bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Nasal Packing Necessary After Endoscopic Dacryocystorhinostomy Without Stent and Mucosal Flaps Preservation?
Authors: Demir Deniz 
Published: February 2021

Objective:
This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps.

Methods:
The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups.

Results:
Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76).

Conclusions:
The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.
Quality, Reliability, and Readability of Online Information on Rhinoplasty
Authors: Ahsanuddin Salma , Cadwell Joshua B. , Povolotskiy Roman , Paskhover Boris 
Published: February 2021

Background:
With an ever-growing reliance on technology, patients are increasingly resorting to websites for their medical information. This study evaluates the readability, quality, and reliability of online information available on rhinoplasty provided by academic centers or impartial reference sources and private practice websites.

Methods:
A cross-sectional study from July to August 2019 was performed looking at the first 42 informational websites on a Google search for the term nose job. Websites were categorized as belonging to impartial sources and academic centers or private practices. Two independent reviewers evaluated websites on their quality, readability, reliability, and technical qualities using several validated measures. The Health on the Net code (HONcode) and DISCERN questionnaire were used to assess the quality and reliability of the information presented on the websites. Significance tests were performed using SPSS Version 25.

Results:
Of the 42 websites, 23 were impartial sources or academic centers (54.8%) and 19 were private practice websites (47.6%). The mean (±SD) for the HONcode and DISCERN scores were 5.7 (±2.8) and 2.6 (±0.7), respectively. The mean (SD) HONcode scores for impartial sources and private practice websites were 7.1 (±2.9) and 4.1 (±1.5), respectively (P < 0.001). The mean (±SD) DISCERN scores were 2.9 (±0.7) and 2.3 (±0.5), respectively (P = 0.009). There was no statistically significant difference in scores for readability and technical qualities.

Conclusions:
While impartial sources and academic centers score higher on quality and reliability scores, their scores were also low. These findings are concerning as many consumers use the information provided by online websites to guide decisions regarding their health.
Clinical Evaluation of Unsintered Hydroxyapatite Particles/Poly L-Lactide Composite Device in Craniofacial Surgery
Authors: Osawa Sayuri , Hashikawa Kazunobu , Naruse Hidemi , Terashi Hiroto 
Published: February 2021

Abstract
A total of 47 patients who underwent the craniofacial implantation of unsintered hydroxyapatite particles and a poly-L-lactide device were evaluated for clinical local findings and computed tomography (CT) images after about 6 months. Long-term follow-up of 3 patients was done from 5 to 11 years. The patients underwent CT imaging pre- and postoperatively, while local clinical examination was done upon follow-up. For the 3 patients who were followed up for more than 5 years, implant changes were evaluated by using CT. Computed tomography revealed 3 patients of dislocation, 2 patients of insufficient bone union, and 3 patients of implant breakage. All patients healed well with no complications requiring a secondary operation. The CT findings of the long-term cases revealed the following: a plate and screw were still present 5 years postsurgery (patient 1), mesh implants were completely resorbed after 9 years and 6 months (patient 2), and plates were almost resorbed after 11 years but some of their shapes remained (patient 3).
The unsintered hydroxyapatite/poly-L-lactide device is useful in the maxillofacial region in terms of strength and radiographic contrast. However, since the absorption rate is slow, it is necessary to keep in mind its long-term radiographic detectability and the possibility of late-onset granuloma.
Myositis Ossificans Traumatica, an Unusual Cause of Mandibular Hypomobility
Authors: Karimi Abbas , Tavakoli Iman , Jalilimanesh Kimia , Tavakoli Ehsan , Tavakoli Ali 
Published: February 2021

Abstract
Myositis ossificans traumatica is a rare condition in which causes restriction of mandibular movement. In this entity, temporomandibular joint is depleted of any problems; although all the patients have the history of trauma to the mandible and the face. Myositis ossificans traumatica can involve other parts of the body like femoral region with higher incidence in compare to the maxillofacial area. Blunt trauma to the head and neck causes muscle contusion injury, hematoma formation in the injured muscles or nearby soft tissues. Calcification of hematoma and heterotopic bone formation in the muscle, soft tissue, or near bony structures causes progressive decrease in mouth opening. Surgical removal of calcified body has been the only and one method for treatment of this disorder but rate of recurrence is high in the literature. The authors want to introduce 2 new cases of myositis ossificans traumatica, and then discuss about etiology and different treatment modalities.
The Effects of Intraoperative Local Tranexamic Acid on Periorbital Edema and Ecchymosis in Septorhinoplasty
Authors: İpek Havva Duru , Bezgin Selin Üstün , Çakabay Taliye , Çelebi Şaban 
Published: February 2021

Introduction:
The aim of the present study is to examine the effect of local administration of tranexamic acid (TXA) through lateral osteotomy line on postoperative periorbital edema and ecchymosis.

Material-Method:
Thirty patients underwent open technical septorhinoplasty were included. Before lateral osteotomies, the surgeon opened narrow subperiosteal tunnels on the both sides. After lateral osteotomies, the surgeon irrigated TXA into the right tunnel with the broken tip of the injection and the same amount of saline into the left tunnel. The patient's photographs were taken on the first, third, and seventh postoperative days. Periorbital edema and ecchymoses were evaluated by the blinded author. The statistical differences between the 2 sides were analyzed.

Results:
Lower Eyelid Edema values were significantly lower in the TXA(+) group than the TXA(–) group on the third day (P = 0.001). There was no statistically significant difference between the sides in terms of lower eyelid edema values on the first and seventh days (P = 0.065, P = 0.317). Upper and lower eyelid ecchymosis values were significantly lower in TXA(+) group than TXA(–) group on the first, third, and seventh days (P < 0.05). Upper eyelid edema values were found to be significantly lower in the TXA(+) group than the TXA(–) group on the first and third days (P = 0.002, P = 0.005). There was no statistically significant between the sides in terms of upper eyelid edema (P = 0.315) on the seventh day.

Conclusions:
It was observed in the present study that local administration of TXA in septorhinoplasty was effective in reducing postoperative periorbital edema and ecchymosis.

Level of evidence: 2c
Mandibular Reconstruction With the Iliac Flap Under the Guidance of A Series of Digital Surgical Guides
Authors: Qiu Shiyu , Kang Yifan , Ding Mengkun , Zhu Houwei , Zhang Yu , Zhang Lei , Shan Xiaofeng , Cai Zhigang 
Published: February 2021

Abstract
The authors aimed to evaluate the accuracy of mandibular reconstruction with the iliac flap under the guidance of a series of digital surgical guides. Seven patients were enrolled to evaluate the accuracy of reconstruction immediately after surgery. Patients underwent mandibular reconstruction with a vascularized iliac flap guided by a series of digital surgical guides at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, from September 2017 to June 2018.
All flaps survived. Chromatographic analysis showed that the area with a chromatographic difference of ≤1 mm between preoperative virtual surgical planning model and postoperative mandible accounted for 73.97% ± 3.89% of mandible surface, the area ≤2 mm accounted for 87.21% ± 2.65%, and the area ≤3 mm accounted for 94.09% ± 2.50%. In all of the 7 cases, the mean of maximum deviation was 6.25 ± 1.00 mm, and the mean of average deviation was 0.95 ± 0.13 mm. The authors conclude that mandibular reconstruction with the iliac flap under the guidance of a series of digital surgical guides is accurate and effective.
Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study)
Authors: Blok Robin D. , Sharabiany Sarah , Stoker Jaap , Laan Ellen T. M. , Bosker Robbert J. I. , Burger Jacobus W. A. , Chaudhri Sanjay , van Duijvendijk Peter , van Etten Boudewijn , van Geloven Anna A. W. , de Graaf Eelco J. R. , Hoff Christiaan , Hompes Roel , Leijtens Jeroen W. A. , Rothbarth Joost , Rutten Harm J. T. , Singh Baljit , Vuylsteke Ronald J. C. L. M. , de Wilt Johannes H. W. , Dijkgraaf Marcel G. W. , Bemelman Willem A. , Musters Gijsbert D. , Tanis Pieter J. 
Published: February 2021

Objective:
To determine long-term outcomes of a randomized trial (BIOPEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia.

Summary Background Data:
BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing).

Methods:
This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic.

Results:
Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0–30) after biological mesh closure versus 30% (95% CI, 10–49) after primary closure (P = 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P = 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P = 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome.

Conclusions:
Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.
Internal and External Validation of an Alcohol Biomarker for Screening in Trauma
Authors: Afshar Majid , Baker Kenneth , Corral Josefine , Ross Erin , Lowery Erin , Gonzalez Richard , Burnham Ellen L. , Callcut Rachael A. , Kornblith Lucy Z. , Hendrickson Carolyn , Kovacs Elizabeth J. , Joyce Cara 
Published: February 2021

Objective:
We aimed to examine biomarkers for screening unhealthy alcohol use in the trauma setting.

Summary and Background Data:
Self-report tools are the practice standard for screening unhealthy alcohol use; however, their collection suffers from recall bias and incomplete collection by staff.

Methods:
We performed a multi-center prospective clinical study of 251 adult patients who arrived within 24 hours of injury with external validation in another 60 patients. The Alcohol Use Disorders Identification Test served as the reference standard. The following biomarkers were measured: (1) PEth; (2) ethyl glucuronide; (3) ethyl sulfate; (4) gamma-glutamyl-transpeptidase; (5) carbohydrate deficient transferrin; and (6) blood alcohol concentration (BAC). Candidate single biomarkers and multivariable models were compared by considering discrimination (AUROC). The optimal cutpoint for the final model was identified using a criterion for setting the minimum value for specificity at 80% and maximizing sensitivity. Decision curve analysis was applied to compare to existing screening with BAC.

Results:
PEth alone had an AUROC of 0.93 [95% confidence interval (CI): 0.92–0.93] in internal validation with an optimal cutpoint of 25 ng/mL. A 4– variable biomarker model and the addition of any single biomarker to PEth did not improve AUROC over PEth alone (P > 0.05). Decision curve analysis showed better performance of PEth over BAC across most predicted probability thresholds. In external validation, sensitivity and specificity were 76.0% (95% CI: 53.0%–92.0%) and 73.0% (95% CI: 56.0%–86.0%), respectively.

Conclusion and Relevance: PEth alone proved to be the single best biomarker for screening of unhealthy alcohol use and performed better than existing screening systems with BAC. PEth may overcome existing screening barriers.
Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3)
Authors: Zwart Maurice J.W. , Nota Carolijn L.M. , de Rooij Thijs , van Hilst Jony , te Riele Wouter W. , van Santvoort Hjalmar C. , Hagendoorn Jeroen , Borei Rinkes Inne H.M. , van Dam Jacob L. , Latenstein Anouk E.J. , Takagi Kosei , Tran Khé T.C. , Schreinemakers Jennifer , van der Schelling George P. , Wijsman Jan H. , Festen Sebastiaan , Daams Freek , Luyer Misha D. , de Hingh Ignace H.J.T. , Mieog Jan S.D. , Bonsing Bert A. , Lips Daan J. , Hilal Mohammed Abu , Busch Olivier R. , Saint-Marc Olivier , Zehl Herbert J. , Zureikat Amer H. , Hogg Melissa E. , Molenaar I. Quintus , Besselink Marc G. , Koerkamp Bas Groot ,   for the Dutch Pancreatic Cancer Group
Published: February 2021

Objective:
To assess feasibility and safety of a multicenter training program in robotic pancreatoduodenectomy (RPD) adhering to the IDEAL framework for implementation of surgical innovation.

Background:
Good results for RPD have been reported from single center studies. However, data on feasibility and safety of implementation through a multicenter training program in RPD are lacking.

Methods:
A multicenter training program in RPD was designed together with the University of Pittsburgh Medical Center, including an online video bank, robot simulation exercises, biotissue drills, and on-site proctoring. Benchmark patients were based on the criteria of Clavien. Outcomes were collected prospectively (March 2016-October 2019). Cumulative sum analysis of operative time was performed to distinguish the first and second phase of the learning curve. Outcomes were compared between both phases of the learning curve. Trends in nationwide use of robotic and laparoscopic PD were assessed in the Dutch Pancreatic Cancer Audit.

Results:
Overall, 275 RPD procedures were performed in seven centers by 15 trained surgeons. The recent benchmark criteria for low-risk PD were met by 125 (45.5%) patients. The conversion rate was 6.5% (n = 18) and median blood loss 250ml [interquartile range (IQR) 150–500]. The rate of Clavien-Dindo grade ≥III complications was 44.4% (n = 122), postoperative pancreatic fistula (grade B/C) rate 23.6% (n = 65), 90-day complication-related mortality 2.5% (n = 7) and 90-day cancer-related mortality 2.2.% (n = 6). Median postoperative hospital stay was 12 days (IQR 8–20). In the subgroup of patients with pancreatic cancer (n = 80), the major complication rate was 31.3% and POPF rate was 10%. Cumulative sum analysis for operative time found a learning curve inflection point at 22 RPDs (IQR 10–35) with similar rates of Clavien-Dindo grade ≥III complications in the first and second phase (43.4% vs 43.8%, P = 0.956, respectively). During the study period the nationwide use of laparoscopic PD reduced from 15% to 1%, whereas the use of RPD increased from 0% to 25%.

Conclusions:
This multicenter RPD training program in centers with sufficient surgical volume was found to be feasible without a negative impact of the learning curve on clinical outcomes.
A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis
Authors: O’Leary D. Peter , Walsh Siun M. , Bolger Jarlath , Baban Chwanrow , Humphreys Hilary , O’Grady Sorcha , Hegarty Aisling , Lee Aoife M. , Sheehan Mark , Alderson Jack , Dunne Ruth , Morrin Martina M. , Lee Michael J. , Power Colm , McNamara Deborah , McCawley Niamh , Robb Will , Burke John , Sorensen Jan , Hill Arnold D. 
Published: February 2021

Objective:
Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.

Summary background data:
Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.

Methods:
Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.

Results:
One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0,
P
< 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).

Conclusions:
Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.
The Tangible Benefits of Living Donation: Results of a Qualitative Study of Living Kidney Donors
Authors: Van Pilsum Rasmussen Sarah E. , Robin Miriam , Saha Amrita , Eno Anne , Lifshitz Romi , Waldram Madeleine M. , Getsin Samantha N. , Chu Nadia M. , Al Ammary Fawaz , Segev Dorry L. , Henderson Macey L. 
Published: February 2021

Background.
The framework currently used for living kidney donor selection is based on estimation of acceptable donor risk, under the premise that benefits are only experienced by the recipient. However, some interdependent donors might experience tangible benefits from donation that cannot be considered in the current framework (ie, benefits experienced directly by the donor that improve their daily life, well-being, or livelihood).

Methods.
We conducted semistructured interviews with 56 living kidney donors regarding benefits experienced from donation. Using a qualitative descriptive and constant comparative approach, themes were derived inductively from interview transcripts by 2 independent coders; differences in coding were reconciled by consensus.

Results.
Of 56 participants, 30 were in interdependent relationships with their recipients (shared household and/or significant caregiving responsibilities). Tangible benefits identified by participants fell into 3 major categories: health and wellness benefits, time and financial benefits, and interpersonal benefits. Participants described motivations to donate a kidney based on a more nuanced understanding of the benefits of donation than accounted for by the current “acceptable risk” paradigm.

Discussion.
Tangible benefits for interdependent donors may shift the “acceptable risk” paradigm (where no benefit is assumed) of kidney donor evaluation to a risk/benefit paradigm more consistent with other surgical decision-making.
Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know
Authors: Basu Arpita , Patzer Rachel , Hosein Darya , Wang Zhensheng , Sharma Nitika , Franch Harold , Rahbari Oskoui Frederic , Gupta Divya , Subramanian Ram , Sridharan Lakshmi , Allison Wanda , Pastan Stephen , Larsen Christian 
Published: February 2021

Background.
The current surge of coronavirus 2019 (COVID-19) cases in certain parts of the country has burdened the healthcare system, limiting access to tertiary centers for many. As a result, COVID-19-positive Solid Organ Transplant (SOT) recipients are increasingly being managed by local healthcare providers. It is crucial for community providers to understand disease severity and know if COVID-19-impacted SOT recipients have a different clinical course compared with COVID-19-negative SOT recipients with a similar presentation.

Methods.
We conducted a retrospective analysis on SOT recipients suspected to have COVID-19 infection tested during March 14, 2020–April 30, 2020. Patients were followed from time of testing to May 31, 2020.

Results.
One hundred sixty SOT recipients underwent testing: 22 COVID-19 positive and 138 COVID-19 negative. COVID-19-positive patients were more likely to have rapid progression of symptoms (median 3 vs 6 d, P = 0.002), greater hospitalizations (78% vs 64%, P < 0.017), and need for intensive care unit care (45% vs 17%, P < 0.001) Severe COVID-19 infection was not observed in patients on Belatacept for immunosuppression (30% vs 87%,P = 0.001). COVID- 19 positive patients in the intensive care unit were more likely to have multifocal opacities on radiological imaging in comparison to those admitted to the medical floor (90% vs 11%). Survival probability was similar in both cohorts.

Conclusion.
COVID-19-infected SOT recipients have a propensity for rapid clinical decompensation. Local providers need to be work closely with transplant centers to appropriately triage and manage COVID-19 SOT recipients in the community.