bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a Chin Retrusion Scale for Chinese Subjects
Authors: Junxue An , Chen Lujia , Xiaobing Ma , Qu Jiazhi , Schumacher Andrew , Dong Li 
Published: July 2021

Abstract
Chin augmentation procedures are gaining in popularity. The purpose of this study was to validate the China (Allergan) Chin Retrusion Scale (CACRS) and to evaluate the reliability of the scale. A team of 10 physicians based in Beijing, China, consisting of 1 principal investigator and 9 independent raters, assessed a pool of subject images. Using standardized equipment to capture 2-dimensional images, 100 subjects were photographed from a left, lateral, 90° view. Two measures were used to assess the validity of the scale: rater evaluations of clinically significant differences in 52 pairs of images and rater assessment of chin retrusion using the CACRS to grade the 100 images. The CACRS demonstrated almost perfect inter-rater agreement during 2 validation sessions, with intraclass correlation coefficients of 0.89 and 0.90 at sessions 1 and 2, respectively. Overall inter-rater agreement for all 9 raters was almost perfect, with a weighted kappa of 0.82. Based on inter- and intra-rater agreement, the CACRS was validated for physician ratings of chin retrusion in Chinese subjects. Results from clinical significance evaluations indicated that a 1-grade difference between image pairs was considered clinically meaningful for the CACRS. The CACRS is a validated and reliable photonumeric scale for the assessment of chin retrusion in Chinese men and women. The scale is a clinically significant reference tool for evaluating the effect of chin augmentation.
The Boundless World of Cranioplasty: A Multicenter Retrospective Study and Therapeutic Flow-Chart Patient-Specific Based
Authors: Lo Bue Enrico , Scalia Gianluca , Nicoletti Giovanni Federico , Maugeri Rosario , Iacopino Domenico Gerardo , Zabbia Giovanni , Umana Giuseppe Emmanuele , Graziano Francesca 
Published: July 2021

Background:
Cranioplasty is both a functional and aesthetical therapeutic option. In the clinical scenario every cranioplasty's material is potentially qualified to achieve the goal of calvarian reconstruction but there is a lack of agreement about the optimum choice, especially between the heterologous ones. The choice of cranioplasty widely depends on surgeon's personal preferences. In this retrospective multicentric study a comparative analysis of hydroxyapatite or titanium cranioplasties was carried on analyzing the main factors considered by the surgeon to choose a material rather than another one. Our results and data were compared with those reported in the scientific literature and a flow-chart regarding the therapeutic approach in the choice of the most suitable cranioplasty was proposed and discussed.

Methods:
The authors present a multicentric study considering 2 groups of patients who underwent 2 different kinds of cranioplasty: hydroxyapatite and titanium. The outcomes measures included the surgical timing and the maintenance of post-operative subgaleal drain.

Results:
A total of 40 patients that had cranioplasty treatment were evaluated. The surgical technique was analyzed. In patients that underwent titanium cranioplasty we observed a reduction in the operative times and in subgaleal drain maintenance. In relation to the age, comorbidity, and neurological status a score, called most suitable material (MSM), was elaborated and a therapeutic algorithm is proposed.

Conclusions:
This study confirms the known advantages and drawback of titanium and hydroxyapatite prostheses. Thanks to the lessons learned from our experience on this field, we elaborated the MSM score that coupled with the therapeutic flow-chart proposed could address the choice of the MSM for a specific patient.
Facial Dysmorphology in Saethre-Chotzen Syndrome
Authors: Junn Alexandra , Dinis Jacob , Lu Xiaona , Forte Antonio Jorge , Mozaffari Mohammad Ali , Phillips Sarah , Lopez Joseph , Alonso Nivaldo , Persing John A. , Alperovich Michael 
Published: July 2021

Purpose:
Classic features of Saethre-Chotzen syndrome (SCS) described in the literature include a prominent nasal bridge, eyelid ptosis, telorbitism, maxillary hypoplasia, and mandibular prognathism. The purpose of this study was to evaluate objectively the bony features of SCS.

Methods:
Preoperative computer tomography scans of 15 SCS patients, 23 normal controls, 13 bicoronal nonsyndromic, and 7 unicoronal nonsyndromic craniosynostosis patients were included for analysis. Unaffected controls and nonsyndromic patients were age- and sex-matched to SCS patients. Morphometric cephalometrics were analyzed using three-dimensional computer tomography reconstructions. Mann–Whitney U were used to compare facial measurements between SCS and normal and nonsyndromic craniosynostosis controls.

Results:
Telorbitism was present in bicoronal SCS patients only (P = 0.04) but absent in the unicoronal and bicoronal/metopic cohorts. The angle of the nasal bone relative to the sella was not different between SCS and controls (P = 0.536), although the angle of the nasal bone relative to the forehead was decreased in SCS by 15.5° (P < 0.001). Saethre-Chotzen syndrome had a 2.6° maxillary retrusion relative to controls (P = 0.03). In addition, SCS patients aged 4 to 7 months had a wider (39.34 versus 35.04, P = 0.017) and anteroposteriorly foreshortened (32.12 versus 35.06, P = 0.039) maxilla. There was no difference in mandibular prognathism among SCS patients as measured by the sella-nasion-B point angle compared to controls (P = 0.705).

Conclusions:
Despite classic descriptions, on morphometric analysis SCS patients did not demonstrate consistency across all suture subtypes in terms of telorbitism, a broad nasal bridge, or mandibular prognathism. Rather, SCS subtypes of SCS based on suture pathology more closely resemble nonsyndromic patients.
Challenging the Norm: Is Routine Use of Cranial CT in Evaluation of Craniosynostosis Necessary?
Authors: Fahradyan Artur , Daneshgaran Giulia , Hoffman Trevor L. , Wexler Andrew , Francis Stacey H. 
Published: July 2021

Background:
Cranial CT is routinely taught to be the gold standard for diagnosis of craniosynostosis and used by craniofacial teams for suspected nonsyndromic single suture craniosynostosis. Given the risks associated with infant CTs, do these scans provide significantly enhanced diagnostic accuracy compared to the physical exam when performed by an experienced clinical provider?

Method:
A retrospective chart review was performed for children who underwent corrective surgery for nonsyndromic, single-suture craniosynostosis over an 11 year period by a single craniofacial team. Ages at presentation and surgery, preoperative clinical diagnosis and imaging, co-existing radiographic findings, and correlation with the intraoperative diagnosis were analyzed.

Results:
A total of 138 patients were included in this study. The mean age was 4.2 months at initial craniofacial evaluation, and 8.0 months at time of surgery. Twenty-seven patients received imaging prior to our clinic. Of those, 21 had plain radiography and 6 had CT scans. Of the remaining 111 patients referred without imaging, craniosynostosis was clinically diagnosed in 102 (92%), whereas 9 (8%) had an unclear clinical diagnosis. Of these 9, 1 (1%) was diagnosed clinically at follow-up exam, and the remaining 8 (7%) were diagnosed using radiography (3 CT scans, 5 plain radiographs). In all patients, the preoperative diagnosis was confirmed during intraoperative assessment.

Conclusions:
Cranial CT was not needed by experienced craniofacial providers in 93% of nonsyndromic, single-suture craniosynostosis. Imaging obtained before craniofacial clinic referral may have been unnecessary. These findings question the classic teaching that preoperative cranial CT is the gold standard for diagnosis in infants with nonsyndromic, single-suture craniosynostosis.
Comparison of Two Scoring Systems in Pediatric Open Globe Injuries
Authors: Dursun Özer , Özer Ömer , Vatansever Mustafa , Dinç Erdem , Oktay Özgün , Örekici Temel Gülhan 
Published: July 2021

Purpose:
The aim of this study is to determine the demographic characteristics of pediatric open globe injuries, evaluate the ocular trauma scores (OTS), and predict the visual outcomes.

Methods:
All patients with pediatric open globe injuries who applied to Department of Ophthalmology, Faculty of Medicine, Mersin University between January 2018 and December 2019 were included in this study. Age, gender, type of injury, time of admission, time to surgery, OTS, and pediatric ocular trauma score (POTS) were calculated for each patient. The relation between these findings and final visual acuity (VA) after 12 months of follow-up was examined.

Results:
Forty-two eyes of 41 patients were included in this study. The most common injuries observed were sharp objects such as knives (23.8%) and stones (23.8%). The wound locations were zone I in 36 patients (85.7%) and zone II in 6 patients (14.3%). The most common concomitant eye pathologies were iris prolapse in 37 (88.1%) and hyphema in 29 (69.1%). The mean original OTS was 77.21 and the mean POTS was 46.78. Association between OTS/POTS and final VA was very good (Kendall Tau-b = 0.665, P < 0.001, Kendall Tau-b = 0.505, P < 0.001, respectively). The level of agreement between the predicted VA for OTS and that for POTS was almost perfect (kappa = 0.8726).

Conclusions:
This study shows that the original OTS is still the gold standard in pediatric cases.
Virtual Surgical Planning Combined With Intraoperative Navigation in Mandibular Bilateral Sagittal Split Osteotomy for Accurate Placement of Patient Specific Implants
Authors: Järvinen Sanna , Suojanen Juho , Suomalainen Anni , Stoor Patricia 
Published: July 2021

Abstract
The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.
Surgery First and Clear Aligners on Relapsed Condylar Hyperplasia
Authors: Meuli S. , Amodeo G. , Marrocco S. , Brugnami F. , Scopelliti D. 
Published: July 2021

Abstract
Condylar hyperplasia is (CH) a mandibular malformation that involves a change in the size and morphology of the condylar neck and head. The CH is an abnormality that usually occurs unilaterally and affects equally both men and women. Its etiology is controversial in its own right. Under this condition, mandibular growth occurs in all the 3 planes of space, but more predominantly in one of them. Treatment protocols are variable, but one of the best treatment choices is high condylectomy. Compared to the past, the change in the treatment protocol, as well as the innovations in both surgical and orthodontic technology, allowed a simplification of the therapeutic path, reduced patient discomfort and ensured more stable long-term postsurgical results.
The authors present a case of a 40-year-old female patient with relapsed of unilateral CH, treated surgically for the second time and with orthodontic treatment with clear aligners. The clear aligners orthodontic treatment is now considered one the best treatment orthodontic options. In this case, considering the relapse of the hyperplasia and the need of a new orthodontic treatment we decide to use this technique to reduce patient discomfort and teeth force appliance.
Comparison of Two Botulinum Toxin Injection Methods for Treatment of Excessive Gingival Display
Authors: Aldhaher Hussain Adnan , Bede Salwan Y. 
Published: July 2021

Background:
Hyperfunction of the muscles of the upper lip is considered as the most common cause of excessive gingival display (EGD). The aim of this study was to demonstrate the effectiveness of botulinum toxin (BT) injection as a conservative treatment for EGD due to muscular hyperfunction and to compare the outcome of 2 injection methods.

Material and Methods:
This study included 40 participants who were randomly assigned into 2 groups of 20 each, The first group received 2.5IU BT injection at 1 point per side (2-points group), while the second group received a total of 5 IU of BT at 2 points per side (4-points group). The outcome variables were the reduction in the central and lateral gingival display expressed as the difference between the pre- and post-injection measurements and the degree of satisfaction of the participants. The follow up visits were at 2- and 12-weeks postinjection. The study variables were statistically analyzed and probability values of <0.05 were considered significant.

Results:
There was a significant improvement (P < 0.0001) in both groups throughout the follow up period, but the improvement achieved by 4-points group was significantly better than that of the 2-points group with respect to the gingival display and the degree of satisfaction (P < 0.0001).

Conclusions:
Botulinum toxin injection represents a safe and less invasive modality for treatment of EGD, the 4-points method results in better outcome in terms of clinical measurements and degree of satisfaction over the 2-points method.
Retromandibular Transparotid Approach for the Treatment of Benign Nontraumatic Conditions of the Mandible. A Retrospective Consecutive Case-Series Study
Authors: Hauer Lukas , Gencur Jiri , Posta Petr , Micopulos Christos , Lišková Veronika , Chalupová Miroslava , Moztarzadeh Omid 
Published: July 2021

Abstract
The retromandibular transparotid approach enables the most direct access to the central and posterior part of the mandibular ramus including the condylar region. So far it has not been widely used for the management of benign pathology of the mandible. The purpose of this study was to evaluate the utilization rate of this approach in the nontrauma setting including the determination of suitable indications for this access. In total, 105 patients with 107 retromandibular transparotid approaches performed in the 6.5 years (from May 2014 to November 2020) were evaluated. Patients suffering from nontrauma pathology accounted for 4.7% of all cases. The recurrences of different types of odontogenic cysts and secondary chronic osteomyelitis were surgically managed via this approach with aesthetically acceptable resultant scar achievement and no identified postoperative complications. All lesions resolved and no recurrences occurred during the follow-up 32.0 ± 20.7 months (range 6 to 59 months, median = 26 months). The retromandibular transparotid approach may be considered for the enucleation of benign bone lesions in selected patients. Another type of surgery for the management of benign nontraumatic conditions in an accessible area without requirements for continuity resection and jaw reconstruction may be also suitable for using this approach.
Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy
Authors: Evans Sarah , McCarter Maggie , Abimbola Obafunbi , Myers Erinn M. 
Published: July 2021

Objective
The objective of this study was to evaluate whether an enhanced recovery after surgery (ERAS) protocol was associated with a higher rate of same-day discharge after robot-assisted or laparoscopic sacrocolpopexy and to describe the safety and feasibility of same-day discharge after these procedures.

Methods
A historical control, retrospective cohort study of women undergoing minimally invasive sacrocolpopexy comparing rates of same-day discharge before and after implementation of an ERAS protocol was conducted. Secondary outcomes were obtained by comparing women discharged the same day with those discharged postoperative day ≥1, including postoperative complications and unplanned postoperative patient encounters within 30 days of surgery. Logistic regression was performed to control for potential confounders.

Results
Of the 166 women identified (83 before ERAS implementation; 83 after ERAS implementation), 43 underwent same-day discharge versus 123 admitted overnight. The rate of same-day discharge increased 28 percentage points after ERAS implementation (12% vs 40%, P < 0.01). Compared with women admitted overnight, same-day discharge women had shorter procedures (154 vs 173 minutes, P = 0.01), spent longer time in the postanesthesia care unit (130 vs 106 minutes, P = 0.01), and were more likely to be discharged with a Foley catheter (58% vs 28%, P < 0.01). After multivariable logistic regression analysis, ERAS was associated with increased odds of same-day discharge (odds ratio, 4.91; 95% confidence interval, 2.17–11.09). There were no differences in unplanned postoperative patient contacts or postoperative complications within 30 days between same-day discharge and overnight admission groups.

Conclusions
Implementation of an ERAS protocol for minimally invasive sacrocolpopexy was associated with a 3-fold increase in same-day discharge.
Characterization of Urethral Diverticula in Women
Authors: Vaidya Rohan V. , Olson Kathleen , Wolter Christopher , Khan Aqsa 
Published: July 2021

Objective
Urethral diverticulum is a rare, yet important condition for the female pelvic surgeon. We aimed to characterize the women who have been seen for this condition across the three Mayo Clinic locations.

Methods
Medical record review was performed for patients across all three Mayo Clinic sites (Rochester, Arizona, Florida) that had International Classification of Diseases, Ninth Revision, (ICD-9) and International Classification of Diseases, Tenth Revision, (ICD-10) codes corresponding to urethral diverticulum (ICD-9, 599.2; ICD-10, N36.1). We also performed a review of patients who underwent urethral diverticulectomy via Current Procedural Terminology (CPT) code 53235. Data were available for patients from June 1, 2003, to October 5, 2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes.

Results
Four hundred forty-seven women met initial coding criteria for urethral diverticula, with 228 women having documented urethral diverticula. The most common presentations were irritative voiding symptoms (93) and infections (92). The most common diagnostic modality was radiographic imaging (198/228) with magnetic resonance imaging accounting for 157 cases. Etiology was unknown in the majority of cases (181/228). Of women who were diagnosed, 172 underwent diverticulectomy with 51 concurrent urethral sling placements. Final pathology demonstrated 2 cases of malignancy. Postoperative follow-up ranged from 0 months to 15 years (mean, 1.4 years; median, 4 months). Forty-three patients had persistent urinary symptoms after diverticulectomy with stress incontinence being the most common. Eight patients underwent subsequent sling placement. Fourteen patients had recurrence.

Conclusions
This appears to be the largest reported series on female urethral diverticula, a rare yet important entity that requires special consideration. Most surgical cases found resolution of symptoms after diverticulectomy. Importantly, less than 2% of urethral diverticula were associated with malignancy.
Molecular Effects of Topical Estrogen on Vaginal Granulation Tissue in Postpartum Women
Authors: Bochenska Katarzyna , Kujawa Stacy , Zhao Hong , Kenton Kimberly , Bulun Serdar E. , Lewicky-Gaupp Christina 
Published: July 2021

Objective
The aims of this study were to evaluate the biomolecular properties of vaginal and perineal granulation tissue in postpartum women and assess the potential impact of vaginal estrogen application.

Methods
We prospectively identified women referred to a subspecialty peripartum clinic between September 2016 and April 2018 who developed symptomatic perineal or vaginal granulation tissue. As part of routine clinical care, granulation tissue was excised from each participant by a urogynecologist and subjected to RNA extraction, real-time quantitative polymerase chain reaction, histologic evaluation, and immunohistochemistry. Serum steroid hormone levels were measured. Comparisons were made between participants who used topical vaginal estradiol (E2) and those who did not (non-E2 controls).

Results
Sixteen postpartum women were recruited for this pilot study. More than 30% of patients (n = 5, 31%) had used topical vaginal estradiol (E2) during their postpartum recovery. Histological appearance of granulation tissue evaluated by hematoxylin and eosin staining was similar in women treated with vaginal E2 and non-E2 controls. Both estrogen receptor α (ERα) and ERβ mRNA and ERα protein were readily detectable in the granulation tissue of E2-treated women. Although not statistically significant, participants who used topical E2 developed granulation tissue that exhibited local estrogen-responsive gene upregulation. Serum levels of estrone, E2, dehydroepiandrosterone, progesterone, and testosterone did not differ between vaginal E2–treated patients and controls.

Conclusions
Estrogen receptor α seems to be the predominant receptor mediating estrogen action in postpartum perineal and vaginal granulation tissue. Vaginal E2 use does not seem to affect serum levels of estrone, E2, dehydroepiandrosterone, progesterone, and testosterone in postpartum women.
The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis
Authors: Axelrod David A. , Chang Su-Hsin , Lentine Krista L. , Schnitzler Mark A. , Norman Doug , Olyaei Ali , Malinoski Darren , Dharnidharka Vikas , Segev Dorry , Istre Gregory R. , Lockridge Joseph B. 
Published: July 2021

Background.
The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R–) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D– organs in negative recipients (R–) has been shown to reduce the risk of viral infection and associated complications.

Methods.
To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D– with CMV D+ organ in CMV R– recipients using data from transplant registry, Medicare claims, and pharmaceutical costs.

Results.
For CMV R– patients, receipt of a CMV D– organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D– kidney.

Conclusions.
Altering national allocation policy to preferentially offer CMV D– organs to CMV R– recipients could improve survival and lower costs after transplant if appropriately implemented.