bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement Method to Determine the Difference in Tear Trough and Palpebromalar Groove Distribution After Transconjunctival Fat Reposition
Authors: Ye Cui , Jiecong Wang , Xiaoling Feng 
Published: February 2021

Purpose:
This study designed an efficient measurement method to evaluate the outcome of transconjunctival fat reposition in the tear trough and palpebromalar groove.

Methods and Techniques:
A total of 41 patients (82 eyes) who underwent transconjunctival fat reposition surgery between January 2016 and March 2019 were retrospectively analyzed. Preoperative and postoperative (at least six months) standardized digital images were taken from the patients. A satisfaction survey was conducted on all patients. Their images were analyzed by using the Adobe Photoshop CS5 software. Ratios of the tear trough and palpebromalar groove were calculated. These data were analyzed by SPSS 20.0.

Results:
The overall satisfaction rate was 90.2%. With a partition in the infraorbital region, a line graph showed that the location of the tear trough and palpebromalar groove moved to the upper squares postoperatively. The number of patients whose end points of the tear trough and palpebromalar groove located outside the midline of the pupil decreased by 30.5%. When we processed all the parameters of the preoperative and postoperative groups by profile analysis, a significant difference in the tear trough and palpebromalar groove before and after surgery was observed (right: F = 79.844, P = 0.000 < 0.01; left: F = 161.799, P = 0.000 < 0.01).

Conclusions:
Digital image analysis is feasible and useful in investigating the improvement of the tear trough and palpebromalar groove. The tear trough and palpebromalar groove shifted up and became shortened, which provided a more reliable evidence for lower eyelid rejuvenation.
Craniofacial Fractures in Equine-Related Injuries: What Should a Maxillofacial Surgeon Expect?
Authors: Puolakkainen Tero , Marttila Emilia , Thorén Hanna , Snäll Johanna 
Published: February 2021

Abstract
Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries.
This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated.
Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients.
As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.
A Finite Element Analysis Model is Suitable for Biomechanical Analysis of Orbital Development
Authors: Song Dongyu , Zhang Jiwu , Yuan Bowei , Rong Qiguo , Li Dongmei 
Published: February 2021

Abstract
The authors investigated orbital bone development in congenital microphthalmia (CM) using a three-dimensional finite element analysis model, after the orbital dimension deficiency was improved with a self-inflating hydrogel expander implant.
Data of a 2-year-old male CM patient were examined. The orbital structure, eyeball, eye muscles, and self-inflating hydrogel expander were constructed according to computed tomography examination data. The effects of self-expanding spherical hydrogel at various locations in the muscle cone on orbital bone development were examined using 3-mL self-expanding expanders placed at shallow (model 1: 2 mm depth) and deep (model 2: 8 mm depth) muscle cone positions. This model simulated the hydrogel expansion process; the orbital bone biomechanics and radial displacement nephograms were obtained when the hydrogel volume increased 3, 5, 7, and 9 times and analyzed.
The orbital bone biomechanics were concentrated at the medial orbital wall center, gradually spreading to the whole orbital wall. Biomechanics and radial displacement of the inferior temporal and lateral distal orbital wall region were the most significant, and were more significant in model 1 than in model 2.
Finite element analysis is suitable for the biomechanical analysis of orbital development in CM. The shallow position inside CM patients’ muscle cone is the optimal site for hydrogel implantation.
Real Appearance of Dendritic Cell on Failed Implant Fixture
Authors: Nguyen Truc Thi Hoang , Eo Mi Young , Kim Soung Min 
Published: February 2021

Abstract
Dendritic cells (DCs) are considered a multifunctional cell population that links the innate and adaptive immune systems. Dendritic cells have a capacity for antigen capture and presentation to T cells, which initiates a cascade of inflammatory reactions. On contrary to its importance in immunology, DCs have not been known well in peri-implantitis.
A scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy examination was used to examine a fixture that failed due to peri-implantitis, and a transmission electron microscopy was used to examine the peri-implant inflamed soft tissue. The presence of a DC was suggested in both scanning electron microscopy and transmission electron microscopy images. Titanium elements were also detected in the fixture-attached bone with energy-dispersive X-ray spectroscopy analysis. These findings suggested a link between Ti particles and DCs activation. The correlation between the presence of Ti particles and DCs will help to elucidate the detailed mechanism of peri-implantitis.
Neuroma of The Supraorbital Nerve Following Forehead Flap Reconstruction – Presentation and Surgical Management
Authors: Bhoopalam Myan , Manson Paul N. , Grant Michael , Reddy Sashank K. 
Published: February 2021

Abstract
Localized pain or headache from neuroma formation is a rare and challenging complication of forehead flap surgery. Here the authors present a patient who developed local pain and dysesthesia following iatrogenic injury to the left supraorbital nerve during forehead flap elevation. Following a diagnostic nerve block in clinic, surgical excision of the neuroma was performed through an upper blepharoplasty approach. The patient had immediate postoperative pain relief and remains pain free at fifteen-month follow-up. The authors describe etiology, workup, and surgical management of sensory nerve injury during forehead flap reconstruction.
Adipocytokine Profile Reveals Resistin Forming a Prognostic-Related Cytokine Network in the Acute Phase of Sepsis
Authors: Ebihara Takeshi , Matsumoto Hisatake , Matsubara Tsunehiro , Matsuura Hiroshi , Hirose Tomoya , Shimizu Kentaro , Ogura Hiroshi , Kang Sujin , Tanaka Toshio , Shimazu Takeshi 
Published: February 2021

ABSTRACT

Introduction:
Cytokines compose a network and play crucial roles in the pathogenesis and prognosis of sepsis. Adipose tissue is an important immune endocrine organ that releases adipocytokines. This study aimed to evaluate adipocytokines in sepsis from a network perspective.

Materials and Methods:
This retrospective study of 37 patients with sepsis and 12 healthy controls was conducted from February 2014 to July 2015. Blood samples were collected from patients on days 1 (within 24 h of diagnosis), 2, 4, 6, 8, 11, and 15 and from healthy controls. Adipocytokines (adiponectin, leptin, resistin, chemerin, visfatin, vaspin, CXCL-12/SDF-1, angiotensinogen), inflammatory cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12/IL-23p40, TNF-α, monocyte chemotactic protein [MCP-1]), and plasminogen activator inhibitor-1 were measured. Acute Physiology and Chronic Health Evaluation II score was evaluated on day 1, and Sequential Organ Failure Assessment (SOFA) score and Japanese Association for Acute Medicine (JAAM) and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation (DIC) scores were assessed at the times of blood sampling.

Results:
Hierarchical clustering analysis showed the cluster formed by resistin, IL-6, IL-8, MCP-1, and IL-10 on days 1, 2, and 4 represented the cytokine network throughout the acute phase of sepsis. Each cytokine in this network was significantly associated with SOFA and JAAM DIC scores over the acute phase. A Cox proportional hazards model focusing on the acute phase showed a significant relation of these five cytokines with patient prognosis.

Conclusions:
Adipocytokines and an inflammatory cytokine profile assessed over time in sepsis patients showed that resistin was involved in an inflammatory cytokine network including IL-6, IL-8, IL-10, and MCP-1 in the acute phase of sepsis, and this network was associated with severity and prognosis of sepsis.
Does Chloride Intake at the Early Phase of Septic Shock Resuscitation Impact on Renal Outcome?
Authors: Chapalain Xavier , Huet Olivier , Balzer Thibault , Delbove Agathe , Martino Frédéric , Jacquier Sophie , Egreteau Pierre-Yves , Darreau Cédric , Saint-Martin Marjorie , Lerolle Nicolas , Aubron Cécile 
Published: February 2021

ABSTRACT

Introduction:
Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings.

Methods:
This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A “high-dose” of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 h of septic shock resuscitation on acute kidney injury (AKI).

Results:
Two hundred thirty-nine patients with septic shock were included. Patients who received a “high-dose” of chloride had significantly higher Sequential Organ Failure Assessment score at the time of enrolment (P < 0.001). Cumulative chloride load was higher in patients requiring renal replacement therapy (RRT) (31.1 vs. 25.2 g/48 h; P < 0.005). Propensity score-weighted regression did not find any association between “high-dose” of chloride and AKI requiring RRT (OR: 0.97 [0.88–1.1]; P = 0.69). There was no association between “high-dose” of chloride and worsening kidney function at H48 (OR: 0.94 [0.83–1.1]; P = 0.42). There was also no association between “high-dose” of chloride and ICU length of stay (P = 0.61), 28-day mortality (P = 0.83), or hospital mortality (P = 0.89).

Conclusion:
At the early stage of resuscitation of critically ill patients with septic shock, administration of “high-dose” of chloride (> 18 g/48 h) was not associated with renal prognosis.
Hemorrhagic Shock and Resuscitation Causes Glycocalyx Shedding and Endothelial Oxidative Stress Preferentially in the Lung and Intestinal Vasculature
Authors: Abdullah Sarah , Karim Mardeen , Legendre Mark , Rodriguez Laura , Friedman Jessica , Cotton-Betteridge Aaron , Drury Robert , Packer Jacob , Guidry Chrissy , Duchesne Juan , Taghavi Sharven , Jackson-Weaver Olan 
Published: February 2021

ABSTRACT

Introduction:
Hemorrhagic shock has recently been shown to cause shedding of a carbohydrate surface layer of endothelial cells known as the glycocalyx. This shedding of the glycocalyx is thought to be a mediator of the coagulopathy seen in trauma patients. Clinical studies have demonstrated increases in shed glycocalyx in the blood after trauma, and animal studies have measured glycocalyx disruption in blood vessels in the lung, skeletal muscle, and mesentery. However, no study has measured glycocalyx disruption across a wide range of vascular beds to quantify the primary locations of this shedding.

Methods:
In the present study, we used a rat model of hemorrhagic shock and resuscitation to more comprehensively assess glycocalyx disruption across a range of organs. Glycocalyx disruption was assessed by fluorescent-labeled wheat germ agglutinin or syndecan-1 antibody staining in flash frozen tissue.

Results:
We found that our model did elicit glycocalyx shedding, as assessed by an increase in plasma syndecan-1 levels. In tissue sections, we found that the greatest glycocalyx disruption occurred in vessels in the lung and intestine. Shedding to a lesser extent was observed in vessels of the brain, heart, and skeletal muscle. Liver vessel glycocalyx was unaffected, and kidney vessels, including the glomerular capillaries, displayed an increase in glycocalyx. We also measured reactive oxygen species (ROS) in the endothelial cells from these organs, and found that the greatest increase in ROS occurred in the two beds with the greatest glycocalyx shedding, the lungs, and intestine. We also detected fibrin deposition in lung vessels following hemorrhage-resuscitation.

Conclusions:
We conclude that the endothelium in the lungs and intestine are particularly susceptible to the oxidative stress of hemorrhage-resuscitation, as well as the resulting glycocalyx disruption. Thus, these two vessel beds may be important drivers of coagulopathy in trauma patients.
Using Motion Tracking to Analyze Forceps Paths During Simulated Forceps-Assisted Vaginal Deliveries
Authors: Bramblet Rachel , Altman Alan , Holbert Michael 
Published: February 2021

Objective
The purpose of this study was to evaluate the ability of motion tracking to discern variation in forceps paths during standardized simulated forceps-assisted vaginal deliveries among experienced and inexperienced obstetric providers.

Methods
This is a pilot study involving 24 obstetrics and gynecology residents and 6 faculty at a single institution. Each participant was filmed performing standardized simulated forceps-assisted vaginal deliveries on a high-fidelity model. Motion tracking software (Kinovea, Medoc, France) was used to track the path of the forceps shank. Data were analyzed for total path length, total x-plane displacement, total y-plane displacement, and final forceps angle. One-way analysis of variance was used to evaluate for statistically significant differences between groups based on education year, with Turkey HSD post hoc test to identify interactions.

Results
Statistically significant differences were noted between groups in the total path length (F = 7.57, P < 0.001) and total y-plane displacement (F = 5.79, P < 0.001). On pairwise comparison, significant differences were noted between faculty and postgraduate year 1 as well as faculty and postgraduate year 2 for total y-plane displacement and total path length. Significant differences were not observed between groups for total x-plane displacement (F = 0.89, P = 0.475) and final forceps angle (F = 2.45, P = 0.052).

Conclusions
Motion tracking of standardized simulated forceps-assisted vaginal deliveries identifies statistically significant differences between experienced and inexperienced obstetric providers. Our findings suggest that motion tracking can be used to design an educational intervention to improve forceps technique among obstetrics and gynecology residents.
Simulation Use in Outreach Setting
Authors: Nader Marie , Tasdelen-Teker Gulsen , DeStephens Anthony J. , Lampotang Samsun , Prelipcean Irina , Smith Robert D. , Bortcosh William H. , Chiriboga Salazar Nicolas R. , Martinez Schlurmann Natalia I. , Hamdan Usama S. , Munoz Pareja Jennifer M. 
Published: February 2021

Summary Statement
Simulation is a well-studied teaching tool for multidisciplinary teamwork, crisis resource management, and communication skills. These attributes are essential for successful international medical missions, which include healthcare providers with different familiarities with the outreach environment and each team member's role. However, immersive simulation remains underused in similar settings. Our team designed a simulation-based curriculum that focuses on multidisciplinary teamwork and crisis resource management skills. In this commentary, we describe its implementation during high-risk cleft care outreach missions conducted by the Global Smile Foundation. We discuss the importance of a simple, feasible, and flexible platform to successfully overcome the limitations of time and resources inherent to outreach mission work while addressing the clinical and geographic needs specific to each site. We highlight challenges, including unpredictability of the outreach environment, a language barrier, and the short duration of missions. Finally, we offer a roadmap for groups involved in similar global health efforts.
Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics
Authors: Claassen Linda , Hannink Gerjon , Luyer Misha D. P. , Ainsworth Alan P. , van Berge Henegouwen Mark I. , Cheong Edward , Daams Freek , van Det Marc J. , van Duijvendijk Peter , Gisbertz Suzanne S. , Gutschow Christian A. , Heisterkamp Joos , Kauppi Juha T. , Klarenbeek Bastiaan R. , Kouwenhoven Ewout A. , Langenhoff Barbara S. , Larsen Michael H. , Martijnse Ingrid S. , Nieuwenhoven Ernst Jan van , van der Peet Donald L. , Pierie Jean-Pierre E. N. , Pierik Robert E. G. J. M. , Polat Fatih , Räsänen Jari V. , Rouvelas Ioannis , Sosef Meindert N. , Wassenaar Eelco B. , Wildenberg Frits J. H. van den , van der Zaag Edwin S. , Nilsson Magnus , Nieuwenhuijzen Grard A. P. , van Workum Frans , Rosman Camiel 
Published: February 2021

Objective:
To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.

Background:
Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.

Methods:
A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.

Results:
This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision.

Conclusions:
More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
Symptom Assessment Following Surgery for Lung Cancer
Authors: Hirpara Dhruvin H. , Coburn Natalie G. , Darling Gail E. , Kidane Biniam , Rousseau Mathieu , Gupta Vaibhav , Doherty Mark , Zuk Victoria , Delibasic Victoria , Chan Wing , Hallet Julie 
Published: February 2021

Objective:
To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small cell lung cancer (NSCLC).

Background:
A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.

Methods:
Retrospective cohort study of patients receiving surgery for stages I to III NSCLC between January 2007 and September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory, and predictors of moderate-to-severe symptoms in the year following surgery.

Results:
A total of 5350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%), and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, interquartile range: 47–72) and last cycle of chemotherapy (140 days, interquartile range: 118–168), respectively. There was eventual stabilization, albeit above the preoperative baseline, within 6 to 7 months after surgery. Female sex (relative risk [RR] 1.09– 1.26), lower income (RR 1.08–1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09–1.42), chemotherapy within 2 weeks of an ESAS assessment (RR 1.14–1.73), and pneumonectomy (RR 1.05–1.15) were associated with moderate-to-severe symptoms following surgery.

Conclusions:
Knowledge of population-level prevalence, trajectory, and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.
Impact of Obesity on Surgical Outcomes of Laparoscopic Appendectomy: Lessons Learned From 2000 Cases in an Urban Teaching Hospital
Authors: Angeramo Cristian A. , Laxague Francisco , Castagnino Bruno , Sadava Emmanuel E. , Schlottmann Francisco 
Published: February 2021

Background:
As the prevalence of obesity continues to increase worldwide, we aimed to determine the surgical outcomes of obese patients with acute appendicitis undergoing laparoscopic appendectomy (LA).

Materials and Methods:
A retrospective analysis of patients undergoing LA during the period 2006 to 2019 was performed. The cohort was divided into 2 groups: G1, patients with body mass index ≥30 kg/m2 and G2: patients with body mass index <30 kg/m2.

Results:
A total of 2009 LA were performed; 114 (6%) were included in G1 and 1895 (94%) in G2. Complicated acute appendicitis rate (G1: 39% vs. G2: 20%, P<0.0001), conversion rates (G1: 12% vs. 1.69%, P<0.0001), overall 30-day morbidity rates (G1: 27% vs. G2: 14%, P=0.0001), and postoperative intra-abdominal abscess rates (G1: 8% vs. (2%), P<0.0001) were higher in obese patients. Furthermore, obesity was an independent risk factor for overall morbidity, postoperative intra-abdominal abscess, and conversion to open surgery.

Conclusion:
In obese patients, LA had inferior clinical outcomes compared with nonobese patients.