bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epstein-Barr Virus-associated Diffuse Large B-cell Lymphoma Identified in a Breast Implant Capsule
Authors: Malata Charles M. , Madada-Nyakauru Rudo N. , Follows George , Wright Penny 
Published: January 2021

Background
Breast implant-associated anaplastic large cell lymphoma is a relatively uncommon T-cell lymphoma with about 900 reported cases worldwide to April 2020 according to the American Society of Plastic Surgeons Breast Implant-Associated Anaplastic Large Cell Lymphoma Physician Resources information.

Case presentation
A 51-year old woman was found to have an Epstein-Barr virus–related diffuse large B-cell lymphoma (EBV-DLCBCL) in her left breast periimplant capsule at the time of a second revision breast implant surgery for recurrent severe capsular contractures following cosmetic breast augmentation 21 years previously. The first revision operation, 15 years earlier, had comprised simple implant exchange from smooth-saline to textured-silicone gel prostheses.

Results
Histopathological and immunohistochemical analyses of the periimplant capsulectomy specimen confirmed a B cell lymphoma which was, in addition, positive for EBV-encoded RNA on in-situ hybridization. Staging investigations including positron emission tomography-computed tomography did not reveal any metastatic disease.

Discussion and Conclusion
Despite recommendations to the contrary (by 2 independent hematological malignancy multidisciplinary teams), the patient has declined explantation of her new breast implants choosing instead to be observed under a watch-and-wait protocol. She remains disease-free 2 years postdiagnosis. To date, a diffuse B-cell lymphoma has never been documented as arising in a breast implant capsule or in association with breast augmentation whether associated with EBV or not. This is the first such report in the world.
Reconstruction of Congenital Alar Rim Defects (Tessier Number 1 Cleft) Using Laterally Based Alar Subunit Rotation Advancement Flap
Authors: Aldabaany Waleed 
Published: January 2021

Background
Alar rim defects develop in most cases as a result of burns, trauma, or tumor excision. Congenital alar rim defects are rare, with an incidence of 1 in 20,000 to 40,000 live births. Tessier classification is the most commonly used classification system for craniofacial defects. Facial clefts involving the nose are categorized as types 0, 1, 2, and 3, whereas cranial clefts with nose lesions are categorized as types 11, 12, 13, and 14. The patterns of nasal clefts are extremely variable, ranging from a simple notch of alar margin to complex craniofacial cleft involving the lip, nose, eyelid, brow, forehead, and underlying bone.

Patients and Methods
This study was conducted at Fayoum University Hospital on 8 male patients who present with congenital alar rim defects (Tessier number 1 cleft). Surgeries were performed under general anesthesia with orotracheal intubation. A full-thickness incision was created along the whole alar subunit, keeping the ala attached only laterally (laterally based alar full-thickness flap). The alar flap was advanced and rotated medially and inferiorly and sutured to the anatomical place in 2 layers, skin and mucosa. Follow-up was done at least 1.5 years postoperatively.

Results
The study was conducted on 8 male patients presenting with congenital alar rim defects (Tessier number 1 cleft). The mean age of patients was 14.2 years, and the cleft was unilateral in 4 patients (50%) and bilateral in 4 patients (50%). The patients were assessed both aesthetically and functionally and followed at 1.5 years postoperatively. The aesthetic outcome was assessed according to both patients' and author's evaluations of the scar appearance, alar symmetry, nostril symmetry, and general satisfaction.

Conclusions
Laterally based alar subunit rotation advancement flap is a reliable option for reconstruction of congenital alar rim defects (Tessier number 1 cleft) with the advantages of being an easy single-stage procedure with good tissue matching and nostril symmetry and only limitation of extremely wide defects with deficient tissues between the ala and tip.
Plastic Surgery Across Continents
Authors: Stoehr Jenna R. , Chappell Ava G. , Hassan Abbas , Nthumba Peter , Salyapongse A. Neil 
Published: January 2021

Abstract
There is a demonstrated need for access to plastic surgical care in low- and middle-income countries worldwide. Recently, there is increasing interest in promoting transcontinental partnerships between academic institutions to improve training opportunities for local surgeons while increasing access to care for patients. Before such programs can be established, it is crucial for US-based surgeons and educators to understand the existing training models in different countries. The aim of this study is to identify the current plastic surgery training model in the College of Surgeons of East, Central, and Southern Africa (COSECSA) group of African nations and compare this to training in the United States. The curricula of 2 accrediting bodies of plastic surgery, COSECSA and the Accreditation Council for Graduate Medical Education of the United States, were compared. Similarities included the length of dedicated plastic surgery training, curriculum content, and final evaluation structure. Differences include training pathways, assessment methodology, and regulation regarding specific competencies, program requirements, and resident benefits. These findings establish a baseline understanding of how plastic surgical training is organized, delivered, and evaluated in Africa, highlight opportunities for educational initiatives, and serve as a foundation for future efforts to develop collaborative partnerships in these communities. Future research will include a survey sent to program directors and plastic surgery attendings in the COSECSA regions to gather additional information.
Staged Approach to Autologous Reconstruction in the Ptotic Breast
Authors: Deptula Peter , Yesantharao Pooja , Wapnir Irene , Nguyen Dung 
Published: January 2021

Background
Nipple-sparing mastectomy (NSM) and autologous breast reconstruction are associated with higher patient satisfaction, quality of life, and aesthetic outcome. For patients with naturally ptotic breasts, this ideal reconstructive treatment of NSM and autologous breast reconstruction poses a challenge. We describe our experience in treating patients with ptotic natural breasts using a 2-staged approach: oncoplastic breast reduction in the first stage followed by nipple-sparing mastectomy and immediate autologous reconstruction in a second stage.

Methods
We reviewed cases of patients with grade III ptosis who underwent a staged reconstruction approach with reduction mammaplasty followed by NSM and immediate reconstruction with an abdominally based free flap (2014–2019). We compared this group of patients to a second group who underwent staging with a technique of nipple-areola complex (NAC) devascularization. A survey was administered to assess for patient satisfaction and aesthetic outcome 1 year after the second stage procedure.

Results
Eight patients were identified in our reduction group, and 9 patients were identified in our devascularization group. No cases of total NAC necrosis were noted in either group (0%). Two cases of partial NAC necrosis were noted in the devascularization group (11%), whereas none were observed in the reduction group. All patients were satisfied with final outcome (100%, P = 1.0). Aesthetic scores across all factors were higher in the reduction group. Scores for overall outcome (4.6 vs 3.7, P = 0.04), natural appearance (4.8 vs 3.8, P = 0.01), breast contour (4.8 vs 3.2, P = 0.002), and position of breasts (5.0 vs 3.9, P = 0.03) were significantly higher in the reduction group.

Conclusions
Breast ptosis no longer represents a contraindication for patients desiring nipple-sparing mastectomy and immediate autologous reconstruction. This series supports the use of a 2-staged approach with reduction mammaplasty in patients with naturally ptotic breasts. A staged reduction approach may offer fewer NAC complications while also allowing for superior aesthetic outcomes.
Modeling Performance of Open Surgical Cases
Authors: Azari David P. , Frasier Lane L. , Miller Brady L. , Pavuluri Quamme Sudha R. , Le Brian V. , Greenberg Caprice C. , Radwin Robert G. 
Published: January 2021

Introduction
Previous efforts used digital video to develop computer-generated assessments of surgical hand motion economy and fluidity of motion. This study tests how well previously trained assessment models match expert ratings of suturing and tying video clips recorded in a new operating room (OR) setting

Methods
Enabled through computer vision of the hands, this study tests the applicability of assessments born out of benchtop simulations to in vivo suturing and tying tasks recorded in the OR.

Results
Compared with expert ratings, computer-generated assessments for fluidity of motion (slope = 0.83, intercept = 1.77, R
2 = 0.55) performed better than motion economy (slope = 0.73, intercept = 2.04, R
2 = 0.49), although 85% of ratings for both models were within ±2 of the expert response. Neither assessment performed as well in the OR as they did on the training data. Assessments were sensitive to changing hand postures, dropped ligatures, and poor tissue contact—features typically missing from training data. Computer-generated assessment of OR tasks was contingent on a clear, consistent view of both surgeon's hands.

Conclusions
Computer-generated assessment may help provide formative feedback during deliberate practice, albeit with greater variability in the OR compared with benchtop simulations. Future work will benefit from expanded available bimanual video records.
Measuring quality of life in older people with cancer
Authors: Fitch Margaret I. , Strohschein Fay J. , Nyrop Kirsten 
Published: January 2021

Purpose of review
The number of individuals aged 65+ with cancer will double in the next decade. Attention to quality of life (QOL) is imperative to identify relevant endpoints/outcomes in research and provide care that matches individual needs. This review summarizes recent publications regarding QOL measurement in older adults with cancer, considering implications for research and practice.

Recent findings
QOL is a complex concept and its measurement can be challenging. A variety of measurement tools exist, but only one specific to older adults with cancer. QOL is frequently measured as functional health, adverse symptoms, and global QOL, thus only capturing a portion of this concept. Yet successful QOL intervention for older adults requires drawing from behavioral and social dimensions.
Growing interest in comprehensive geriatric assessment (CGA) and patient-reported outcomes (PROs) provides important opportunities for measuring QOL. Recommendations for use of CGAs and PROs in clinical practice have been made but widespread uptake has not occurred.

Summary
QOL is important to older adults and must be central in planning and discussing their care. It is modifiable but presents measurement challenges in this population. Various domains are associated with decline, survival, satisfaction with life, coping, and different interventions. Measurement approaches must fit with intention and capacity to act within given contexts.
Direct admission versus transfer to a tertiary hospital for definitive management of lower extremity injuries: Systematic review and meta-analysis
Authors: Klifto Kevin M. , Azoury Saïd C. , Othman Sammy , Klifto Christopher S. , Levin L. Scott , Kovach Stephen J. 
Published: January 2021

BACKGROUND
Delays in definitive management for traumatic lower extremity injuries may result in morbidity. We compared patients with lower extremity injuries directly admitted to a tertiary hospital for definitive care with patients transferred to that hospital following initial treatment elsewhere.

METHODS
PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched. Participants sustained lower extremity injuries, definitively treated at a tertiary hospital. Interventions were direct admission to a tertiary hospital for definitive care and patients transferred to that hospital for definitive care after initial management at another location. PRISMA, Cochrane, and grading of recommendations assessment, development and evaluation certainty-evidence guidelines were implemented.

RESULTS
Nineteen studies published from 1991 to 2020 compared 3,367 patients directly admitted with 1,046 patients transferred to a hospital for definitive management of lower extremity injuries. Direct admission to a tertiary center, compared with transfer, decreased time to first definitive surgical procedure (standard mean difference, −0.36; 95% confidence interval [CI], −0.57 to −0.16; p = 0.0006; participants, 788; studies, 6; I
2 = 34%; high-certainty evidence) and wound infections (risk ratio [RR], 0.38; 95% CI, 0.19–0.77; p = 0.007; participants, 475; studies, 7; I
2 = 27%; high-certainty evidence). Risks for diabetic patients (RR, 0.87; 95%CI, 0.77–0.98; p = 0.03; participants, 2,973; studies, 4; I
2 = 0%; moderate-certainty evidence), total number of surgeries (standard mean difference, −0.69; 95% CI, −1.02 to −0.36; p < 0.0001; participants, 259; studies, 4; I
2 = 35%; moderate-certainty evidence), osteomyelitis (RR, 0.47; 95% CI, 0.28–0.80; p = 0.006; participants, 212; studies, 2; I
2 = 0%; moderate-certainty evidence), and total complications (RR, 0.47; 95% CI, 0.32–0.67; p < 0.0001; participants, 729; studies, 5; I
2 = 32%; moderate-certainty evidence) are likely lower for direct admits compared with transfers. Direct admission may reduce risks for systemic infections (RR, 0.08; 95% CI, 0.01–0.51; p = 0.007; participants, 198; studies, 2; I
2 = 0%; low-certainty evidence), venous thromboembolism (RR, 0.09; 95% CI, 0.01–0.73; p = 0.02; participants, 94; studies, 1; low-certainty evidence), and postoperative bleeding (RR, 0.74; 95% CI, 0.59–0.93; p = 0.01; participants, 2,725; studies, 3; I
2 = 0%; low-certainty evidence), compared with transfer.

CONCLUSION
Earlier admission to a definitive tertiary center avoids morbidity associated with transfer delays.

LEVEL OF EVIDENCE
Systematic Review/meta-analysis, level III.
A reappraisal of injuries and accidents in people with epilepsy
Authors: Asadi-Pooya Ali A. , Tomson Torbjörn 
Published: January 2021

Purpose of review
We review data on injuries and traffic accidents affecting people with epilepsy with emphasis on the overall risk of injuries, specific types of injuries, and risk factors.

Recent findings
Population-based studies of incident epilepsy cohorts indicate that the risk of physical injuries in people with epilepsy in general is increased only modestly. The risk is higher in selected populations that attend epilepsy clinics or referral centers. Soft tissue injuries, dislocations, and fractures are the most common injures, whereas the greatest increase in risk is reported for more uncommon injuries such as drowning. People with epilepsy are at a two-fold to four-fold increased risk for fatal injuries. Comorbidities contribute to fatal as well as nonfatal injuries. The other major risk factor is poorly controlled major convulsive seizures (generalized as well as focal to bilateral tonic-clonic seizures). Serious transport accidents associated with increased risks for people with epilepsy include pedestrian, bicycle, as well as car accidents.

Summary
Individualized information on the risk of physical injuries and accidents should be part of counseling of patients with epilepsy. Improved seizure control is likely the most effective way to reduce risks, but work place and home adjustments should also be considered.
Serotonergic therapy in epilepsy
Authors: Gilliam Frank G. , Hecimovic Hrvoje , Gentry Matthew S. 
Published: January 2021

Purpose of review
The serotonergic system is implicated in multiple aspects of epilepsy, including seizure susceptibility, sudden unexpected death in epilepsy (SUDEP), and comorbid depression. Despite the complexity of serotonin's effects on various neuronal networks, ongoing research provides considerable insight into the role of serotonin in human epilepsy. This review explores the potential roles of serotonergic therapies to improve clinical outcomes in epilepsy.

Recent findings
In recent decades, research has markedly increased our knowledge of the diverse effects of serotonin on brain function. Animal models of epilepsy have identified the influence of serotonin on seizure threshold in specific brain regions, serotoninergic augmentation's protective effects on terminal apnea and mortality in SUDEP, and mechanisms underlying behavioral improvement in some models of comorbid depression. Human clinical studies are largely consistent with animal data but the translation into definitive treatment decisions has moved less rapidly.

Summary
Evidence for serotonergic therapy is promising for improvement in seizure control and prevention of SUDEP. For some epilepsies, such as Dravet syndrome, basic research on serotonin receptor agonists has translated into a positive clinical trial for fenfluramine. The cumulative results of safety and efficacy studies support the routine use of SSRIs for comorbid depression in epilepsy.
Insular seizures and epilepsies: Ictal semiology and minimal invasive surgery
Authors: Ryvlin Philippe , Nguyen Dang Khoa 
Published: January 2021

Purpose of review
The increased identification of seizures with insular ictal onset, promoted by the international development of stereo-electroencephalography (SEEG), has led to the recent description of larger cohorts of patients with insular or insulo-opercular epilepsies than those previously available. These new series have consolidated and extended our knowledge of the rich ictal semiology and diverse anatomo-clinical correlations that characterized insular seizures. In parallel, some experiences have been gained in the surgical treatment of insular epilepsies using minimal invasive procedures.

Recent findings
The large majority of patients present with auras (mostly somatosensory and laryngeal) and motor signs (predominantly elementary and orofacial), an underlying focal cortical dysplasia, and an excellent postoperative seizure outcome. Many other subjective and objective ictal signs, known to occur in other forms of epilepsies, are also observed and clustered in five patterns, reflecting the functional anatomy of the insula and its overlying opercula, as well as preferential propagation pathways to frontal or temporal brain regions. A nocturnal predominance of seizure is frequently reported, whereas secondary generalization is infrequent. Some rare ictal signs are highly suggestive of an insular origin, including somatic pain, reflex seizures, choking spells, and vomiting. Minimal invasive surgical techniques have been applied to the treatment of insular epilepsies, including Magnetic Resonance Imaging-guided laser ablation (laser interstitial thermal therapy (LITT)), radiofrequency thermocoagulation (RFTC), gamma knife radiosurgery, and responsive neurostimulation. Rates of seizure freedom (about 50%) appear lower than that reported with open-surgery (about 80%) with yet a significant proportion of transient neurological deficit for LITT and RFTC.

Summary
Significant progress has been made in the identification and surgical treatment of insular and insulo-opercular epilepsies, including more precise anatomo-clinical correlations to optimally plan SEEG investigations, and experience in using minimal invasive surgery to reduce peri-operative morbidity.
Totally Implantable Venous-Access Device in Maintenance Electroconvulsive Therapy
Authors: Macau Elisabet , Valero Ricard , Gil-Badenes Joaquín , Valentí Marc , Baeza Inmaculada , Pacchiarotti Isabella , Bioque Miquel 
Published: January 2021

Objectives
Electroconvulsive therapy (ECT) is an effective and safe treatment of certain severe mental disorders, but there are some barriers to the implementation of continuation/maintenance ECT courses in some cases. Repeated difficulties in achieving intravenous access before each session may contribute to premature ECT discontinuation. The placement of a totally implantable venous-access device (TIVAD) could be an alternative to overcome these difficulties in certain subjects.

Methods
For the present study we retrospectively identified all patients treated with continuation/maintenance ECT in our facilities during a 13-year period to which a TIVAD was implanted, paying attention to specific factors related to clinical characteristics, treatment course, and ECT technique.

Results
We identified a TIVAD in 16 (3.33%) of 481 patients receiving ECT in our unit, of whom 87.5% were female. Half of the cases met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for schizophrenia, 6 for bipolar disorder, and 2 for major depression disorder. Age of the study cases ranged from 17 to 87 years. A total of 1957 ECT sessions were registered in this group of cases during the observation period. Patients had undergone a mean of 124.06 ± 132.41 ECT sessions before the TIVAD was implanted, with the device mean time of utilization being 5.39 ± 3.46 years. In 2 cases, the device was removed after ECT discontinuation. Few incidents associated with the implantation and operation of the TIVAD were registered, comparable to the use of this device in other clinical contexts.

Conclusions
This case series suggest that a TIVAD placement can be an effective and safe solution for patients in continuation/maintenance ECT courses with difficult intravenous access. Future studies will need to carefully monitor the benefit and the potential complications of TIVAD placement in patients undergoing continuation/maintenance ECT programs.
Evolution of spray and aerosol from respiratory releases: theoretical estimates for insight on viral transmission
Authors: de Oliveira P. M. , Mesquita L. C. C. , Gkantonas S. , Giusti A. , Mastorakos E. 
Published: January 2021

By modelling the evaporation and settling of droplets emitted during respiratory releases and using previous measurements of droplet size distributions and SARS-CoV-2 viral load, estimates of the evolution of the liquid mass and the number of viral copies suspended were performed as a function of time from the release. The settling times of a droplet cloud and its suspended viral dose are significantly affected by the droplet composition. The aerosol (defined as droplets smaller than 5
μ
m) resulting from 30 s of continued speech has O(1 h) settling time and a viable viral dose an order-of-magnitude higher than in a short cough. The time-of-flight to reach 2 m is only a few seconds resulting in a viral dose above the minimum required for infection, implying that physical distancing in the absence of ventilation is not sufficient to provide safety for long exposure times. The suspended aerosol emitted by continuous speaking for 1 h in a poorly ventilated room gives 0.1–11% infection risk for initial viral loads of

10
8

–

10

10

copies ml

l

−

l

, respectively, decreasing to 0.03–3% for 10 air changes per hour by ventilation. The present results provide quantitative estimates useful for the development of physical distancing and ventilation controls.