bluuebunny/crossref_metadata_2025_split huggingface dataset:
An 8-Year-Old Boy With Treatment-Resistant Encopresis
Authors: Stein Martin T. , Benninga Marc A. , Felt Barbara T. 
Published: January 2021

CASE:
Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 21/2 years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as “inconsistent” due to multiple caretakers.
Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, “I didn't do it; someone else must have put it there.” One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was “agitated and talkative” in the early morning, he would often soil that day.
He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with “overflow incontinence secondary to stool withholding.” When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a cleanout with a polyethylene glycol/electrolyte solution.
Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.
Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.
Growth–and Documentation–Deficits: Where To Start in Helping Families
Authors: Hernandez Wilhelmina , Frank Deborah A. , Morton Samantha , Palacios Carmen , Augustyn Marilyn 
Published: January 2021

CASE:
Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although she had been brought to the United States as a child, she had never finished high school. Pedro was born what mother thought was full-term at his parent's home, where a lay midwife assisted during the delivery. Pedro was not brought to a medical facility at birth; therefore, neither medical nor legal documentation of his birth in the United States, or elsewhere, existed.
After enduring 4 years of ongoing verbal and physical abuse, Clara fled to her maternal aunt in our community. The child's initial exposure to medical care was during the emergency visit, which ended up in referral to us. The ED physician suggested that the child visit a primary care physician, but establishment of pediatric care was not made until months later. The child received his first vaccines and immediately was referred to the Growth and Nutrition clinic due to mild wasting and stunting based on Waterlow criteria.
1
Pedro speaks both English and Spanish and has no 2-word combinations and a 50-word combined vocabulary in English and Spanish. In addition, a complete blood count was consistent with iron deficiency anemia, but both sickle cell and G6PD screening are negative.
The nutritionist from the specialty clinic obtained a detailed history including overall appetite, feeding skills, meal plans, and eating environment noting that the child was a competent finger feeder. The family's meals were distributed throughout the day as a meal at home and a shared fast food meal while accompanying mother, as she worked as a hair stylist 6 days per week. In addition, the diet is supplemented by ricewater mixed with sugar and ground carrots throughout the day.
Where would you head next?
REFERENCE
1. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-569.
“Media Addiction” in a 10-Year-Old Boy
Authors: Brown Scott , Scharf Michael A. , Bustos Cristina , Chavira Denise , Stein Martin T. 
Published: January 2021

CASE:
Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been hyperactive and oppositional since a very young age. He has been previously diagnosed with attention-deficit hyperactivity disorder and has been treated with appropriate stimulant medications for several years; however, despite this, his parents feel increasingly unable to manage his difficult behaviors. He refuses to do chores or follow through with household routines. He refuses to go to bed at night. His family feels unable to take him to public places because he “climbs all over everything.” At school, he acts up in class, is often disruptive, and requires close supervision by teachers. He was recently kicked off of the school bus. He has very few friends, and his parents state that other children do not enjoy to be around him.
Bryan's parents also report that he is “obsessed” with electronics. He spends most his free time watching TV and movies and playing computer games. He has a television in his bedroom because otherwise he “monopolizes” the family television. The family also owns several portable electronic devices that he frequently uses. Bryan insists on watching TV during meals and even that the TV stays on in an adjacent room while showering. He gets up early each morning and turns on the television. He refuses to leave the house unless he can take a portable screen device with him. His parents admit to difficulty placing limits on this behavior because they feel it is the only way to keep his other behaviors under control. His mother explains “it is our only pacifier” and that attempts to place restrictions are met with explosive tantrums and have thus been short lived. These efforts have also been impeded due to the habits of his parents and older sibling, who also enjoy spending a significant amount of time watching television.
Maternal proximity to Central Appalachia surface mining and birth outcomes
Authors: Buttling Lauren G. , McKnight Molly X. , Kolivras Korine N. , Ranganathan Shyam , Gohlke Julia M. 
Published: January 2021

Background:
Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure.

Methods:
We developed characterizations of annual surface mining boundaries in Central Appalachia between 1986 and 2015 using Landsat data. Maternal address on birth records was geocoded and assigned amount of surface mining within a 5 km radius of residence (street-level). Births were also assigned the amount of surface mining within residential ZIP code tabulation area (ZCTA). Associations between exposure to active mining during gestation year and birth weight, LBW, preterm birth (PTB), and term low birth weight (tLBW) were determined, adjusting for outcome rates before active mining and available covariates.

Results:
The percent of land actively mined within a 5 km buffer of residence (or ZCTA) was negatively associated with birth weight (5 km: β = –14.07 g; 95% confidence interval [CI] = –19.35, –8.79, P = 1.79 × 10–7; ZCTA: β = –9.93 g; 95% CI = –12.54, –7.33, P = 7.94 × 10–14). We also found positive associations between PTB and active mining within 5 km (odds ratio [OR] = 1.06; 95% CI = 1.03, 1.09, P = 1.43 × 10–4) and within ZCTA (OR = 1.04; 95% CI = 1.03, 1.06, P = 9.21 × 10–8). Positive relationships were also found between amount of active mining within 5 km or ZIP code of residence and LBW and tLBW outcomes.

Conclusions:
Maternal residency near active surface mining during gestation may increase risk of PTB and LBW.
Centralizing environmental datasets to support (inter)national chronic disease research
Authors: Brook Jeffrey R. , Doiron Dany , Setton Eleanor , Lakerveld Jeroen 
Published: January 2021

Background:
Whereas environmental data are increasingly available, it is often not clear how or if datasets are available for health research. Exposure metrics are typically developed for specific research initiatives using disparate exposure assessment methods and no mechanisms are put in place for centralizing, archiving, or distributing environmental datasets. In parallel, potentially vast amounts of environmental data are emerging due to new technologies such as high resolution imagery and machine learning.

Objectives:
The Canadian Urban Environmental Health Research Consortium (CANUE) and the Geoscience and Health Cohort Consortium (GECCO) provide a proof of concept that centralizing and disseminating environmental data for health research is valuable and can accelerate discovery. In this essay, we argue that more efficient use of exposure data for environmental epidemiological research over the next decade requires progress in four key areas: metadata and data access portals, linkage with health databases, harmonization of exposure measures and models over large areas, and leveraging “big data” streams for exposure characterization and evaluation of temporal changes.

Discussion:
Optimizing the use of existing environmental data and exploiting emerging data streams can provide unprecedented research opportunities in environmental epidemiology through a better characterization of individuals’ exposures and the ability to study the intersecting impacts of multiple environmental features or urban attributes across different populations around the world. Proper documentation, linkage, and dissemination of new and emerging exposure data leads to a better awareness of data availability, a reduction of duplication of effort and increases research output.
Intra-abdominal Deep Inferior Epigastric Vessel Course Does Not Preclude Successful DIEP Flap Breast Reconstruction
Authors: Helm Douglas L. , Steigner Michael L. , Serebrakian Arman T. , Erdmann-Sager Jessica 
Published: January 2021

Summary:
We present 2 patients in whom the course of the deep inferior epigastric vessels was intra-abdominal during deep inferior epigastric perforator (DIEP) flap breast reconstruction. Preoperative computed tomography angiography gave no indication of an unusual pedicle location. In both cases, pedicle dissection was completed safely without bowel injury, and reconstruction was completed successfully. Reconstructive surgeons need not abandon DIEP flap reconstruction upon discovering that the deep inferior epigastric vessels are intra-abdominal. Unfortunately, computed tomography angiography imaging does not identify this variant preoperatively. The risk of postoperative ileus after intra-abdominal pedicle dissection may be higher than the risk after dissection of retrorectus deep inferior epigastric pedicles, and thus it is reasonable to consider the use of prophylactic mesh in these cases.
A Competency Assessment Tool for Unilateral Cleft Lip Repair
Authors: Rogers-Vizena Carolyn R. , Sideridis Georgios D. , Patel Krishna G. , Garland Catharine B. , Mount Delora L. , Yao Caroline A. 
Published: January 2021

Background:
Objective evaluation of operative performance is increasingly important in surgical training. Evaluation tools include global rating scales of performance and procedure-specific skills checklists. For unilateral cleft lip repair, the numerous techniques make universal evaluation challenging. Thus, we sought to create a unilateral cleft lip evaluation tool agnostic to specific repair technique.

Methods:
Four surgeons with expertise in 3 common cleft lip repair techniques participated in a 3-round Delphi process to generate consensus evaluation points spanning all techniques. Items were categorized as marking the repair, performing the repair, and final result. Two blinded raters then scored videos of simulated cleft lip repairs using both the 21-item novel checklist and the modified Objective Structured Assessment of Technical Skills. Kappa and T values were calculated for both scales to determine level of agreement.

Results:
Ten videos of repairs performed by novice residents through experienced craniofacial fellows were scored. Moderate (κ = 0.41–0.60) to substantial (κ = 0.61–0.80) interrater reliability was seen for the majority of questions in both the novel tool and the Objective Structured Assessment of Technical Skills. A single question in the novel tool had almost perfect agreement (κ = 0.81–1.00), 8 had moderate agreement, and 6 had substantial agreement. Poorly scoring questions were discarded from the final 18-item tool.

Conclusions:
Despite variations in unilateral cleft lip repair technique, common themes exist that can be used to assess performance and outcome. A universal evaluation tool has potential implications for trainee assessment, surgeon credentialing, and screening for surgical missions.
Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates
Authors: Schwartz Jean-Claude 
Published: January 2021

Background:
Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS.

Methods:
Patients who underwent mastectomy and immediate prepectoral tissue expander reconstruction were included in this retrospective study. Surgery was performed in an ASC with same-day discharge or the HS with overnight observation or same-day discharge. Patient demographics, operative details, outcomes, complications, and patient satisfaction were compared.

Results:
One hundred six women (183 breasts) underwent surgery in the HS, and 103 women (177 breasts) had their surgery in an ASC between August 2014 and September 2019. Demographics, comorbidities, and operative details were similar. Although there was no difference in the rates of most major complications, infectious complications requiring operative intervention were less frequent in the ASC [2.3% (n = 4) versus 11.5% (n = 21); P = 0.001]. Patient satisfaction, evaluated with a 5-point Likert scale, was higher in the ASC.

Conclusions:
Mastectomy and prepectoral reconstruction in an ASC is a safe alternative to the standard approach of performing this procedure in the HS. Although the rates of most surgical complications are similar between the HS and ASC, we have found a significantly reduced rate of major infectious complications requiring surgical intervention in the ASC which reduces overall cost and patient morbidity. Finally, patient satisfaction was higher in the ASC compared with the HS.
Should We Consider Preparing Patients for Future Face Transplant when Managing Complex Facial Trauma?
Authors: Zeiderman Matthew R. , Firriolo Joseph M. , Dave Dattesh R. , Pu Lee L.Q. 
Published: January 2021

Summary:
With advancements in microsurgical technique and experience, face transplantation is becoming a clinical reality and acceptable procedure. Preparation of the maxillofacial skeleton and initial soft-tissue coverage for face transplant candidates is essential for optimizing the ultimate outcome by providing immediate coverage of vital structures, functionality, and a stable skeletal framework. We present our experience of preparing such a patient who underwent a successful face transplant, with an excellent outcome. A 24-year-old man sustained a self-inflicted ballistic injury to his face. Composite tissue deficits included significant soft-tissue loss in the central lower and midface, comminuted fractures of midface, and large bone gaps of the maxilla and mandible. He underwent open reduction internal fixation of bilateral LeFort III, zygomaticomaxillary complex, and complex maxillary and mandibular fractures with titanium plates and a free anterolateral thigh perforator flap to the midface with concomitant pedicled left supraclavicular artery fasciocutaneous flap to the lower face. He subsequently underwent a second free anterolateral thigh perforator for the exposed mandibular hardware due to partial necrosis of the supraclavicular artery fasciocutaneous flap. The patient achieved stable bone reconstruction and soft-tissue coverage and was discharged home. He was placed on the waiting list for a face transplant by another center in the country and eventually underwent a successful face transplant. We believe that the preparation of the patient with complex craniomaxillofacial trauma for face transplant should be considered when the extent of injury exceeds conventional reconstructive limits. Our approach provides the best opportunity for an optimal face transplant outcome while minimizing flap donor site morbidity.
Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy
Authors: Kracoff-Sella Sharon L. , Allweis Tanir M. , Bokov Inna , Kadar-Sfarad Hadas , Shifer Yehonatan , Golzman Evgenia , Egozi Dana 
Published: January 2021

Introduction:
Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM.

Method:
All NSM procedures performed at our institution between 2014 and 2018 were reviewed. The tumor-to-nipple distance was measured for each patient using mammography, ultrasound, or magnetic resonance imaging. All patients underwent a frozen section (FS) biopsy of the base of the nipple during surgery, and if cancer was detected, the procedure was converted to a skin-sparing mastectomy. Patients were followed for postoperative complications and cancer recurrence.

Results:
Sixty-eight patients (98 breasts) underwent NSM with immediate reconstruction. Fifty-three patients (78%) underwent the procedure for breast cancer. Nipple involvement was detected on FS in 1 patient and on permanent pathology after a negative FS in 1 patient. Forty-three percent of our patients had a tumor-to-nipple distance of ≤2 cm. During a mean follow-up of 32.5 months (±19.4 months), no locoregional recurrences were observed; however, distant metastasis occurred in 3 patients.

Conclusions:
When histologic examination from the base of the nipple is negative (either by FS or permanent pathology), NSM can be considered oncologically safe. Lack of nipple involvement by preoperative clinical and imaging assessment and intraoperative FS is sufficient to classify patients as suitable for NSM.
Lymphatic Malformation Treated with Lymphatic Malformation–Venous Anastomosis Under Local Anesthesia
Authors: Furuse Kiichi , Kato Motoi , Morishita Yuya , Kumagai Tomoyo , Nakatsukasa Shuichi , Kuwata Tomoyuki 
Published: January 2021

Summary:
Lymphatic malformation (LM) can occur in the head and neck regions and cause cosmetic problems in adults. Sclerotherapy and surgical resection have been frequently applied; however, both are far from being minimally invasive in terms of aesthetic satisfaction, including the aesthetic downtime. We performed a less-invasive treatment using the venous anastomosis technique, named the lymphatic malformation–venous anastomosis (LMVA), mainly in pediatric patients with intractable microcystic lesions, in whom general anesthesia was required because the pediatric patients could not remain still. Here, we report the case of a 35-year-old man with a cystic submandibular LM successfully treated with LMVA under local anesthesia. He presented with a gradually enlarging LM on the neck. For improving aesthetics, LMVA was planned under local anesthesia. Lymphography by injecting indocyanine green revealed no inflow or outflow connection to the malformation; thus, we created an outflow bypass using the sidewall of the LMVA technique. The patient was discharged on the following day of the operation without any postoperative complications. A volumetric analysis 6 months later showed a 43.5% reduction of the malformation, with the patient being completely satisfied with the result. To the best of our knowledge, there has been no previous report on performing LMVA under local anesthesia in an adult. LMVA can be a novel treatment of choice when other options are less feasible.
Targeted Muscle Reinnervation for Symptomatic Neuromas Utilizing the Terminal Anterior Interosseous Nerve
Authors: Grome Luke J. , Agrawal Nikhil A. , Wang Eric , Netscher David T. 
Published: January 2021

Summary:
Sensory nerve trauma at the level of the wrist can lead to debilitating neuromas. Targeted muscle reinnervation (TMR) is an effective therapy for the treatment of neuromas. Here we propose the use of the terminal anterior interosseous nerve (AIN) as a viable recipient for TMR. All superficial sensory nerves around the wrist, including the dorsal ulnar sensory nerve, the distal lateral antebrachial cutaneous nerve, the distal branches of the superficial branch of the radial nerve, and the palmar cutaneous branch of the median nerve were dissected in 2 cadaver specimens. The AIN branch to pronator quadratus was divided just distal to the final branch of flexor pollicis longus to preserve adequate length for TMR. The sensory nerves at the wrist were fully dissected to identify a viable location for coaptation to the AIN. After the cadaveric concept was demonstrated, the technique was successfully used in a clinical case. In summary, the distal AIN is a versatile recipient for TMR as a treatment of painful sensory neuromas at the level of the wrist, with minimal donor-site morbidity.
Deep Inferior Epigastric Artery Perforator Flap Reconstruction for Breast Burn Deformities
Authors: Tugertimur Buğra , Dec Wojciech 
Published: January 2021

Summary:
The anterior chest wall is commonly involved in pediatric burn injuries. In women, deep thermal injuries may result in damage to the breast bud and breast skin, which can disrupt breast development and result in long-term deformities. In adulthood, the techniques frequently applied to correct these deformities focus on scar release in combination with skin grafting and implant-based procedures; however, these techniques often result in suboptimal aesthetic outcomes. In this report, we present superior outcomes from applying an autologous breast reconstruction technique to this challenging problem.