bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sphenotemporal and Fronto-Orbital Dysmorphology in Unilateral Coronal Synostosis Using Geometric Morphometric Curve-Based Analysis
Authors: Rutland John W. , Delman Bradley N. , Bellaire Christopher P. , Napoli James G. , Villavisanis Dillan F. , Margulies Ilana G. , Goel Pedram , Urata Mark M. , Taub Peter J. 
Published: February 2021

Background:Geometric morphometric analysis with Procrustes superimposition is a commonly used method to characterize and study complex dysmorphology. The present study employs an advanced Procrustes-based approach to studying craniofacial dysmorphology in unilateral coronal synostosis and quantitatively describe bony patterns in this disorder, in order to better understand the associated fronto-orbital and sphenotemporal deformities.Methods:Forty-one unilateral coronal synostosis (UCS) patients and 41 age- and sex-matched controls underwent high-resolution computed tomography imaging. Thirty-one anatomical landmarks were labeled on each imaging set. Landmarks were used to calculate angle, lengths, and define fronto-orbital and sphenotemporal anatomical curves. A validated geometric morphometric workflow was used to perform a Procrustes superimposition to register landmarks into a common space and perform a principal components analysis.Results:Supraorbital bar curvature was significantly increased ipsilateral to the fused suture and decreased contralateral,P < 0.0001 for both sides. The sagittal sphenotemporal curve also showed ipsilateral increase in curvature (P < 0.0001) but there was no effect on the contralateral side (P > 0.05).Conclusions:Geometric morphometric analysis revealed significant dysmorphology between UCS patients and controls. These results suggest bilateral changes in fronto-orbital curvature and ipsilateral changes in sagittal sphenotemporal curvature, which may be useful in further characterizing the dynamic craniofacial changes in UCS.
Original Design of the Limberg Flap: An Opposite Triangular Flap
Authors: Hwang Kun 
Published: February 2021

Abstract
The aim of this study was to identify the original design of the Limberg flap.
Publications by the original author, Limberg, and his original designs of the so-called “Limberg flap” were searched in PubMed. These included his original monograph written in Russian (Mathematical Principles of Local Plastic Procedures on the Surface of the Human Body, 1946), the first English paper (“Design of Local Flaps,” 1966), and English translation of his book by Wolfe (1984).
Three figures that may be the prototypes of the Limberg flap were found in the 1946 Russian monograph. One figure involved designing unilaterally active opposite triangular flaps, placed on a lateral incision on the edge of the defect. Another was closure of a defect of the nasal dorsum with a cheek flap with opposite triangular flaps with lateral incision angles of 30° and 105°. The third depicted closure of the lateral section of a fusiform defect using adjacent opposite triangular patches. In 1966 English chapter, he described the rotation of a triangular flap for the closure of a rhomboid defect. Two standing cones and a lying cone are still formed and should be sited where the tissues are lax enough to compensate. In 1984 English translation, the “unilaterally active opposite triangular flaps” and “rotation of a triangular flap in the closure of a rhomboid defect,” were translated as “convergent triangular flaps” and “convergent triangular flaps” respectively.
Limberg first called original design of the flap “opposite triangular flap,” and later “local triangular flap” for closing rhomboid skin defects.
A Surgical Management for Severe Rhinophyma With Five-Blade Scratcher
Authors: Wang Dong-Ming , He Xu-Feng , He Xiang , Zhang Hui-Min 
Published: February 2021

Abstract
Rhinophyma, the final stage of acne rosacea, severely influences the patient's appearance and can only be treated by surgical methods. This case reports a simple, safe, effective, and economical surgical method-five-blade scratcher. After the surgical treatment, the overall nasal contour of the patient, a male with severe rosacea, was restored without scar formation. Thus, this surgical method reported in this case is feasible and easy to operate, and worthy of clinical promotion.
Spatial Analysis of the Temporomandibular Joint and Condyle Following Mandibular Distraction in Robin Sequence
Authors: Pourtaheri Navid , Chandler Ludmila , Singh Anusha , Maniskas Seija , Wilson Alexander T. , Sun Alexander Haosi , Steinbacher Derek M. 
Published: February 2021

Abstract
To comprehensively assess changes in temporomandibular joint and mandibular condyle morphology in Robin sequence (RS) patients undergoing mandibular distraction osteogenesis (MDO). A retrospective analysis of pediatric patients with RS and functional temporomandibular joints who underwent MDO by a single surgeon was performed. Preoperative and postoperative computed tomography (CT) scans were morphometrically analyzed three-dimensional in 3-matic and Mimics (Materialise). Comparative analysis was performed using Wilcoxon signed-rank tests. Fourteen RS patients were included (28 condyles, 56 CT scans), 78% male and 22% females. The mean age at surgery was 9.4 weeks (range 1.6–46.7 weeks). The average age at initial CT was 5.3 days (range 0–11 days). The mean time interval for CT scan before MDO and after hardware removal were 8.8 ± 6.4 days and 11.2 ± 25.8 days, respectively. Rotatory changes of the condyle revealed a significantly decreased horizontal angle following MDO (–7.55°, 95% confidence interval –11.13° to –3.41°; P < 0.001). Anteroposteriorly, the angle between condylar process and ramus (incline) increased significantly (14.14°, 95% confidence interval 10.71°–19.59°; P < 0.001). Intragroup analysis revealed no difference between left versus right condylar position measurements. The condyle itself increased in size and length and the intercondylion distance increased post-MDO. There were no complications and all patients achieved relief of airway obstruction without tracheostomy. Morphologic and positional changes of the mandibular condyle following MDO in RS patients parallel changes that occur during normal development in non-RS patients. As a result, MDO may facilitate normal condylar morphology and function in RS patients.
Fan-Shaped Thin Fat Pedicles for Tear Trough Correction Through a Layer-Level Fixation: A Modified Transconjunctival Blepharoplasty
Authors: Cheng Liying , Sun Xiaoming , Ye Lingxiao , Chen Lu , Zhang Liucheng , Mao Xiyuan , Jin Rong , Zhang Lu , Zhang Yuguang , Zhang Ying 
Published: February 2021

Abstract
Fat repositioning is an effective way to treat tear trough deformity (TTD) in Asians. Recent techniques mainly focused on the fixation technique, whereas how to precisely shape and individually quantify the fat pedicle has been ignored. This article introduced an individualized, targeted, and tension-free technique to fabricate a fan-shaped thin septum fat pedicle for repositioning. Furthermore, a layer-level fixation method was advocated to provide sufficient, continuous, uninterrupted filling of the TTD. From January 1, 2009, to December 31, 2018, 492 patients underwent this procedure. Through a transconjunctival incision, a continuous fan-shaped, tension-free, customized septum fat pedicle was precisely designed to match the TTD anatomy. The pedicle could either be elongated, or thickened, or debulked, or translocated, to meet the patients’ individual needs. At the same time, a layer-level fat pedicle fixation technique was applied to fully interrupt the TTD. The mean operation time was 60 ± 9.3 minutes. All patients demonstrated a significant improvement with elimination of both eye bags and TTD. High satisfaction was noted among the patients. No obvious resorption of the fat pedicles was observed, and the lower lid contour improvements were durable. One infection occurred after 3 days of surgery, and was resolved by removal of the suture followed by topical application of iodine and oral antibiotics for 3 to 5 days. No other complications were observed. Precisely repositioning transconjunctival fat using a layer-level fixation technique with a fan-shaped thin fat pedicle under a subperiosteal plane is an effective, lasting, and safe approach for individually treating TTD.
Treatment of Facial Fractures at Safety-Net Hospitals: A National Analysis of Inpatient Burden and Cost
Authors: Musavi Leila S. , Chin Patrick , Pfaff Miles , Fadavi Darya , Aliu Oluseyi , Yang Robin 
Published: February 2021

Purpose:
Safety-net hospitals (SNHs) are vital in the care of trauma populations, but little is known about the burden of facial trauma presenting to SNHs. The authors sought to characterize the presentation and treatment of facial fractures across SNHs and determine the association between SNH care and healthcare utilization in patients undergoing fracture repair.

Methods:
Adult patients presenting with a facial fracture as their primary admitting diagnosis from the year 2012 to 2015 were identified in the National Inpatient Sample. The “safety-net burden” of each hospital was defined based on the proportion of Medicaid and self-pay discharges. Patient factors analyzed were sex, race, age, income level, insurance status, fracture location, and comorbidities. Hospital factors analyzed were safety-net burden, teaching status, geographic region, bed size, and ownership status. The main outcomes were length of stay (LOS), hospital costs, time to repair, and postoperative complications.

Results:
Of 78,730 patients, 27,080 (34.4%) were treated at SNHs and 24,844 (31.6%) were treated at non-SNHs. Compared to non-SNHs, patients treated at SNHs were more likely to undergo operative repair at SNHs (65.8% versus 53.9%, P < 0.001). Overall mean LOS was comparable between non-SNH and SNH (3.43 versus 3.38 days, P = 0.611), as was mean hospital cost ($15,487 versus $15,169, P = 0.434). On multivariate linear regression, safety-net status was not a predictor of increased LOS, cost, or complications. However, safety-net status was significantly associated with lower odds of undergoing repair within 48 hours of admission (odds ratio 0.783, 95% confidence interval = 0.680–0.900, P = 0.001).

Conclusions:
Safety-net hospitals are able to treat facial trauma patients with greater injury burden and lower socioeconomic resources without increased healthcare utilization. Healthcare reform must address the financial challenges that endanger these institutions to ensure timely treatment of all patients.
Air-Evacuation-Relevant Hypobaria Following Traumatic Brain Injury Plus Hemorrhagic Shock in Rats Increases Mortality and Injury to the Gut, Lungs, and Kidneys
Authors: Proctor Julie L. , Medina Juliana , Rangghran Parisa , Tamrakar Pratistha , Miller Catriona , Puche Adam , Quan Wei , Coksaygan Turhan , Drachenberg Cinthia B. , Rosenthal Robert E. , Stein Deborah M. , Kozar Rosemary , Wu Feng , Fiskum Gary 
Published: February 2021

ABSTRACT
Rats exposed to hypobaria equivalent to what occurs during aeromedical evacuation within a few days after isolated traumatic brain injury exhibit greater neurologic injury than those remaining at sea level. Moreover, administration of excessive supplemental O2 during hypobaria further exacerbates brain injury. This study tested the hypothesis that exposure of rats to hypobaria following controlled cortical impact (CCI)-induced brain injury plus mild hemorrhagic shock worsens multiple organ inflammation and associated mortality. In this study, at 24 h after CCI plus hemorrhagic shock, rats were exposed to either normobaria (sea level) or hypobaria (=8,000 ft altitude) for 6 h under normoxic or hyperoxic conditions. Injured rats exhibited mortality ranging from 30% for those maintained under normobaria and normoxia to 60% for those exposed to 6 h under hypobaric and hyperoxia. Lung histopathology and neutrophil infiltration at 2 days postinjury were exacerbated by hypobaria and hyperoxia. Gut and kidney inflammation at 30 days postinjury were also worsened by hypobaric hyperoxia. In conclusion, exposure of rats after brain injury and hemorrhagic shock to hypobaria or hyperoxia results in increased mortality. Based on gut, lung, and kidney histopathology at 2 to 30 days postinjury, increased mortality is consistent with multi-organ inflammation. These findings support epidemiological studies indicating that increasing aircraft cabin pressures to 4,000 ft altitude (compared with standard 8,000 ft) and limiting excessive oxygen administration will decrease critical complications during and following aeromedical transport.
The Addition of High-Technology Into the Stop the Bleed Program Among School Personnel Improves Short-Term Skill Application, Not Long-Term Retention
Authors: Jafri Farrukh N. , Dadario Nicholas B. , Kumar Anshul , Silverstein Samantha R. , Quintero Frank , Larsen Erik A. , Fasciglione Kimberly , Mirante Doreen , Ellsworth Kelly , Amicucci Bernadette , Ricca Joseph 
Published: February 2021

Introduction
The Stop the Bleed (STB) program trains the general public on identifying and treating life-threatening bleeding. Data on efficacy and retention of skills taught through this program are limited, with the role of high-technology modalities to augment the program, such as simulation and feedback devices, untested.

Methods
A convenience sample of 66 school personnel participated in an open-label observational study from January to August 2019. The control group received the standard bleeding control course, while the intervention group received the bleeding control course with addition of a simulation and a feedback device for wound packing. Assessment was performed by STB instructors using performance metrics from prior studies as well as a feedback device. Retention testing was performed 2 to 8 months after intervention. The study was approved by the hospital's institutional review board.

Results
The intervention group performed better than the control group on correct tourniquet application [90.3% vs. 71.0%; odds ratio (OR) = 11.28; P = 0.015; 95% confidence interval (CI) = 1.86 to 104.67] wound packing scores (59.5% vs. 29.6%; OR = 0.33; P = 0.007; 95% CI = 9.36 to 56.00) and were more likely to assess their safety (OR = 5.49; P = 0.034; 95% CI = 1.28 to 27.66), and reported higher comfort scores on stepping into an emergency scenario (OR = 11.19; P = 0.004; 95% CI = 2.51 to 63.11), wound packing (OR = 5.16; P = 0.025; 95% CI = 1.35 to 22.46), and using a tourniquet (OR = 11.41; P = 0.003; 95% CI = 2.57 to 67.59). Thirty-one participants (46.9%) were assessed again at retention 2 to 8 months later where scores for tourniquet placement and wound packing were not significantly different in the two groups.

Conclusions
Augmenting STB with simulation and feedback improved both self-reported comfort level and skill set of participants, but the retention of skills was poor in both groups.
Clinical Significance of a Circulating Tumor Cell-based Classifier in Stage IB Lung Adenocarcinoma
Authors: Ren Lijuan , Zhong Xiaoming , Liu Wei , Xu Di , Lei Yiyan , Zhou Jianwen , Jiang Wenting , He Qiong , Sun Yu , Ke Zunfu 
Published: February 2021

Objective:
To investigate the effectiveness of a CTC-based classifier in stratifying stage IB LUAD.

Summary of Background Data:
Stage IB LUADs have an approximately 70% 5-year survival rate. The clinical application of ACT is controversial due to inconsistent results in a series of trials and few useful guide biomarkers. Thus, there is a pressing need for robust biomarkers to stratify stage IB patients to define which group would most likely benefit from ACT. Methods: Two hundred twelve stage IB LUAD patients were enrolled and were divided into 3 independent cohorts. The aptamer-modified NanoVelcro system was used to enrich the CTCs.

Results:
A cutoff of <4 or >4 CTCs as the optimal prognostic threshold for stage IB LUAD was generated to stratify the patients in a 70-patient cohort into low-risk and high-risk groups. Patients with ≥ 4 CTCs in the training cohort had shorter progression-free survival (P < 0.0001) and overall survival (P < 0.0001) than patients with <4 CTCs. CTC number remained the strongest predictor of progression-free survival and overall survival even in a multivariate analysis including other clinicopathological parameters. Furthermore, a nomogram based on the CTC count was developed to predict the 3-year and 5-year survival in the training cohort and performed well in the other 2 validation cohorts (C-index: 0.862, 0.853, and 0.877).

Conclusion:
The presence of >4 CTCs can define a high-risk subgroup, providing a new strategy to make optimal clinical decisions for stage IB LUAD.
The AUGIS Survival Predictor: Prediction of Long-Term and Conditional Survival After Esophagectomy Using Random Survival Forests
Authors: Rahman Saqib A. , Walker Robert C. , Maynard Nick , Nigel Trudgill  , Crosby Tom , Cromwell David A. , Underwood Timothy J. ,   on behalf of the NOGCA project team AUGIS
Published: February 2021

Objective:
The aim of this study was to develop a predictive model for overall survival after esophagectomy using pre/postoperative clinical data and machine learning.

Summary Background Data:
For patients with esophageal cancer, accurately predicting long-term survival after esophagectomy is challenging. This study investigated survival prediction after esophagectomy using a Random
Survival Forest (RSF) model derived from routine data from a large, well-curated, national dataset.

Methods:
Patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2012 and 2018 in England and Wales who underwent an esophagectomy were included. Prediction models for overall survival were developed using the RSF method and Cox regression from 41 patient and disease characteristics. Calibration and discrimination (time-dependent area under the curve) were validated internally using bootstrap resampling.

Results:
The study analyzed 6399 patients, with 2625 deaths during follow-up. Median follow-up was 41 months. Overall survival was 47.1% at 5 years. The final RSF model included 14 variables and had excellent discrimination with a 5-year time-dependent area under the receiver operator curve of 83.9% [95% confidence interval (CI) 82.6%–84.9%], compared to 82.3% (95% CI 81.1%—83.3%) for the Cox model. The most important variables were lymph node involvement, pT stage, circumferential resection margin involvement (tumor at < 1 mm from cut edge) and age. There was a wide range of survival estimates even within TNM staging groups, with quintiles of prediction within Stage 3b ranging from 12.2% to 44.7% survival at 5 years.

Conclusions:
An RSF model for long-term survival after esophagectomy exhibited excellent discrimination and well-calibrated predictions. At a patient level, it provides more accuracy than TNM staging alone and could help in the delivery of tailored treatment and follow-up.
Laparoscopic Liver Resection Using a Silicone Band Retraction Method (With Video)
Authors: Sakai Hisamune , Sato Toshihiro , Nomura Yoriko , Goto Yuichi , Hisaka Toru , Akagi Yoshito , Okuda Koji 
Published: February 2021

Background:
The success of laparoscopic liver resection (LLR) depends on stable and full exposure of the parenchymal transection plane. We evaluated the efficacy of LLR using a silicone band retraction method for lesions in the anterolateral and posterosuperior segments.

Methods:
We retrospectively analyzed 189 consecutive patients who had undergone LLR in our hospital between July 2010 and July 2020. They were divided into 2 groups according to whether LLR was performed before (conventional group; n=64) or after (silicone band group; n=125) the introduction of the silicone band retraction method.

Results:
The silicone band group demonstrated significantly less blood loss than that by the conventional group. The mean operative time and the hospital stay in the silicone band group were obviously shorter than that in the conventional group. The open conversion rate and the major complication rate were significantly lower in the silicone band group than that in the conventional group.

Conclusion:
The silicone band retraction method is a useful approach that results in a safe LLR.
Stent Insertion With High Intensity–Focused Ultrasound Ablation for Biliary Obstruction Caused by Pancreatic Carcinoma: A Randomized Controlled Trial
Authors: Zhang Feng-Qin , Li Lin , Huang Ping-Chao , Xia Feng-Fei , Zhu Lei , Cao Chi 
Published: February 2021

Purpose:
This study was designed to assess the clinical efficacy of stent insertion with high intensity–focused ultrasound ablation (HIFUA) in patients with malignant biliary obstruction (MBO) as a consequence of pancreatic carcinoma (PC).

Materials and Methods:
This was a single-center, open-label, prospective, randomized controlled trial. Consecutive patients with MBO caused by PC were randomly assigned to undergo stent insertion with or without HIFUA from June 2019 to February 2020. This study was registered at ClinicalTrials.gov (NCT03962478).

Results:
In total, 92 patients were enrolled in this study and assigned to the stent-only (n=46) or combined (stent+HIFUA; n=46) treatment groups. Stent insertion was associated with a 100% technical success rate. For patients in the combination treatment group, 26, 18, and 2 patients underwent 2, 3, and 4 cycles of HIFUA, respectively. A positive clinical response to HIFUA treatment was noted in 38 patients (82.6%). Stent dysfunction was detected in 9 and 15 patients in the combination and stent-only groups, respectively (P=0.154), while median stent patency in these 2 groups was 188 and 120 days, respectively (P<0.001). All patients died over the course of the follow-up, with median survival periods of 218 and 140 days in the combination and stent-only treatment groups, respectively (P=0.001). The only detected predictor of prolonged survival was HIFUA treatment (P=0.004), and there were no significant differences in complication rates between these 2 treatment groups.

Conclusion:
A combination of stent insertion and HIFUA can improve stent patency and overall survival in patients suffering from MBO because of PC relative to stent insertion alone.
Patients With Unexplained Dilated Pancreatic Duct Have High Risk of Biliopancreatic Malignancy Detected by EUS
Authors: Téllez-Ávila Félix I. , Tepox-Padrón Alejandra , Duarte-Medrano Gilberto , Ramírez-Luna Miguel A. , Lopezarce-Ángeles Gustavo , Jiménez-Gutiérrez José M. , Herrera-Mora David 
Published: February 2021

Introduction:
Patients with unexplained dilated common bile duct (CBD) and/or dilated main pancreatic duct (MPD) on noninvasive abdominal imaging tests are often referred for endoscopic ultrasound (EUS) in order to rule out biliopancreatic cancer. The aim of the study was to evaluate the diagnostic yield of EUS in this patient group.

Methods:
A prospective study was conducted. Patients with unexplained dilated CBD and/or MPD on abdominal imaging, who underwent EUS, were enrolled.

Results:
Fifty-four patients underwent EUS (CBD dilation n=38, MPD dilation n=5 or both n=11). In 31/54 patients (57.4%), EUS revealed pathologic findings. Sixteen patients (29.6%) had EUS evidence of biliopancreatic cancer and 15 patients (27.7%) had benign pathology. Ten (62.5%) of the patients with biliopancreatic cancer had MPD dilation. MPD dilation was significantly associated with malignancy (P=0.017).

Conclusion:
Patients with unexplained dilated MPD on noninvasive image have a high risk of biliopancreatic malignancy detected by EUS.