bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unsuspected Accessory Ossicle in Possible Sinus Tarsi Syndrome
Authors: Achong Dwight M. 
Published: February 2020

Abstract
Three-phase bone scan was performed for evaluation of possible sinus tarsi syndrome in a 52-year-old man with chronic left ankle pain. MRI was initially read as unremarkable, and there was little symptomatic improvement after intra-articular anesthetic injection. The primary finding that appreciated only delayed bone SPECT/CT images was focal increased uptake associated with a well-corticated 8-mm bony fragment adjacent to the left calcaneus, thought to represent an accessory ossicle within the left sinus tarsi. The increased uptake suggested fracture or severe degenerative change of the ossicle, likely contributing to the patient's chronic pain.
18F-FDOPA PET/CT Findings in a Patient With Primary Cerebral Amyloidoma
Authors: Rozenblum Laura , Bertaux Marc , Bielle Franck , Ollivier Morgan , Choquet Sylvain , Garcilazo Ytel , Mokhtari Karima , Kas Aurélie 
Published: February 2020

Abstract
Amino acid PET, including 18F-FDOPA, is recommended for initial characterization, delineation of tumor extent, and follow-up of gliomas because of its high diagnostic performances. 18F-FDOPA accumulates inside tumor cells via the l-type amino acid transporter 1 (LAT1) whose expression is increased in gliomas. We report here a case of a histopathologically proven brain amyloidoma that was first addressed for a suspected glioma. Congo red staining showed scattered extracellular deposits of amyloid and immunohistochemistry-highlighted LAT1 expression, explaining the high 18F-FDOPA uptake found in this lesion. This case indicates that differential diagnosis of the 18F-FDOPA uptake in brain lesions should include amyloidoma.
Incorporating Cleft Lip Simulation Into a “Bootcamp-Style” Curriculum
Authors: Saldanha Francesca Y.L. , Loan Gregory J. , Calabrese Carly E. , Sideridis Georgios D. , Weinstock Peter H. , Rogers-Vizena Carolyn R. 
Published: February 2020

Introduction
The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures.

Methods
By revisiting principles of adult learning theory, the authors created a “bootcamp-style” cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by “operating” on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. A self-assessment survey was taken before and after each component of the session, including a self-confidence survey to conclude the session. Anthropometric measures of lip/nasal symmetry were assessed.

Results
Sixteen trainees participated in the program. Little increase in self-assessed knowledge/skill was seen after the lecture, but significant increases in most aspects of cleft lip repair were seen after simulation. The greatest increase in self-assessment was seen for the program as a whole, with significant differences across all aspects of the self-assessment. Higher levels of training were associated with both higher self-assessment scores and better lip symmetry. Regardless of level of training, all participants strongly agreed that simulation helped them actively engage in learning and should be a required aspect of training, whereas 94% (n = 15) thought simulation was much more effective than standard preparation alone.

Conclusions
This pilot curriculum illustrates a mechanism to incorporate lessons from adult learning theory into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.
Use of Sentinel Lymph Node Incision for Second Stage Implant-Based Breast Reconstruction After Radiation
Authors: Lobb David C. , Deal Alexandra L. , Campbell Christopher A. 
Published: February 2020

Background
Staged expander to implant breast reconstruction is associated with a high complication rate when the patient has had postmastectomy radiation. With an increasing number of American women undergoing implant-based breast reconstruction after postmastectomy radiation, surgeons may find themselves operating in a radiated field with synthetic devices. We report the performance characteristics of a novel surgical modification to the second stage expander to implant exchange after adjuvant radiation using a transaxillary approach through a prior sentinel lymph node incision, a site remote from the breast implant pocket.

Methods
We performed a retrospective review of a prospectively maintained database to evaluate the surgical outcomes of serial patients undergoing second staged expander to implant exchange through the sentinel lymph node incision 6 months or more after completing whole breast radiation. A case matched cohort to age, body mass index, and comorbid status was used to compare outcomes between patients in the group of interest versus a traditional skin sparing incision on the anterior breast mound through the radiated skin envelope. All patients included demonstrated grade 1 or 2 skin changes on the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema for the skin organ system.

Results
Nineteen breasts were reconstructed for 18 women after immediate tissue expander placement and adjuvant whole breast radiation were included in our group of interest. Forty-one case-matched second controls were identified for the comparison group. There were no intraoperative complications. Two postoperative complications were reported for the sentinel lymph node approach group (10.5%) with an average of 9 months of follow-up: 1 operative exploration for hematoma and 1 minor wound requiring recloser in the office. The case matched cohort demonstrated significantly more minor postoperative complications (P = 0.037) with a total complications rate of 41.4%. There were 31.7% of the patients that experienced a minor complication alone, whereas 9.7% of the case-matched cohort experienced a major complication.

Conclusions
These data support the use of the existing axillary sentinel lymph node access incision for second stage placement of a gel implant after immediate expander and adjuvant radiation therapy. The sentinel lymph node incision approach facilitates layered closure over the breast pocket at a site remote from irradiated tissue, reducing the incidence of postoperative minor complications. Forthcoming long-term data will determine if differences in reported capsular contracture rates can be achieved with a remote transaxillary approach to second stage implant reconstruction after radiation.
Autologous Fat Grafting Does Not Increase Risk of Oncologic Recurrence in the Reconstructed Breast
Authors: Vyas Krishna S. , DeCoster Ryan C. , Burns Jack C. , Rodgers Louis T. , Shrout Max A. , Mercer James P. , Coquillard Cristin , Dugan Adam J. , Baratta Michael D. , Rinker Brian D. , Vasconez Henry C. 
Published: February 2020

Introduction
Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction after mastectomy; however, the oncological safety of AFG remains in question. The aim of this study was to determine whether AFG increases the risk of cancer recurrence in the reconstructed breast.

Methods
A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. χ2 analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing.

Results
Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG, whereas 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% vs 9.0%, P < 1.000). Unadjusted (hazard ratio = 1.03, confidence interval = 0.41–2.60, P < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic recurrence when comparing AFG to non-AFG. In addition, no statistical differences in disease-free survival were found (P = 0.96 by log rank test).

Conclusion
Autologous fat grafting for breast reconstruction is oncologically safe and does not increase the likelihood of oncologic recurrence. Larger studies (eg, meta analyses) with longer follow-up are needed to further elucidate the long-term safety of AFG as a reconstructive adjunct.
Health-Related Quality of Life in Craniofacial Conditions
Authors: Morgan Austin , Ataseven Burçin , Din Hena , Blum Jessica , Paap Michael , Meier Annie , Carrizosa Claudia , Malcarne Vanessa , Gosman Amanda 
Published: February 2020

IntroductionCraniofacial conditions (CFCs) profoundly influence health-related quality of life (HRQoL). In children with CFCs, patient-reported outcome measures have become an integral adjunct to more objective surgical outcome measures. Patient-reported outcome measures are designed to assess HRQoL domains. Few studies have evaluated parent and child agreement about HRQoL in the context of CFCs. The aims of this study were to explore the impact of CFCs on HRQoL domains in children and their parents and to determine whether patient and parent perspectives converge.MethodsThe Craniofacial Conditions Quality of Life Scale (CFC-QoL) is a newly developed 5-domain survey available in child self-report and parent report and in English- and Spanish-language versions. The 5 domains are the following: social impact, psychological function, physical function, family impact, and appearance impact. Children with CFCs (ages 7–21 years) and parents of children with CFCs were recruited via the craniofacial care team clinic at a major metropolitan children's hospital. All children and parents completed the CFC-QoL Scale in their preferred language of English or Spanish. Scale internal consistencies were calculated for child patients and parents, for English and Spanish versions. Scores on the 5 domains were compared for children and parents across English versus Spanish versions.ResultsFor children with CFCs (N = 75), the sex was distributed almost equally. Patients were mostly Hispanic (69.3%), and their ages ranged from 7 to 21 years old (M = 13.2, SD = 3.62). The mean values for patient and parent scores were low, suggesting good HRQoL across all 5 domains. Pearson correlation coefficients were computed to explore the interrelationships between patient and parent report for each of the 5 CFC-QoL subscales. For the total sample, patient and parent scores were significantly and moderately positively correlated for all subscales. When analyzed separately based on sex, ethnicity, and diagnostic group, the correlation patterns were not identical to those found for the total sample. When analyzed separately for diagnostic group, there was less consistency in patterns, with patient-parent dyads showing different levels of agreement based on child's diagnostic grouping.ConclusionsAlthough there is substantial agreement between parents and patients when considered on a group level, there is moderate agreement between patients and parents when considered at the dyadic level, underscoring the importance of measuring and considering both perspectives.
Improving the Versatility of the Latissimus Dorsi Myocutaneous Flap Using the Perforator Propeller Flap Concept
Authors: Liu Yuanbo , Zang Mengqing , Wu Lehao , Zhu Shan , Chen Bo , Li Shanshan , Han Tinglu , Qu Huayi 
Published: February 2020

Background
The latissimus dorsi myocutaneous flap is widely used in reconstructive surgery; however, primary donor-site closure remains challenging when a wide flap is harvested.

Methods
A large latissimus dorsi myocutaneous flap was elevated and transferred to repair defects. Perforators adjacent to the donor site of the myocutaneous flap were explored using an ultrasound Doppler probe or a technique of extensive exploration along the margins of the donor site wound. A single or multiple perforator propeller flaps based on these perforators were used to close the donor site defect.

Results
From June 2012 to April 2018, this method was used to restore posttraumatic and oncologic defects of the chest wall in 14 cases, upper extremity in 6 cases, and lower extremity in 1 case. The size and width of the latissimus dorsi myocutaneous flaps ranged from 16 × 11 cm to 33 × 17 cm (mean area, 335.6 cm2) and 9 cm to 20 cm (mean width, 14 cm), respectively. The donor site defect was closed primarily by using a single flap in 11 cases, dual flap in 9, and triple flap in one. Donor site breakdown was not observed in any of the cases.

Conclusions
The perforator propeller flap could be used to reconstruct a latissimus dorsi myocutaneous flap donor site defect, ensuring not only the harvesting of a wide flap but also achieving primary donor site closure, thus greatly improving the versatility and capability of the latissimus dorsi myocutaneous flap in the reconstruction of large-sized defects.
Comparison of Rhinoplasty Patients Informed With Standard Verbal Information in Preoperative Period and Rhinoplasty Patients Informed and Treated With Visual Information Through Catalog in Terms of the Development of Agitation, Edema and Ecchymose in the Postoperative Period
Authors: Keleş Havva Pinar , Besir Ahmet , Livaoğlu Murat 
Published: February 2020

Aim:
In this study, we aimed to compare the effects of standard verbal information in the preoperative period and the information by visual expression and physical applications in the development of agitation, edema and ecchymosis in the postoperative period.

Materials and Methods:
The study was carried out in 60 ASA I-II patients who were going to undergo open rhinoplasty by plastic surgery. In the Preoperative Anesthetic Assessment the patients were divided into two groups as the patients given standard verbal information (Group S; n = 30) and those informed with a catalog which contains visuals (Group V; n = 30) In the preoperative period, anxiety levels of the patients were evaluated. Standard anesthesia induction was performed in both groups after standard monitoring. Patients were monitored in the post-anesthesia care unit and ward. Patient's extubation quality, presence of postoperative agitation and periorbital edema and ecchymosis at the 6th, 12th, 18th, and 24th hours were evaluated.

Results:
No significant difference was found between the groups in terms of intraoperative and postoperative MAP, HR, extubation quality, presence of recovery agitation, postoperative pain, development edema and ecchymosis (P > 0.05). Significant positive correlation was found between post-extubation MAP and edema scores at the 16th and 24th hours postoperatively and between the post-anesthesia care unit entry MAP and ecchymosis at the 24th postoperative hours independently of the groups (r = 0.27; P = 0.038, r = 0.302; P = 0.019, r = 0.345; P = 0.007, respectively).

Result:
In our study, it was concluded that detailed visual information and physical application in the preoperative period among rhinoplasty patients had no effect on the incidence of postoperative agitation, development of edema and ecchymosis.
Huge Anterior Skull Base Defect Reconstruction on Communicating Between Cranium and Nasal Cavity: Combination Flap of Galeal Flap and Reverse Temporalis Flap
Authors: Shin Dongwoo , Yang Chae Eun , Kim Yong Ook , Hong Jong Won , Lee Won Jai , Lew Dae Hyun , Chang Jong Hee , Kim Chang Hoon 
Published: February 2020

Introduction:
Traditionally, galeal flap or cranialization was often used to reconstruct the skull base defect caused by trauma or tumor removal. However, in the case of huge skull base defect, galeal flap is not enough to block the communication between nasal cavity and intracranial space. In this study, authors suggest combination flap of galea and reverse temporalis muscle as a method for reconstruction of huge skull base defect.

Materials and Methods:
From 2016 to 2019, retrospective review was conducted, assessing 7 patients with bone defect which is not just opening of frontal sinus but extends to frontal sinus and cribriform plate. Reconstructions were done by combination of galeal flap and reverse temporalis muscle flap transposition.

Results:
Defects were caused by nasal cavity tumor with intracranial extension or brain tumor with nasal cavity extension. There was no major complication in every case. During the follow up period, no patient had signs of complication such as ascending infection, herniation and CSF rhinorrhea. Postoperative radiologic images of all patients that were taken at least 6 months after the surgery showed that flaps maintained the lining and the volume well.

Discussion:
Conventional reconstruction of skull base defect with galeal flap is not effective enough to cover the large sized defect. In conclusion, galeal flap in combination with reverse temporalis muscle flap can effectively block the communication of nasal cavity and intracranium.
Use of Intravenous Immunoglobulins in Patients with Suspected Toxin-Mediated Shock Requiring Extracorporeal Membrane Oxygenation
Authors: Peetermans Marijke , Wan Ruth Y.Y. , Camporota Luigi , Barrett Nicholas A. , Retter Andrew 
Published: February 2020

ABSTRACT

Background:
Toxin-producing, gram-positive bacteria can lead to severe and refractory septic shock with high attributable mortality. Adjunctive therapies such as intravenous immunoglobulins (IVIG) have been proposed for these patients. However, at presentation the presence of a toxin-producing organism is most often unknown. As IVIG is a potentially valuable but also limited resource, we investigated the use of IVIG in our critically ill patients requiring extracorporeal membrane oxygenation (ECMO).

Materials and methods:
Retrospective cohort study (April 2016 to March 2018) of adult patients with clinically suspected toxin-mediated shock requiring ECMO and who received IVIG in our regional severe respiratory failure (SRF)/ECMO center.

Results:
In 44% (15/34) of the patients, group A Streptococcus or Panton-Valentine Leukocidin producing S aureus was isolated. IVIG use in these patients was safe. The mortality was 30%, lower than the predicted mortality of >90% based on the SOFA scores.

Conclusion:
IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock.
The Value of Serum Uncoupling Protein-2 Level for the Patients With Sepsis
Authors: Huang Wei , Wang Xiaoting , Zhang Hongmin , Wang Cui , Liu Dawei 
Published: February 2020

ABSTRACT

Background:
To investigate the potential utility of serum uncoupling protein-2 (UCP2) level as a biomarker in septic patients.

Methods:
Critically ill patients with diagnoses of sepsis—sepsis non-shock group (n = 20) and septic shock group (n = 53), and a control group (n = 15) were enrolled within 24 h of entry into the ICU. Serum levels of UCP2 were measured by enzyme-linked immunosorbent assay (ELISA) at ICU admission for all the groups and at ICU discharge for septic shock group. Clinical parameters and laboratorial tests (APACHE II, SOFA, lactate, etc.) were also collected.

Results:
Serum UCP2 concentrations on ICU admission were significantly increased in septic shock group and sepsis non-shock group, compared with control subjects (263.21 ± 29.99 vs. 115.96 ± 32.99 vs. 60.56 ± 10.05 pg/mL, P < 0.001). Concentrations of UCP2 performed better than other parameters (APACHE II score, SOFA score, procalcitonin, and WBC) in predicting the incidence of sepsis or septic shock on the day of ICU admission, as reflected by AUC. On the day of ICU admission, the AUC for UCP2 level associated with 28-day mortality was 0.704, higher than the AUC for SOFA and APACHE II scores. Patients with higher admission levels of UCP2 (>246.52 pg/mL) had significantly increased 28-day mortality compared with those with lower UCP2 levels (<246.52 pg/mL).

Conclusion:
Serum UCP2 levels at admission were markedly increased in patients with sepsis, which is useful for early diagnose and prognostic prediction. UCP2 is a potential biomarker for sepsis, or even a subtype of sepsis.
Conversion of Mild Cognitive Impairment to Alzheimer Disease in Monolingual and Bilingual Patients
Authors: Berkes Matthias , Bialystok Ellen , Craik Fergus I.M. , Troyer Angela , Freedman Morris 
Published: February 2020

Purpose:
Conversion rates from mild cognitive impairment (MCI) to Alzheimer disease (AD) were examined considering bilingualism as a measure of cognitive reserve.

Methods:
Older adult bilingual (n=75) and monolingual (n=83) patients attending a memory clinic who were diagnosed with MCI were evaluated for conversion to AD. Age of MCI and AD diagnoses and time to convert were recorded and compared across language groups.

Patients:
Patients were consecutive patients diagnosed with MCI at a hospital memory clinic.

Results:
Bilingual patients were diagnosed with MCI at a later age than monolingual patients (77.8 and 75.5 y, respectively), a difference that was significant in some analyses. However, bilingual patients converted faster from MCI to AD than monolingual patients (1.8 and 2.8 y, respectively) resulting in no language group difference in age of AD diagnosis. This relationship held after accounting for education, cognitive level, immigration status, and sex.

Discussion:
The findings suggest that greater cognitive reserve as measured by language status leads to faster conversion between MCI and AD, all else being equal.
Quantitative MRI markers in Parkinson's disease and parkinsonian syndromes
Authors: Arribarat Germain , Péran Patrice 
Published: February 2020

Purpose of review
In Parkinson's disease and parkinsonian disorders, the differential diagnosis is still challenging. We aim to review current developments in MRI quantitative markers and their potential in a clinical and neuroscientific setting.

Recent findings
There have been efforts to improve MRI acquisition methods and to explore new promising biomarkers. In parallel, technological advances in data analysis (i.e. deep learning) open new ways to use these biomarkers. The MRI markers may differ according to the brain structure investigated. Even if the newly adopted acquisition protocols served mainly the development of brainstem-related biomarkers (neuromelanin MRI, nigrosome sensitive MRI), more established markers (e.g. morphometric values) in basal ganglia, cortex and cerebellum demonstrate their relevance especially to differential diagnosis in parkinsonian syndromes.

Summary
We provide an overview on recent advances in MRI quantitative markers of Parkinson's disease that we divide for didactic purposes in three anatomical levels – cortical/cerebellum structures, basal ganglia and brainstem. We show the complementarity of new biomarkers sensitive to brain tissue properties to established morphometrics.