bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Brain Injury in Trauma Patients With Isolated Facial Fractures
Authors: McCarty Justin C. , Kiwanuka Elizabeth , Gadkaree Shekhar , Siu Jennifer M. , Caterson Edward J. 
Published: April 2020

Background:
Diagnosis of traumatic brain injury (TBI), and specifically mild TBI (mTBI), is a diagnostic challenge which can delay diagnosis preventing early intervention and follow-up care. Facial fractures represent an objective surrogate marker for potential force transmission to the neural cavity. The authors’ objective was to characterize the prevalence of TBI in trauma patients with isolated facial fractures stratified by injury severity.

Methods:
The authors performed a retrospective cross-sectional study of the National Trauma Databank (NTDB) from 2007 to 2014 assessing a total of 1,867,761 participants identified as having a TBI and 306,785(60.2%) had an isolated facial fracture using ICD-9 codes. TBI severity was subdivided using Glasgow Coma Scale into mTBI and moderate-to-severe TBI. Logistic regression assessed odds of mTBI and moderate-to-severe TBI with different isolated facial fractures adjusted for injury severity.

Results:
Trauma patients with isolated facial fractures of the nasal bone, mandible, malar region and maxilla, orbital floor, and alveolar and palate had a concomitant prevalence of mTBI ranging from 21.3% to 46.0% and moderate-to-severe TBI ranging from 7.3% to 18.4%. Mandibular fractures had the lowest odds of mTBI and moderate to severe TBI while alveolar and palate fractures had the highest odds of mTBI [OR3.20,95%CI (3.11–3.30)] and moderate to severe TBI [OR3.83,95%CI (3.65–4.01)].

Conclusions:
Isolated facial fractures have a high prevalence of mTBI at all injury severity levels. Clinicians can use the presence of facial fractures in trauma patients to serve as clinical markers for TBI, without distracting from already existing trauma protocols and their focus on treatment of immediate life-threatening injuries raising both awareness and potential for early intervention.
Volumetric Analysis of the Pterygopalatine Fossa by Semiautomatic Segmentation of Cone Beam Computed Tomography
Authors: Lentzen Max-Philipp , Safi Ali-Farid , Riekert Maximilian , Visser-Vandewalle Veerle , Grandoch Andrea , Zirk Matthias , Zöller Joachim E. , Kreppel Matthias 
Published: April 2020

Abstract
The aim of this study was to provide volumetric data of the pterygopalatine fossa by semiautomatic segmentation based upon cone beam computed tomography.
Cone beam computed tomography (CBCT) images of 100 patients were analyzed. By using the open source software “ITK-Snap,” the volumetric measurements of 200 pterygopalatine fossae were performed. For statistical investigations paired t test, and independent Student t test were performed. Also, the Pearsons chi-square test was applied. P values P < 0.05 were considered significant.
The mean volume was 578.376 mm3 for the right and 560.979 mm3 for the left side. The results indicated statistically significant differences according to the right and the left pterygopalatine fossa, regardless of gender (P < 0.05). The analysis of differences between males and females did not show any significant results (P > 0.05), although males present a slightly larger volume than females. According to the median age (59 years), younger patients presented smaller volumes, whereas older patients presented larger volumes. Nevertheless, no statistically significant differences according to age (χ2 = 3.520; P > 0.05) could be found.
Clinical intervention with the application of local anesthetics into the complex and vulnerable anatomy of the pterygopalatine fossa makes a thorough knowledge about the volumetric capacity indispensable. Therefore, the semiautomatic segmentation of CBCT images provides a useful, available and validated tool. Our results show that a final injected anesthetic volume larger than 1 ml exceeds the pterygopalatine fossa capacity considerably and could cause complications. To prevent this, volumetric analysis of this region can provide further information and enables an individualized patients‘ treatment.
Prevention of Autologous Costal Cartilage Graft Warping in Secondary Rhinoplasty
Authors: McGuire Connor , Samargandi Osama A. , Boudreau Colton , Whelan Ashley , Bezuhly Michael 
Published: April 2020

Background:
Autogenous costal cartilage grafts (ACCG) are frequently used in secondary rhinoplasty; however, these grafts tend to warp. The objective of this study is to systematically evaluate current interventions to prevent warping of ACCGs and to assess long-term outcomes with their use.

Methods:
A systematic review was undertaken using a computerized search. Eligible articles assessed adult patients undergoing secondary rhinoplasty with ACCGs. Interventions to reduce warping were examined. Publication descriptors were extracted, heterogeneity was examined, and methodological quality of articles was assessed.

Results:
Eighteen studies were included. Most studies were published after 2010 (83.3%), assessed a single intervention (83.3%), and were of levels of evidence III and IV. Mean patient age was 30 (range 5–95 years) and studies included a mean of 64 cases (range 9–357). Nine of the 15 non-comparative studies were considered of high methodological quality, while all 3 comparative studies were considered high quality. Secondary rhinoplasties which did not describe a method to address warping showed increased rates of warping compared to counter balancing techniques, chimeric grafts, titanium microplating, Kirschner wire and suture usage, irradiation, and various carving techniques. Rates of warping remained low with no major complications with the use of a variety of approaches.

Conclusions:
ACCG warping during secondary rhinoplasty can be alleviated with a variety of techniques with no clear difference in outcomes between approaches. Plastic surgeons may consider adopting one of the various techniques described in order to reduce warping, maximize aesthetic outcomes and patient satisfaction.
Quantitative Evaluation of the Postoperative Changes in Nasal Septal Deviation by Diverse Movement of the Maxilla After Le Fort I Osteotomy
Authors: On Sung Woon , Baek Seung-Hak , Choi Jin-Young 
Published: April 2020

Abstract
The purposes of this study were to compare the postoperative changes in nasal septal (NS) deviation between total impaction (TI) and anterior elongation (AE) of the maxilla after Le Fort I osteotomy (LF-IO) and to investigate the correlation between the change in NS deviation and the amount of surgical maxillary movement. Twenty-eight patients, who underwent LF-IO and sagittal split osteotomy by a single surgeon, were divided into TI group (N = 13; mean = 1.5 mm) and AE group (N = 15; mean = 1.6 mm). NS deviation was measured using computed tomography and deviation indices before and after surgery at 3 coronal measurement planes (CMP) passing through the nasion, crista galli, and the most anterior point of the sphenoid sinus (MAPS). Then, statistical analysis was performed. The AE group did not have significant changes in any deviation indices after surgery. The TI group; however, exhibited significant increases in the MAPS-CMP and total deviation indices (0.67–1.16 mm, P < 0.01; 5.45–6.43 mm, P < 0.05). The TI group also exhibited a greater increase in the ΔMAPS-CMP deviation index than the AE group (0.49 mm versus 0.06 mm, P < 0.05). The amount of forward movement of the maxilla was positively correlated with the nasion-CMP and total deviation indices (r = 0.422, P < 0.05; r = 0.398, P < 0.05). LF-IO for TI and forward movement can worsen NS deviation posteriorly and anteriorly, respectively. It is necessary to manage the nasal septum and the nasal crest of the maxilla meticulously during LF-IO procedure.
Analysis of Clinical Significance of the Pterygospinous and Pterygoalar Bars
Authors: Harikrishnan Pandurangan 
Published: April 2020

Abstract
Presence of ossified structures at the skull base near the sphenoid bone in the infra temporal fossa are clinically significant. We studied the incidence of pterygospinous bar (PSB) and pterygoalar bar (PAB) in 140 dried human skulls. The incidence of pterygospinous bar was 22% and pterygoalar bar was 11%. An unusual large pterygspinous foramen was present in one of the skulls on the left side. Clinical significance of these bars are reviewed.
Technical Modifications Specific to the Cleft Le Fort I Osteotomy
Authors: Susarla Srinivas M. , Ettinger Russell , Preston Kathryn , Hitesh Kapadia  , Egbert Mark A. 
Published: April 2020

Purpose:
To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement.

Methods:
This was a retrospective evaluation of patients with cleft palate (+/− cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/− bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P
< 0.05 was considered significant.

Results:
Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ± 1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0–10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ± 0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ± 0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P
> 0.33).

Conclusion:
Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of < 1 mm at 1-year post-operatively.
Early outcomes following trauma related to sex: A matched analysis of military service members in the department of defense trauma registry
Authors: Morte Kaitlin , Kuckelman John , Marenco Christopher , Lammers Daniel , Bingham Jason , Eckert Matthew 
Published: April 2020

BACKGROUND
Several studies have identified sex as a factor influencing early outcomes after trauma. With the increased representation of women in combat roles, there is a need for improved understanding of the pathophysiology of traumatic injury in women. The purpose of this study was to define sex-based differences in early combat trauma outcomes amongst military service members.

METHODS
A retrospective review of the Department of Defense Trauma Registry between 2008 and 2016 was performed. A 2:1 case control match was performed to match for Injury Severity Score, mechanism of injury, and age. The primary outcome of the study was mortality.

RESULTS
A total of 4,625 patients were included in the study, 2.2% of whom were women. Women were less significantly injured than men (Injury Severity Score, 7.7 vs. 11, p = 0.003) and more likely to sustain blunt trauma (81% vs. 62.5%, p = 0.01). After case-control matching, 202 men and 101 women were evaluated. There was no statistical difference in the primary outcome of mortality. There was no statistical difference in Glasgow Coma Scale score, crystalloid or colloid administration, Packed Red Blood Cells (PRBC), platelet, cryoprecipitate, or plasma usage between men and women.

CONCLUSION
Contrary to the civilian trauma literature, our study demonstrated no significant difference in early mortality between male and female combat casualties in a matched cohort. This finding may represent a difference in injury patterns, resuscitation practices, or lifesaving interventions in a deployed setting as compared with civilian setting. As the proportion of women involved in combat operations continues to increase, prospective studies should be performed to better define injury patterns, as well as early and late outcomes related to military trauma in the female population.

LEVEL OF EVIDENCE
Retrospective, Level IV.
Relationship of body mass index, serum creatine kinase, and acute kidney injury after severe trauma
Authors: Vasquez Charles R. , DiSanto Thomas , Reilly John P. , Forker Caitlin M. , Holena Daniel N. , Wu Qufei , Lanken Paul N. , Christie Jason D. , Shashaty Michael G.S. 
Published: April 2020

OBJECTIVES
Body mass index (BMI) is associated with acute kidney injury (AKI) after trauma, but underlying mechanisms are unclear. Body mass index correlates with both excess adiposity and increased muscle mass. Since the latter could predispose to severe rhabdomyolysis after trauma, we hypothesized that the BMI-AKI association may be partially explained by a direct relationship of BMI with serum creatine kinase (CK).

METHODS
Prospective cohort study of 463 critically ill patients admitted to a level I trauma center from 2005 to 2015 with Injury Severity Score of >15 and serum CK measured in the first 7 days. We defined AKI by AKI Network creatinine criteria. We used simple linear regression to determine the association of BMI with peak CK and multivariable logistic regression to adjust the BMI-AKI association for peak CK and confounders.

RESULTS
Median age was 43 years, 350 (76%) were male, 366 (79%) had blunt mechanism, and median Injury Severity Score was 24. Body mass index was associated with peak CK (R
2 = 0.05, p < 0.001). Acute kidney injury developed in 148 patients (32%), and median time to peak CK was 29 hours (interquartile range, 15–56 hours) after presentation. Body mass index was significantly associated with AKI in multivariable models adjusted for age, race, sex, diabetes, injury mechanism and severity, and red blood cell transfusions (odds ratio [OR], 1.31 per 5 kg/m2; 95% confidence interval [CI], 1.09–1.58; p = 0.004). Adding peak CK to the model partially attenuated the association of BMI with AKI (OR, 1.26 per 5 kg/m2; 95% CI, 1.04–1.52; p = 0.018), and peak CK was also associated with AKI (OR, 1.19 per natural log; 95% CI, 1.00–1.41; p = 0.049). Peak CK remained associated with AKI when restricted to patients with values of <5,000 U/L (OR, 1.31 per natural log; 95% CI, 1.01–1.69; p = 0.043).

CONCLUSION
Serum CK correlated with BMI and partially attenuated the association of BMI with AKI after major trauma, suggesting that excess muscle injury may contribute to the BMI-AKI association.

LEVEL OF EVIDENCE
Epidemiologic study, level III.
Risk assessment for intra-abdominal injury following blunt trauma in children: Derivation and validation of a machine learning model
Authors: Pennell Christopher , Polet Conner , Arthur L. Grier , Grewal Harsh , Aronoff Stephen 
Published: April 2020

BACKGROUND
Computed tomography is the criterion standard for diagnosing intra-abdominal injury (IAI) but is expensive and risks radiation exposure. The Pediatric Emergency Care Applied Research Network (PECARN) model identifies children at low risk of IAI requiring intervention (IAI-I) in whom computed tomography may be omitted but does not provide an individualized risk assessment to positively predict IAI-I. We sought to apply machine learning algorithms to the PECARN blunt abdominal trauma (BAT) data set experimentally to create models for predicting both the presence and absence of IAI-I for pediatric BAT victims.

METHODS
Using the PECARN data set, we derived and validated predictive models for IAI-I. The data set was divided into derivation (n = 7,940) and validation (n = 4,089) subsets. Six algorithms were tested to create 2 models using 19 clinical variables including emesis, dyspnea, Glasgow Coma Scale score of <15, visible thoracic or abdominal trauma, seatbelt sign, abdominal distension, tenderness or rectal bleeding, peritoneal signs, absent bowel sounds, flank pain, pelvic pain or instability, sex, age, heart rate, and respiratory rate (RR). Five algorithms were fitted to predict the absence (low-risk model) or presence (high-risk model) of IAI-I. Models were validated using the test subset.

RESULTS
For the low-risk model, four algorithms were significantly better than the baseline rate (2.28%) when validated using the test set. The random forest model identified 73% of children as low risk, having a predicted IAI-I rate of 0.54%. For the high-risk model, all six algorithms had added predictive power compared with the baseline rate with the highest reportable risk being 39.0%. By incorporating both models into a web application, child-specific risks of IAI-I can be estimated ranging from 0.28% to 39.0%

CONCLUSION
We developed a tool that provides a child-specific risk estimate for IAI-I after BAT. This publically available model provides a powerful tool for clinicians triaging pediatric victims of blunt abdominal trauma.

LEVEL OF EVIDENCE
Prognostic, Level II.
Retrobulbar Spot Sign in Metachronous Bilateral Central Retinal Artery Occlusion of Cardioembolic Origin
Authors: Lottspeich Christian , Mackert Marc J. , Köhler Anton , Bauer Axel , Hoffmann Ulrich , Czihal Michael 
Published: April 2020

Abstract:
A 78-year-old man suffered sudden visual loss of his right eye. Five years earlier, he had experienced vision loss of his left eye due to central retinal artery occlusion (CRAO); back then, the etiology for the CRAO was not established. Current ocular ultrasound depicted a hyperechoic spot within the optic nerve in both eyes. Echocardiography identified a calcified mass adherent to the mitral valve as the embolic source of the CRAO. This case shows the value of ocular B-mode ultrasound in demonstration and proof of the etiology for CRAO.
Room-temperature-storable PCR Mixes for SARS-CoV-2 Detection
Authors: Xu Jiasu , Wang Jin , Zhong Zecheng , Su Xiaosong , Yang Kunyu , Chen Zhongfu , Zhang Dongxu , Li Tingdong , Wang Yingbin , Zhang Shiyin , Ge Shengxiang , Zhang Jun , Xia Ningshao 
Published: April 2020

AbstractA novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) emerged in late 2019, causing an outbreak of pneumonia [coronavirus disease 2019 (COVID-19)] in Wuhan, China, which then rapidly spread globally. Although the use of ready-made reaction mixes can enable more rapid PCR-based diagnosis of COVID-19, the need to transport and store these mixes at low temperatures presents challenges to already overburdened logistics networks. Here, we present an optimized freeze-drying procedure that allows SARS-CoV-2 PCR mixes to be transported and stored at ambient temperatures, without loss of activity. Additive-supplemented PCR mixes were freeze-dried. The residual moisture of the freeze-dried PCR mixes was measured by Karl-Fischer titration. We found that freeze-dried PCR mixes with ∼1.2% residual moisture are optimal for storage, transport, and reconstitution. The sensitivity, specificity, and repeatability of the freeze-dried reagents were similar to those of freshly prepared, wet reagents. The freeze-dried mixes retained activity at room temperature (18∼25°C) for 28 days, and for 14 and 10 days when stored at 37°C and 56°C, respectively. The uptake of this approach will ease logistical challenges faced by transport networks and make more cold storage space available at diagnosis and hospital laboratories. This method can also be applied to the generation of freeze-dried PCR mixes for the detection of other pathogens.
Dual mechanisms of ictal high frequency oscillations in human rhythmic onset seizures
Authors: Smith Elliot H. , Merricks Edward M. , Liou Jyun-You , Casadei Camilla , Melloni Lucia , Thesen Thomas , Friedman Daniel , Doyle Werner , Emerson Ronald G. , Goodman Robert R. , McKhann Guy M. , Sheth Sameer A. , Rolston John D. , Schevon Catherine A. 
Published: April 2020

ABSTRACTHigh frequency oscillations (HFOs) recorded from intracranial electrodes during epileptiform discharges are a proposed biomarker of epileptic brain tissue and may also be useful for seizure forecasting, with mixed results. Despite such potential for HFOs, there is limited investigation into the spatial context of HFOs and their relationship to simultaneously recorded neuronal activity. We sought to further understand the biophysical underpinnings of ictal HFOs using unit recordings in the human neocortex and mesial temporal lobe during rhythmic onset seizures. We compare features of ictal discharges in both the seizure core and penumbra (spatial seizure domains defined by multiunit activity patterns). We report differences in spectral features, unit-local field potential coupling, and information theoretic characteristics of HFOs before and after local seizure invasion. Furthermore, we tie these timing-related differences to spatial domains of seizures, showing that penumbral discharges are widely distributed and less useful for seizure localization.
Analysis of Infected Host Gene Expression Reveals Repurposed Drug Candidates and Time-Dependent Host Response Dynamics for COVID-19
Authors: Xing Jing , Shankar Rama , Drelich Aleksandra , Paithankar Shreya , Chekalin Evgenii , Dexheimer Thomas , Chua Mei-Sze , Rajasekaran Surender , Tseng Chien-Te Kent , Chen Bin 
Published: April 2020

SummaryThe repurposing of existing drugs offers the potential to expedite therapeutic discovery against the current COVID-19 pandemic caused by the SARS-CoV-2 virus. We have developed an integrative approach to predict repurposed drug candidates that can reverse SARS-CoV-2-induced gene expression in host cells, and evaluate their efficacy against SARS-CoV-2 infectionin vitro. We found that 13 virus-induced gene expression signatures computed from various viral preclinical models could be reversed by compounds previously identified to be effective against SARS- or MERS-CoV, as well as drug candidates recently reported to be efficacious against SARS-CoV-2. Based on the ability of candidate drugs to reverse these 13 infection signatures, as well as other clinical criteria, we identified 10 novel candidates. The four drugs bortezomib, dactolisib, alvocidib, and methotrexate inhibited SARS-CoV-2 infection-induced cytopathic effect in Vero E6 cells at < 1 µM, but only methotrexate did not exhibit unfavorable cytotoxicity. Although further improvement of cytotoxicity prediction and bench testing is required, our computational approach has the potential to rapidly and rationally identify repurposed drug candidates against SARS-CoV-2. The analysis of signature genes induced by SARS-CoV-2 also revealed interesting time-dependent host response dynamics and critical pathways for therapeutic interventions (e.g. Rho GTPase activation and cytokine signaling suppression).