bluuebunny/crossref_metadata_2025_split huggingface dataset:
Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose
Authors: Raghavan Ullas , Daoud Mahmoud , Heywood Emily G , Ullas Gautham 
Published: May 2021

Abstract

Background
Many locations for the nasal valve have been suggested, and more recently the concept of the flow-limiting segment was introduced. Rather than being controlled by an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum, and inferior turbinate.

Objectives
The aim of this study was to assess the balanced cantilever graft (BCLG) as a technique to support the lateral nasal wall.

Methods
Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow-up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with a visual analog scale (VAS) and aesthetic outcomes by FACE-Q score. Objective assessment of the airway was performed with a nasal peak inspiratory flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported.

Results
Sixty patients received BCLGs. The VAS score for nasal obstruction increased from 2.6 preoperatively to 8.1 postoperatively. FACE-Q increased from 16.7 preoperatively to 36.6 postoperatively. NPIF was 74.9 L/minute preoperatively, improving to 95 L/minute postoperatively. Statistically significant improvements were seen in these functional and aesthetic scores.

Conclusions
BCLGs support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and the graft can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support.

Level of Evidence: 4
A Novel Fat Making Strategy With Adipose-Derived Progenitor Cell-Enriched Fat Improves Fat Graft Survival
Authors: Fan Pengju , Fang Man , Li Jingjing , Solari Mario G , Wu Dingyu , Tan Wuyuan , Wang Yongjie , Yang Xinghua , Lei Shaorong 
Published: May 2021

Abstract

Background
A low survival rate is one of the main challenges in fat grafting.

Objectives
This study aimed to evaluate whether microfat obtained by a novel strategy promoted the survival and retention of fat grafts.

Methods
A 5-mm-diameter blunt tip cannula with large side holes (~30 mm2/hole) was used to obtain macrofat. A novel strategy based on a newly invented extracorporeal cutting device was then used to cut the macrofat into microfat, which was named adipose-derived progenitor cell enrichment fat (AER fat); Coleman fat was used as the control. Aliquots (0.5 mL) of both types of fat were transplanted into 10 nude mice and analyzed 10 weeks later. Western blotting, flow cytometry, and immunofluorescence were performed to assess the AER fat characteristics and underlying mechanisms.

Results
The retention rate of fat grafts in AER fat–treated animals was significantly higher than that in the Coleman group (mean [standard deviation] 54.6% [13%] vs 34.8% [9%]; P &lt; 0.05) after 10 weeks. AER fat contained more dipeptidyl peptidase-4–expressing progenitor cells (3.3 [0.61] × 103 vs 2.0 [0.46] × 103 cells/mL; P &lt; 0.05), adipose-derived plastic-adherent cells (6.0 [1.10] × 104 vs 2.6 [0.17] × 104 cells/mL; P &lt; 0.001), and viable adipocytes than Coleman fat. Moreover, histologic analysis showed that AER fat grafts had better histologic structure and higher capillary density.

Conclusions
AER fat transplantation is a potential strategy to improve the survival and long-term retention of fat grafts. AER fat contained more dipeptidyl peptidase-4–expressing progenitor cells.
C1QTNF6 participates in the pathogenesis of PCOS by affecting the inflammatory response of granulosa cells
Authors: Yan Sisi , Ding Jinli , Zhang Yi , Wang Jiayu , Zhang Sainan , Yin Tailang , Yang Jing 
Published: May 2021

Abstract
Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease. It has been reported that chronic low-grade inflammation might participate in its pathogenesis. C1q and TNF related 6 (C1QTNF6) is a newly identified adiponectin paralog associated with inflammation. The aim of the present study was to investigate the role of C1QTNF6 in the development of chronic inflammation in PCOS and the underlying molecular mechanism. After analyzing the expression of C1QTNF6 in the serum and granulosa cells (GCs) of PCOS patients and healthy controls, we verified the roles of C1QTNF6 in inflammation through dehydroepiandrosterone-induced PCOS mouse models and cell models of lipopolysaccharide (LPS)-induced inflammation. The results demonstrated that C1QTNF6 expression in the serum and GCs of patients with PCOS was significantly elevated compared with those of the controls, and similar results were observed in the serum and ovary of PCOS mouse models. In PCOS mice and C1QTNF6-overexpressing PCOS mice, serum levels of pro-inflammatory factors including C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor-α (TNFα) were increased, while the opposite effects were observed when C1QTNF6 was down-regulated in PCOS mice. Furthermore, C1QTNF6 overexpression up-regulated the levels of TNFα, IL6, and CRP and activated the AKT/NF-κB pathway in LPS-treated KGN cells, whereas C1QTNF6 knockdown and BAY-117082 (an NF-κB inhibitor) treatment resulted in the opposite effects. Taken together, our results indicate that C1QTNF6 is involved in the pathogenesis of PCOS by affecting the inflammatory response via the AKT/NF-κB signaling pathway.
Inclusive Sustainability Approaches in Common-Pool Resources from the Perspective of Blackologists
Authors: Yitbarek Senay , Bailey Karen , Tyler Shakara , Strickland Jeramie , McCary Matthew , Harris Nyeema C 
Published: May 2021

Abstract
The tragedy of the commons posits that depletion of common resources harms all stakeholders. Although such a downward spiral is plausible, the potential outcomes are far more complex. In the present article, we report on this coupled feedback between resource strategies and the environment from the perspective of Blackologists. We fully embrace that our understanding and appreciation for nature are inherently shaped by our identity, culture, and lived experiences. First, we deconstruct the uses and beneficiaries of the shared resource. Then, we identify potential cascades of conflict through the lens of resource partitioning, plasticity, and mitigation strategies recognizing the inherent human dimension nested within these dynamics. We emphasize that who studies these processes can alter the framing and outcome of the tragedy through several case studies. We recommend that avoidance of environmental tragedies is possible with inclusive engagement, interdisciplinarity, and oversight at different spatial and temporal scales.
28 Shifting to Virtual MDT in the COVID-19 Era and Beyond
Authors: Vijayan D , Malik K , Natarajan K , Berland J , Morton D , Beggs A , Ashraf S 
Published: May 2021

Abstract

Aim
The COVID19 pandemic has accelerated the need for staff to work remotely. Our aim was to demonstrate how a next-generation digital platform could be used to create a virtual MDT ecosystem in order to manipulate holographic 2D and 3D images in real-time.

Method
This study involved setting up a mock virtual MDT using de-identified DICOM files from a patient who had been treated for colorectal cancer and then subsequently found to have a liver metastasis. The image file was segmented and converted into a 2D and 3D format for visualisation within Microsoft HoloLens 2 ® (smart glasses) using Holocare Solutions ® (Mixed Reality software).

Results
A seamless cross-border pipeline was developed that involved "clinician" training, DICOM segmentation and virtual connection. We successfully performed a virtual MDT with participants able to visualise and manipulate a virtual 3D organ in real-time. The digital network remotely connected sites in England and Norway. The streaming quality was stable and HIPAA compliant. Each participant could observe others as "avatars" interacting with images within the virtual ecosystem allowing image characteristics to be highlighted.

Conclusions
We successfully conducted a virtual MDT using novel hardware and software. Our intention is to conduct a large-scale study to assess the platform's effectiveness in “Real World" MDTs.
30 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma
Authors: Allen N , McBride R , Lindsay R , Wallace W 
Published: May 2021

Abstract

Introduction
Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation.
We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61-year-old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.

Method
Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.

Conclusions
This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control, and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time.
This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.
105 The Mustaq Method: Could This be The Simplest Shoulder Dislocation Reduction Method?
Authors: Eltayeb M , Ilo K , Mushtaq A 
Published: May 2021

Abstract

Introduction
The Mushtaq Method is a new shoulder reduction technique. It is a simple, reliable, and less traumatic time modulated procedure.

Method
Patients are placed in the supine position if plausible. Fully adducting the affected arm with the elbow at right angle. The practitioner applies gentle traction above the elbow with the other hand placed deep into the axilla, palpation of the humeral head is followed by lateral pressure resulting in a successful relocation. Internal rotation and a broad arm sling complete the technique. No assistants are needed, and simple analgesia was often enough.

Results
95% had a successful reduction within 5 minutes. 75% required analgesia alone, and no periprocedural complications were observed.

Conclusions
With so many options already, available it is essential to understand what dictates the success and failures of these methods. We have a new, safe, easy to use method requiring minimal force. We hope to increase our cohort size in the future to draw firm conclusions.
146 Ligamentization and Remnant Integration: Implications for Scapholunate Reconstruction
Authors: Lindsay T , Myers H , Tham S 
Published: May 2021

Abstract

Introduction
Scapholunate interosseous ligament (SLIL) injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date, no reconstructive technique has been described that discusses the potential benefit of the preservation of the scapholunate ligament remnant. Little is known about the ‘ligamentization’ of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices.

Method
We conducted a systematic review of the literature using Pubmed, Embase and Medline. Keywords were ‘Ligament’ AND ‘Reconstruction’ AND ‘Remnant’. We identified 366 original studies for title and abstract review. A total of 5 studies were included in the final analysis.

Results
In 5 animal studies, remnant stump integration resulted in enhanced ligamentization of grafted tissue as measured by vascularity, biomechanics, and proprioception.

Conclusions
Our review demonstrates a trend towards enhanced early ligamentization in grafts that incorporate the remnant stump. Remnant preservation is not currently performed in SLIL reconstruction and may provide an avenue for enhanced therapies. As such, it is a promising area for further, wrist specific, research.
162 An Examination of Scar Modelling and Assessment Methods for the Evaluation of Scar Treatments
Authors: Mistry R 
Published: May 2021

Abstract

Introduction
Scarring is the final common pathway for healing within the skin. Scars can be itchy, painful, tight, and disfiguring. Despite advances in surgery there is currently no reliably effective treatment for reducing or preventing scarring. The primary aim of this research is to assess the currently available models for scarring and evaluate/further develop the utility of current assessment tools, in an effort to design a pilot randomised control trial (RCT) for silicone gel treatment of scars.

Method
A systematic review of scar models in humans and animals. Examination of currently used subjective and objective scar assessment tools in a plastic surgery scar clinic. A retrospective cohort study assessing long-term scar outcomes in paediatric burn patients.

Results
Limitations and drawbacks of many existing methods to assess scar treatments were found. No statistically significant difference in long-term scarring outcomes was found between paediatric burns patients treated surgically versus conservatively. A RCT for silicone gel sheeting in the treatment of scars was set up and successful in recruitment.

Conclusions
Here, we have demonstrated difficulties in establishing a scientific scar treatment model; and created a pilot study that will help to provide high-quality evidence for the efficacy of silicone gel sheeting as a treatment for scars.
225 Clinical application and efficacy of Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d): A Systematic Review and Meta-Analysis
Authors: Mantelakis A 
Published: May 2021

Abstract

Background
This study evaluates the current clinical evidence of Negative Pressure Wound Therapy with Instillation and dwell time (NPWTi-d) to establish its clinical application and efficacy.

Method
MEDLINE, EMBASE, and CENTRAL databases were searched from 1946 to July 2019 for studies reporting clinical outcomes on wounds treated with NPWTi-d. The primary outcome was proportion of wounds with complete healing. The secondary outcomes were mean time for healing, NPWTi-d settings, cost, length of stay and adverse events.

Results
Thirteen articles were included with a total of 624 wounds in 542 patients involving wounds of various aetiology. The pooled proportion of wound that achieved complete healing was 93.65% (95%CI: 84.02-99.04). Normal saline was the most commonly used instillation solution with the mean dwell time of 14.23 minutes (95%CI: 10.88-17.59) and instillation cycle every 4.17 ± 2.32 hourly. The mean therapy duration was 10.69 days (95%CI: 10.46-10.91) with daily cost of $194.80. The mean hospital stay was 18.1 days (95%CI: 17.20-19.00). There were no severe adverse effects reported.

Discussion

NPWTi-d is an adjuntive therapy to aid complete healing of the vast majority of wounds. However, the current data is limited by the lack of level 1 evidence.
293 Enhancing Your Recovery: A Mobile Application for Patients Undergoing Vascular Surgery
Authors: Hodge S , Pattabathula K , Jenkins J , Ogg M 
Published: May 2021

Abstract

Aim:
With increasing demands on the healthcare system, a central (and currently essential) push for remote consultations, and an increasing number of co morbidities in the surgical population, the aim was to create an application that placed the focus on pre-hospital optimisation, education and autonomy – addressing these sector trends to enhance outcomes for patients and ease the burden on healthcare settings.

Method
After obtaining baseline data, I worked alongside students from the Queensland University of Technology to produce an application suitable for both iOS and android platforms.

Results
The application has four facets which mirror a patient’s journey from their initial outpatient appointment through to recovery. The application is easy to use, free to download and readily accessible. On opening the application, the user can select their planned operation and navigate along a personalised decision tree.

Conclusions
The application has been designed to educate and empower a patient to become an active participant in their care, leading to long-term changes in healthcare. Assessment is ongoing but early indications suggest that this will be a valuable tool in optimising outcomes for patients undergoing vascular surgery – leading to fewer post-operative complications and earlier restoration of functional status.
345 A Novel Study Exploring the Hidden Cost of Insufficient Investment in Computer Technology in a District General Hospital
Authors: Rogers A , Ramasubbu R , Ramasubbu B 
Published: May 2021

Abstract

Introduction
The NHS’ move towards increasing digitisation is limited by inadequate resourcing. It is estimated 70% of a junior doctor’s time is spent completing computer-based administrative work. Aging and insufficient equipment leads to inefficiency. The objective of this study is to investigate the hidden cost of insufficient and poorly performing computer technology.

Method
Surveys were disseminated to doctors and data was collected regarding designation, ward, salary and estimated ‘minutes-waiting’ for computers to become free (CF) and to load (CL).

Results
33 surveys were completed. The hospital-wide average CF and CL were 25 minutes and 31.06 minutes respectively, with a corresponding average daily cost per doctor of £10.16 (CF) and £12.63 (CL), totalling £22.79/doctor/day. In the highest-expense ward, CF (31.66 minutes) and CL (38.33 minutes) equated to £30.28/doctor/day. Following acquisition of new hardware and re-audit, CL was significantly reduced to 20.4 minutes (p = 0.0142).

Conclusions
This study highlights the hidden cost of insufficient, poorly performing hardware. Every day the total cost of time-wasted greatly surpasses the cost of a single computer unit, illustrating the false economy of reduced capital investment in computer technology.
498 The Bristol Sign - A Technical Tip to Confirm Skin Flap Vascularity
Authors: Schrire Timothy , Emam Ahmed , Colavitti Giulia , Khan Umraz 
Published: May 2021

Abstract

Introduction
In modern medicine, free flap reconstruction has become the gold standard when faced with soft tissue defects. The impressive cosmesis, and adaptability of free flaps means that we can securely state that we are in the era of Plastic Surgery defined by free flap reconstruction. However, as part of free flap reconstruction, clinical monitoring of the flap is a central tenet post-operatively. Different departments have different protocols for this.

Method
In our unit, it is practice to insert a single interrupted stitch overlying the Doppler site just before dressings. This localises the site of the pedicle for Doppler monitoring, and allows the surgeon to examine the quality of the blood droplets, demonstrating flap perfusion.

Results
The use of the stitch is considered practical, replicable, and safe, and aids in providing gold standard monitoring post-operatively. The additional analysis of the blood droplet is another sign, in itself, of a healthy flap, and excludes venous congestion.

Conclusions
The Bristol stitch is a useful adjunct to free flap reconstruction. It’s localisation of the Doppler signal allows medical and nursing staff to confidently approach post-operative monitoring, and the blood elicited by the stitch insertion is a useful sign of flap vascularity and venous status.
500 Tetraminos Flap
Authors: Schrire T , Din A , Khan U 
Published: May 2021

Abstract
30 year old male, who had been hit at 90mph whilst on a motorbike sustaining femoral, tibial and right foot open fractures. He underwent an open reduction and internal fixation (ORIF) of his right lateral femoral condyle, a right retrograde femoral nail, and ORIF of the tibia. He had 2 separate free flaps (a chimera scapular/parascapular and antero-lateral thigh-ALT) to his right lower leg, and split skin grafting to the remainder of the right lower limb. Upon regular post-operative review it was found that whilst healed the limb was showing a poor return of function and a major contributor was the lack of motion of the right knee joint. Patient had an excision of the split skin graft, with a quadriceps plasty, where the myofascial planes were released, and the contractures incised, with a chimeric scapular and parascapular free flap onto the defect. This resulted in coverage of large soft tissue defect with no need to skin graft donor sites and no functional implication of muscle harvest. Tetraminos in appearance, like the popular computer game, which has never before been described, compared with normal coverage, which would be latissimus dorsi free flap and graft.
504 Can Measuring Heart Rate Variability in The Operating Surgeon Provide Insight into Intra-Operative Stress? A Literature Review and Direction for Research
Authors: Pearson L , Narayanan A , Fisher J P , Khashram M 
Published: May 2021

Abstract

Introduction
Stress affects the internal environment of the operating surgeon. Examining ways to mitigate this could prove important to the health of both surgeon, and patients.
Heart rate variability (HRV) is emerging as a novel, validated measure of autonomic nervous system (ANS) function with developing accessible and non-invasive technologies. HRV parameters correlate to ANS function and can be used to measure responses to various stimuli.

Method
A search strategy was developed to identify 23 articles that matched inclusion criteria. These included data collected intra-operatively with ambulatory monitoring, in simulated settings and one systematic review.

Results
Several studies found increased sympathetic response in the operating surgeon – which correlates with subjective reporting of stress. Some studies compared variables; one study suggested that laparoscopic colorectal surgery caused higher mental strain than open, while another suggested higher stress in surgeons while teaching compared to when primary operator. There have been no comparative trials using HRV in surgeons.

Conclusions
We present a review of the growing literature regarding HRV measurement in surgeons. This novel tool is a promising avenue to provide psychophysiological insight into the operating surgeon. This could guide future research into optimising the theatre environment for intra-operative performance using controlled or in-situ design.