Tool and the quality of evidence was determined using the GRADE Working Group criteria.

RESULTS
Of the 5,083 citations identified, 45 studies with 27,717 patients met inclusion criteria. In this group, six studies evaluated weight-based dosing regimens, four used a weight-stratified or weight-tiered strategy, five used a body mass index–stratified approach, 29 assessed fixed-dose regimens, and two used continuous infusions. The majority of the studies evaluated anti-factor Xa levels as their primary outcome rather than reduction in VTE.

CONCLUSION
Weight-based and high fixed-dose chemoprophylaxis regimens achieved target anti-Xa concentrations more frequently than standard fixed-dose regimens but were not associated with a reduction in VTE. Additionally, high fixed-dose approaches are associated with increased bleeding complications. Further evaluation with large randomized trials is warranted in trauma and surgery patients with obesity.

LEVEL OF EVIDENCE
Systematic review, level III.
Donor-host Lymphatic Anastomosis After Murine Lung Transplantation
Authors: Outtz Reed Hasina , Wang Liqing , Kahn Mark L. , Hancock Wayne W. 
Published: November 2019

Background.
Establishing lung lymphatic drainage is thought to be important for successful lung transplantation. To date, there has been a complete absence of knowledge of how lymphatic connections are reestablished after lung transplant, despite evidence suggesting that this does indeed occur. The present study aimed to elucidate whether and how lymphatic anastomosis occurs after lung transplant.

Methods.
An orthotopic murine model of lung transplant using lymphatic reporter mice and whole mount immunohistochemistry was used to evaluate the lymphatic vasculature and donor-host connections after lung transplantation.

Results.
Immunohistochemistry of transplanted lungs demonstrated robust lymphatic vessels, and functional assays demonstrated lymphatic drainage in the transplanted lung that was comparable with that in native lungs. Lymphatic vessels in the donor lung exhibited active sprouting toward the host at the anastomosis within the first 3 days after lung transplantation, with more numerous and complex lymphatic sprouting developing thereafter. Donor lymphatic vessels were numerous at the site of anastomosis by day 14 after lung transplantation and formed physical connections with host lymphatic vessels, demonstrating a mechanism by which lymphatic drainage is reestablished in the transplanted lung.

Conclusions.
Lymphatic drainage after lung transplantation is established by active sprouting of donor lymphatic vessels towards the host and the formation of donor-host lymphatic connections at the level of the transplant anastomosis.
Eye Movement Disorders and the Cerebellum
Authors: Shemesh Ari A. , Zee David S. 
Published: November 2019

Summary:
The cerebellum works as a network hub for optimizing eye movements through its mutual connections with the brainstem and beyond. Here, we review three key areas in the cerebellum that are related to the control of eye movements: (1) the flocculus/paraflocculus (tonsil) complex, primarily for high-frequency, transient vestibular responses, and also for smooth pursuit maintenance and steady gaze holding; (2) the nodulus/ventral uvula, primarily for low-frequency, sustained vestibular responses; and (3) the dorsal vermis/posterior fastigial nucleus, primarily for the accuracy of saccades. Although there is no absolute compartmentalization of function within the three major ocular motor areas in the cerebellum, the structural–functional approach provides a framework for assessing ocular motor performance in patients with disease that involves the cerebellum or the brainstem.
The CPM Effect: Functional Assessment of the Diffuse Noxious Inhibitory Control in Humans
Authors: Leone Caterina , Truini Andrea 
Published: November 2019

Summary:
The diffuse noxious inhibitory control, which has been investigated extensively in animals, consists of the inhibitory modulation of pain pathways after heterotopic noxious stimulation. The subnucleus reticularis dorsalis, which lies in the caudal part of the medulla, together with its descending projections to the wide-dynamic-range neurones, is responsible for the diffuse noxious inhibitory control. Many studies have investigated the diffuse noxious inhibitory control phenomenon in humans. However, owing to the complexity of the effect of descending modulation on human pain perception, expert opinion has recommended the term “conditioned pain modulation” to describe the psychophysical paradigm in which a heterotopic noxious stimulus is used to affect pain pathways in humans. In this narrative review, we present the current knowledge on the mechanisms underlying the diffuse noxious inhibitory control in animals and show how this phenomenon can be investigated in humans by using the conditioned pain modulation paradigm. We also demonstrate the relevance of conditioned pain modulation to the pathophysiology of pain.
Disturbance Sensitivity Shapes Patterns of Tree Species Distribution in Afrotropical Lowland Rainforests More Than Climate or Soil
Authors: Nuñez Chase L. , Clark James S. , Poulsen John R. 
Published: November 2019

AbstractUnderstanding how tropical forests respond to changes in the abiotic environment and human disturbance is critical for preserving biodiversity, mitigating climate change, and maintaining ecosystem services in the coming century. To evaluate the relative roles of the abiotic environment and disturbance on Afrotropical forest community composition we employ tree inventory data, remotely sensed historic climatic data, and soil nutrient data collected from 30 1-ha plots distributed across a large-scale observational experiment in previously logged, hunted, and pristine forests in northern Republic of Congo (Brazzaville). We show that Afrotropical plant communities are more sensitive to human disturbance than to climate, with particular sensitivities to hunting and distance to village (a proxy for other human activities, including tree-cutting, gathering, etc.). This study serves as an important counterpoint to work done in the Neotropics by providing contrasting predictions for Afrotropical forests with substantially different ecological, evolutionary, and anthropogenic histories.
Physical modeling and geometry configuration simulation for flexible cable in a virtual assembly system
Authors: Hongwang Du , Xiong Wei , Haitao Wang , Zuwen Wang 
Published: November 2019

Purpose
In this paper, a novel and unified method for geometry configuration simulation of flexible cable under certain boundary conditions is presented. This methodology can be used to realize cable assembly verification in any computer-aided design/manufacturing system. The modeling method, solution algorithm, geometry configuration simulation and experimental results are presented to prove the feasibility of this proposed methodology. The paper aims to discuss these issues.

Design/methodology/approach
Considering the gravity, bending and torsion, modeling of cable follows the Kirchhoff theory. For this purpose, Euler quaternions are used to describe its spatial geometry configuration by a carefully chosen set of coordinates. Then the cable is discretized by the FEM, and the equilibrium condition per element is computed. In this way, the global static behavior is independent of the discretization. The static evolution of the cable is obtained by numerical integration of the resulting Kirchhoff equations. Then the manner is demonstrated, in which this system of equations can be decoupled and efficiently solved. Geometry configuration simulation examples with different boundary conditions are presented. Finally, experiment validation are given to describe the effectiveness of the models and algorithms.

Findings
The method presented in this paper can be adapted to computer-aided assembly verification of flexible cable. The experimental results indicate that both of the model and algorithm are efficient and accurate.

Research limitations/implications
The method should be extended to flexible cables with multiple branches and more complex constraints (holes, curved surfaces and clamps) and non-circular sections. Dynamic assembly process simulation based on the Kirchhoff theory must be considered in the future.

Originality/value
Unlike in previous approaches, the cable behavior was independent of the underlying discretization, and the finite element approach enables physically plausible cable assembly verification.
Optical alignment and compensation control of die bonder for chips containing through-silicon vias
Authors: Lin Chern Sheng , Hung Chang-Yu , Chen Chung Ting , Lin Ke-Chun , Huang Kuo Liang 
Published: November 2019

PurposeThis study aims to present an optical alignment and compensation control of die bonder for chips containing through-silicon vias and develop three-dimensional integrated circuit stacked packaging for compact size and multifunction.Design/methodology/approachThe machine vision, optical alignment method and sub-pixel technology in dynamic imaging condition are used. Through a comparison of reference image, the chip alignment calibration can improve machine accuracy and stability.FindingsAccording to the experimental data and preliminary results of the analysis, accuracy can be achieved within the desired range, and the accuracy is much better than traditional die bonder equipment. The results help further research in die bonder for chips containing through-silicon vias.Originality/valueIn subsequent testing of the chip, the machine can simultaneously test multiple chips to save test time and increase productivity.