bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-induction with intravenous Ustekinumab after secondary loss of response is a valid optimization strategy in Crohn’s disease
Authors: ten Bokkel Huinink Sebastiaan , Biemans Vince , Duijvestein Marjolijn , Pierik Marieke , Hoentjen Frank , West Rachel L. , van der Woude Christien J. , de Vries Annemarie C. 
Published: August 2021

Background and aim
Re-induction with intravenous ustekinumab after secondary loss of response in Crohn’s disease is a relatively new strategy to regain efficacy. This real-world cohort study aimed to evaluate its effectiveness and safety.

Methods
Crohn’s disease patients with loss of response after initial response to ustekinumab and treated with a second intravenous dose of ustekinumab were included. Clinical, biochemical and endoscopic data were collected. Primary outcome was drug survival. Secondary effectiveness outcomes included clinical remission, primary nonresponse and adverse events.

Results
In total, 31 Crohn’s disease patients were included after re-induction with intravenous ustekinumab. All patients had failed prior biologic therapy, that is 77% were exposed to two or more antitumor necrosis factor agents and 65% were exposed to vedolizumab prior to initiation of ustekinumab treatment. Median treatment duration between initial treatment and re-induction with intravenous ustekinumab was 11.1 months (interquartile range 6.9–19.5). Ustekinumab therapy after a second dose of intravenous ustekinumab was maintained in 74 and 71% of the patients at weeks 20 and 52. Clinical remission rates after re-induction at weeks 8, 20 and 52 were 37, 56 and 45%, respectively. Nonresponse occurred in 16% of the patients. Adverse events were reported in four patients.

Conclusions
Re-induction with intravenous ustekinumab after secondary loss of response results in continuation of ustekinumab treatment for at least 1 year in almost three-quarters of patients and in clinical remission in half of patients after 1 year. Therefore, ustekinumab re-induction may be considered an important rescue treatment option in patients with refractory Crohn’s disease.
Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care
Authors: Luo Zhehui , Gardiner Joseph C. , Smith Robert C. 
Published: August 2021

Background:
Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care.

Objectives:
We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents.

Methods:
A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program.

Results:
The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars.

Conclusions:
Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.
A New 3-Stage Approach for Reoperative Hypospadias
Authors: Jordan Ashley , Sumfest Joel , DeSantis Joseph 
Published: August 2021

Background
Most hypospadias patients undergo 1 surgical procedure and go on to live normal lives. However, there is a small subset of patients who have remaining functional complications after their repair. Patients presenting with diffuse scarring of the urethral plate and a shortage of penile skin for closure are referred to as “hypospadias cripples.” We present our experience using tissue expanders in the treatment of reoperative hypospadias with skin deficiency.

Methods
We retrospectively reviewed hospital records from 2009 to 2019. Five hypospadias cripple patients were encountered. A multidisciplinary team involving plastic surgery and pediatric urology collaborated a 3-stage reconstructive plan:
Stage 1—Scar excision and buccal mucosal graft harvest
Stage 2—Dorsal tissue expander placement
Stage 3—Tissue expander explantation, creation of neourethra, and skin closure.

Results
Successful skin closures were achieved in all patients. There were no cases of expander explanation. Average time between tissue expander placement and final reconstruction ranged from 3 to 4 months. Complications included 2 cases of penile cellulitis, 1 with an associated abscess, and 2 limited urethrocutaneous fistulas, which were addressed with an additional operative procedure.

Conclusions
The 3-stage approach is advantageous in treating hypospadias cripple patients. This population can benefit greatly from tissue expander placement after buccal result with an acceptable complication rate. Using a multidisciplinary approach is beneficial in treating these complex patients.
Pediatric Mandibular Reconstruction Using the Vascularized Fibula Free Flap
Authors: Zavala Abraham , Ore Juan F. , Broggi Alfredo , De Pawlikowski Wieslawa 
Published: August 2021

Background
The vascularized fibula free flap is a workhorse flap in pediatric mandibular reconstruction. This study aimed to address functional outcomes, complications, and morbidity associated with the fibula resection in a consecutive series of mandibular reconstruction using this technique in skeletally immature patients.

Methods
Functional outcomes in terms of maximal mouth opening capacity, patient-reported eating ability, occlusion, and gait were retrospectively reviewed in 34 consecutive pediatric patients (18 males, 16 females) who underwent mandibular reconstruction using the vascularized free fibula flap. Data regarding donor and recipient site complications were also retrieved.

Results
The mean follow-up period was 50.6 months (range, 12–108 months). The average age was 10.3 years (range, 2–15 years). Underlying pathologies included ossifying fibroma, ameloblastoma, mandibular arteriovenous malformation, fibrous dysplasia, Goldenhar syndrome, dentigerous cyst, mandibular lymphoma, odontogenic fibroma, adenomatoid odontogenic tumor, aneurysmal bone cyst, neurogenic sarcoma, and central giant cell granuloma. Defect length ranged from 8 to 17 cm. Mean return to normal ambulation was achieved 12 days postoperatively. All patients reported ability to eat solids and liquids, with 29 of 34 achieving normal mouth opening. Normal or minimally disturbed occlusion was maintained postoperatively in most patients. Temporomandibular joint ankylosis and condylar displacement were each developed in one patient. Two patients reported gait disturbances that receded after physical therapy. No other major donor site complications, including flexion contracture of the great toe, were identified.

Conclusions
The vascularized fibula free flap is reaffirmed to be the criterion standard for mandible reconstruction in pediatric patients, providing satisfactory functional results and adequate adaptation to the growing facial skeleton with minimal sequelae. Complications regarding hallux function may be prevented by assessing the vascularity of the flexor hallucis longus intraoperatively and ensuring tension-free closure of the donor site.
Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction
Authors: Xiong Xu , Xu Min , Shuai Ming , Guo Chao-Jian , Wang Chao , He Zhi-Ling , Li Hao 
Published: August 2021

Objective
This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction.

Patients and Methods
We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated.

Results
The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications.

Conclusions
The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.
The Incidence of Traumatic Optic Neuropathy Associated With Subtypes of Orbital Wall Fracture
Authors: Sakong Yong , Chung Kyu Jin , Kim Yong Ha 
Published: August 2021

Background:
Traumatic optic neuropathy (TON) is a rare disease but leaves critical sequelae to patient. Purpose of this study is to evaluate the incidence of TON in each orbital wall fracture.

Materials and Methods:
Retrospective review of 2629 patients with orbital wall fracture was performed in from January 2010 to March 2019, based on diagnostic code, Korean Standard Classification of Diseases, 7th Revision. The orbital wall fractures were divided into 4 subtypes: superior, medial, inferior, and lateral wall. Incidence of TON is analyzed according to subtypes, single and multiple wall fracture.

Results:
Among 2629 patients with orbital wall fractures, 27 patients were diagnosed with TON with an incidence of 1.02%. In single wall fracture, only lateral wall showed significantly high TON incidence, which only zygomatic fracture was included in single lateral wall fracture. In multiple wall fracture, it was statistically significant in the superior wall.

Conclusions:
Fracture on lateral and superior orbital wall showed a tendency to increase the incidence of TON. Based on the above results, radiologic evaluation and physical examination is necessary for patient who has lateral and superior orbital wall fracture.
NonSurgical Approach to Treat Lip Vascular Complication Caused by Hyaluronic Acid Filler
Authors: Alcantara Allan Rafael , Machado-Filho Daniel Augusto , Provenzano Renato Goulart , Vieira Leonardo Caldas , Kim Jun Ho , Cortes Arthur Rodriguez Gonzalez 
Published: August 2021

Abstract
The use of hyaluronic acid (HA) fillers in lip augmentation represents today 1 of the most widely used nonsurgical aesthetic procedures in the world. Regarding the severe complications are rare, insufficient professional experience for recognizing signs of vascular impairment and inadequate technique could lead to severe lip skin necrosis complications. Several of existing treatment protocols in the literature to treat vascular complication are mainly based on the use of hyaluronidase. Nevertheless, there is no consensus on dosage, interval between doses and complementary protocol among the aforementioned studies. This case aims to present a conservative approach for the clinical management of serious vasculature complications with HA injection. A high dose of hyaluronidase(11500 IU) with additional multimodal treatment was performed to the upper lip, nasolabial fold, and nose that successfully reversed a vascular complication process. The present findings suggest that the use of high doses of hyaluronidase with the complementary protocol used herein might be a promising approach in the treatment of severe vascular complication in the lips caused by HA filling.
Oral Mucosal Melanoma
Authors: Nisi Marco , Izzetti Rossana , Gennai Stefano , Pucci Angela , Lenzi Chiara , Graziani Filippo 
Published: August 2021

Purpose:
Primary oral mucosal melanoma (OMM) is a rare neoplasm accounting for the 0.2% to 0.8% of all melanomas. The aim of the present manuscript is (1) to describe 2 cases of primary OMM treated at our department, and (2) to perform a systematic literature review on primary OMM occurrence and treatment

Methods:
Two cases of primary OMM were described. A systematic review is presented in order to assess the treatment options, recurrence, metastasis development, and survival rate of primary OMM.

Results:
Two patients were referred for the development of a lesion of the hard palate and the maxillary gingival mucosa, respectively. An incisional biopsy was performed in both patients, followed by extensive surgical resection after a thorough consideration of patient history and systemic involvement. The literature search retrieved 447 primary OMM cases. In the 30% of cases, distant metastases were already present at the time of diagnosis. The management of primary OMM most frequently involved surgical treatment and adjuvant radiotherapy.

Conclusions:
Primary OMM still represents a challenge for the clinician, as the diagnosis is often performed when metastases have already developed. The prognosis is generally poor, thus highlighting the need for further investigations to improve early diagnosis.
Effect of Dichotomous Conchal Cartilage Transplantation on Correction of Unilateral Cleft Lip Nasal Deformity
Authors: Han Zhiqiang , Wu Beibei , Jiang Banghong , Song Peijun , Li Guangzao , Xu Jing 
Published: August 2021

Background:
Autologous conchal cartilage is becoming increasingly popular as a source of material for secondary reconstruction. The aim of this study was to verify the effect of dichotomous autologous conchal cartilage transplantation in the treatment of unilateral cleft lip nasal deformity.

Methods:
Eighteen patients (10 males and 8 females) with unilateral cleft lip nasal deformity treated from August 2018 to August 2019 were selected for the study. The cut C-shaped conchal cartilage was trimmed into a strip shape and a shield shape and transplanted into the alar cartilage and the tip of the nose, respectively. The effect of the operation was evaluated in terms of patient satisfaction, two-dimensional linear quantitative results, and three-dimensional spatial differences after the operation.

Results:
During follow-up from 6 months to 2 years, the nasal appearance of 18 patients was significantly improved. The postoperative patient satisfaction survey revealed more than 93% satisfaction for each research index. Two-dimensional linear quantitative analysis revealed that the height of the nasal columella and nostril was significantly increased and that the nasal base and breadth were significantly decreased after the operation. Evaluation of the three-dimensional spatial difference between the unaffected side and the affected side before and after the operation revealed a significant decrease in the difference in the soft tissue volume between the unaffected side and the affected side (P < 0.05).

Conclusions:
Dichotomous autologous conchal cartilage transplantation is an ideal method for the treatment of unilateral cleft lip nasal deformity.
Outcomes and Healthcare Utilization Among New Persistent Opioid Users and Nonopioid Users After Curative-intent Surgery for Cancer
Authors: Lin Na , Dabas Eashita , Quan May Lynn , Cheung Winson Y. , Cuthbert Colleen , Feng Yuanchao , Kong Shiying , Sauro Khara M. , Brenner Darren R. , Yang Lin , Lu Mingshan , Xu Yuan 
Published: August 2021

Objective:
The aim of the study was to compare the health outcomes and resource use of cancer patients who were new persistent opioid users with those who were not, after undergoing curative intent surgery for cancer.

Background:
Little is known about long-term health outcomes (overdose, mortality) and resource utilization of new persistent opioid users among cancer patients undergoing curative-intent surgery.

Methods:
This retrospective cohort study included all adults with a diagnosis of solid cancers who underwent curative-intent surgery during the study period (2011–2015) in Alberta, Canada and were opioid-naïve before surgery, with a follow-up period until December 31, 2019. The key exposure, “new persistent opioid user,” was defined as a patient who was opioid-naive before surgery and subsequently filled at least 1 opioid prescription between 60 and 180 days after surgery. The primary outcome was opioid overdose that occurred within 3 years of surgery. All-cause death, noncancer caused death, and department visit (yes vs. no), and hospitalization (yes vs. no) in the follow-up periods were also included as outcomes.

Results:
In total, 19,219 patients underwent curative intent surgery with a median follow-up of 47 months, of whom 1530 (8.0%) were identified as postoperative new persistent opioid users. In total, 101 (0.5%) patients experienced opioid overdose within 3 years of surgery. Compared with nonopioid users, new persistent opioid users experienced a higher rate of opioid overdose (OR = 2.37, 95% CI: 1.44–3.9) within 3 years of surgery. New persistent opioid use was also associated with a greater likelihood of being hospitalized (OR = 2.03, 95% CI: 1.76–2.33) and visiting an emergency room (OR = 1.83, 95% CI: 1.62–2.06) in the first year after surgery, and a higher overall (HR = 1.28, 95% CI: 1.1–1.49) and noncancer caused mortality (HR = 1.33, 95% CI: 1.12–1.58), when compared with nonopioid users.

Conclusion:
Postoperative new persistent opioid use among cancer patients undergoing curative-intent surgery is associated with subsequent opioid overdose, worse survival, and more health resource utilization.
No Light Perception Vision in Neuro-Ophthalmology Practice
Authors: Garg Anubhav , Margolin Edward , Micieli Jonathan A. 
Published: August 2021

Background:
To determine differential diagnosis and visual outcomes of patients with no light perception (NLP) vision related to neuro-ophthalmic conditions.

Methods:
Retrospective case series of patients seen at tertiary neuro-ophthalmology practices. Patients were included if they had NLP vision any time during their clinical course. Outcome measures were final diagnosis, treatment, and visual outcome.

Results:
Seventy-two eyes of 65 patients were included. The average age was 57.6 (range 18–93) years, and 58% were women. The Most common diagnosis (21 patients) was compressive optic neuropathy (CON) with meningioma being the most common culprit (12). Other diagnoses included optic neuritis (ON) (11 patients), infiltrative optic neuropathies (8), posterior ischemic optic neuropathy (7), nonarteritic anterior ischemic optic neuropathy (4), arteritic anterior ischemic optic neuropathy (3), ophthalmic artery occlusion (3), nonorganic vision loss (3), radiation-induced optic neuropathy (2), cortical vision loss (1), retinitis pigmentosa with optic disc drusen (1), and infectious optic neuropathy (1). Ten patients recovered vision: 7 ON, 2 infiltrative optic neuropathy, and 1 CON. Corticosteroids accelerated vision recovery in 7 of the 11 patients with ON to mean 20/60 (0.48 logMAR) over 9.0 ± 8.6 follow-up months. Eleven patients deteriorated to NLP after presenting with at least LP; their diagnoses included CON (3), ophthalmic artery occlusion (2), infiltration (2), ON (1), posterior ischemic optic neuropathy (1), arteritic anterior ischemic optic neuropathy (1), and radiation-induced optic neuropathy (1).

Conclusions:
NLP vision may occur because of various diagnoses. Vision recovery was mainly seen in patients with ON. Serious systemic conditions may present or relapse with NLP vision, which clinicians should consider as an alarming sign in patients with known malignancies.
Advanced materials design based on waste wood and bark
Authors: Wenig Charlett , Dunlop John W. C. , Hehemeyer-Cürten Johanna , Reppe Friedrich J. , Horbelt Nils , Krauthausen Karin , Fratzl Peter , Eder Michaela 
Published: August 2021

Trees belong to the largest living organisms on Earth and plants in general are one of our main renewable resources. Wood as a material has been used since the beginning of humankind. Today, forestry still provides raw materials for a variety of applications, for example in the building industry, in paper manufacturing and for various wood products. However, many parts of the tree, such as reaction wood, branches and bark are often discarded as forestry residues and waste wood, used as additives in composite materials or burned for energy production. More advanced uses of bark include the extraction of chemical substances for glues, food additives or healthcare, as well as the transformation to advanced carbon materials. Here, we argue that a proper understanding of the internal fibrous structure and the resulting mechanical behaviour of these forest residues allows for the design of materials with greatly varying properties and applications. We show that simple and cheap treatments can give tree bark a leather-like appearance that can be used for the construction of shelters and even the fabrication of woven textiles.
This article is part of the theme issue ‘Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 1)’.
Life cycle assessment (LCA): informing the development of a sustainable circular bioeconomy?
Authors: Sevigné-Itoiz Eva , Mwabonje Onesmus , Panoutsou Calliope , Woods Jeremy 
Published: August 2021

The role of life cycle assessment (LCA) in informing the development of a sustainable and circular bioeconomy is discussed. We analyse the critical challenges remaining in using LCA and propose improvements needed to resolve future development challenges. Biobased systems are often complex combinations of technologies and practices that are geographically dispersed over long distances and with heterogeneous and uncertain sets of indicators and impacts. Recent studies have provided methodological suggestions on how LCA can be improved for evaluating the sustainability of biobased systems with a new focus on emerging systems, helping to identify environmental and social opportunities prior to large R&D investments. However, accessing economies of scale and improved conversion efficiencies while maintaining compatibility across broad ranges of sustainability indicators and public acceptability remain key challenges for the bioeconomy. LCA can inform, but not by itself resolve this complex dimension of sustainability. Future policy interventions that aim to promote the bioeconomy and support strategic value chains will benefit from the systematic use of LCA. However, the LCA community needs to develop the mechanisms and tools needed to generate agreement and coordinate the standards and incentives that will underpin a successful biobased transition. Systematic stakeholder engagement and the use of multidisciplinary analysis in combination with LCA are essential components of emergent LCA methods.
This article is part of the theme issue ‘Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 1)’.