bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postcholecystectomy biliary injuries: frequency, and role of early versus late endoscopic retrograde cholangiopancreatography
Authors: Emara Mohamed H. , Ali Reda F. , Mahmoud Ramadan , Mohamed Salem Y. 
Published: February 2021

Background and study aim
Bile duct injuries are not infrequently seen during hepatobiliary surgery, particularly after liver transplantation and cholecystectomy. The current study aims to figure out the frequency of postcholecystectomy biliary injuries (PCBI) and the role of early versus late endoscopic retrograde cholangiopancreatography (ERCP) in their management.

Patients and methods
Totally 960 cases operated by both laparoscopic and open cholecystectomy were evaluated in the current study. In total, 942 cases were operated in our institutes, by both laparoscopic (n = 925) and open (n = 17) cholecystectomy, and the frequency of PCBI among patients operated in our institutes was (9/942) 0.95%. Additional 18 cases of PCBI referred to our centers were included in the study. One patient was treated by repair during the surgery, in the remaining 26 patients, ERCP management was attempted. The full details of the 26 patients regarding ERCP management were discussed.

Results
The overall success rate of ERCP management was 88.46% (23/26), whereas 11.54% of cases were treated surgically by choledochal-jejunal anastomosis due to complete common bile duct ligation. There were no differences between patients treated by early (first week) versus late (after the first week) ERCP regarding the needed interventions, type of PCBI, type and diameter of the inserted stents, and the overall success. There were no adverse events associated with ERCP management.

Conclusions
ERCP was valuable in the treatment of 88.46% of injured cases. There were no differences between early and late ERCP in the treatment of PCBI. Furthermore, ERCP management was not associated with adverse events.
Improving accuracy of 18F-fluorodeoxyglucose PET computed tomography to diagnose nodal involvement in non-small cell lung cancer: utility of using various predictive models
Authors: Mathew Boon , Purandare Nilendu C. , Pramesh C S , Karimundackal George , Jiwnani Sabita , Agrawal Archi , Shah Sneha , Puranik Ameya , Kumar Rajiv , Prakash Agarwal Jai , Prabhash Kumar , Tandon Sandeep , Rangarajan Venkatesh 
Published: February 2021

Purpose
To determine predictive models (PM) that could improve the accuracy for identifying metastatic regional nodes in non-small cell lung cancer based on both PET and CT findings seen on 18F-FDG PET CT.

Methods
Three hundred thirty-nine biopsy-proven NSCLC patients who underwent surgical resection and had a staging 18F-FDG PET CT were enrolled. PET parameters obtained were (1) presence of visual PET positive nodes, (2) SUVmax of nodes (NSUV), (3) ratio of node to aorta SUVmax (N/A ratio) and (4) ratio of node to primary tumour SUVmax (N/T ratio). CT parameters obtained were (1) short-axis diameter and (2) Hounsfield units (HU) of PET-positive nodes. PET and CT parameters were correlated with nodal histopathology to find out the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. Different PM combining these parameters were devised and the incremental improvement in accuracy was determined.

Results
Visual PET positivity showed sensitivity, specificity, PPV, NPV and accuracy of 72.4, 76.1, 30.1, 95.1 and 75.6, respectively. PM2 which combined visual PET positivity, NSUV and HU appears more clinically relevant and showed sensitivity, specificity, PPV, NPV and accuracy of 53.5, 96.5, 68.9, 93.6 and 91.2, respectively. PM6 which combined visual PET positivity, NSUV, N/A ratio and HU showed the maximum PPV (80.0%), specificity (98.3%) and accuracy of (91.9%).

Conclusion
PM combining parameters like nodal SUVmax, N/A ratio, N/T ratio and HU values have shown to improve the PPV, specificity and overall accuracy of 18FDG PET CT in the preoperative diagnosis of nodal metastases.
Measuring Nurse Leaders’ and Direct Care Nurses’ Perceptions of a Healthy Work Environment in an Acute Care Setting, Part 1
Authors: Huddleston Penny , Gray Jennifer 
Published: February 2021

BACKGROUND:
The American Association of Critical-Care Nurses Healthy Work Environment Assessment tool (AACN HWEAT) was developed as a simple screening assessment for clinical units to quickly get individual feedback on the status of the nurses' work environments based on the AACN standards of a healthy work environment (HWE). Pilot studies were conducted to determine the psychometric properties of the tool after seeking permission from AACN and the Vital Smarts Company.

PURPOSES:
The purposes of these research studies were to assess the psychometric properties of the AACN HWEAT and to measure the nurse leaders' and direct care nurses' perceptions of an HWE in an acute care setting.

METHODS:
Nonexperimental descriptive survey designs were implemented with 3 convenience samples for a total sample of 321 nurse leaders and direct care nurses.

RESULTS:
Cronbach's αs of .97 for nurse leaders and .91 for direct care nurses demonstrated strong reliability or internal consistency of the tool. Face validity demonstrated 13 of 18 items placed in the correct category. The scale content validity index score was 96.63. Concurrent validity demonstrated that items were highly correlated, ranging from 0.42, with 95% confidence interval (CI) of 0.57 to 0.69, to 0.85, with 95% CI of 0.70-0.93, P < .05. Principal component analysis revealed 2 components for the tool.

CONCLUSIONS:
As a result of these findings, an opportunity was identified to develop additional tools to measure an HWE for nurses at all levels in acute care settings.
G2 Research Radically Invasive Projectile
Authors: Zhang Xin , Cain Matthew D. , Williams Christian D. , Spears Timothy A. , Poulos Christopher K. 
Published: February 2021

Abstract
Many fragmenting and frangible projectiles have been developed in the course of firearm history. In addition, partially because of the concerns of range and environmental contamination, bullets constructed without lead have become increasingly common. A case regarding a unique projectile that incorporates both features, the G2 Research Radically Invasive Projectile ammunition, is discussed in this article. Here we report a 25-year-old woman who died of multiple gunshot wounds caused by G2 Research Radically Invasive Projectile ammunition. Because of the bullet's unique design, the wounds demonstrated characteristic radiographic patterns and unique autopsy findings. Familiarity with these findings is important to forensic pathologists in terms of case documentation, projectile recovery, and personal safety.
Crowdsourced Assessment of Aesthetic Outcomes after Breast Reconstruction
Authors: Teotia Sumeet S. , Alford Jake A. , Kadakia Yash , Haddock Nicholas T. 
Published: February 2021

Background:
Evaluating the aesthetic success of breast reconstruction can be difficult. Patients, surgeons, and the general population may differ in what constitutes a successful outcome. Recently, crowdsourcing has emerged to accumulate and analyze data on a massive scale. The authors propose that crowdsourcing can be a useful tool to reliably rate aesthetic outcomes of breast reconstruction.

Methods:
One hundred one deidentified photographs of patients at various stages of breast reconstruction were gathered. Assessment tools included a five-point Likert scale and the transverse rectus abdominis myocutaneous (TRAM) visual assessment scale. Anonymous crowd workers and a group of expert reconstructive surgeons rated an identical set of photographs on the Likert scale. Crowd workers also rated the set of photographs on the TRAM scale.

Results:
The authors obtained 901 anonymous, layperson evaluations on both Likert and TRAM scales. Crowdsourced assessment data collection took 28.6 hours. Expert assessment took 15 months. Expert and crowdsourced scores were equivalent on the Likert scale (overall interrater reliability, κ = 0.99; 95 percent CI, 0.98 to 0.99). Intrarater reliability among each subcomponent was highly reproducible for the crowd (r = 0.98; 95 percent CI, 0.97 to 0.99) and experts (r = 0.82; 95 percent CI, 0.77 to 0.87). Breast contour and positioning were most predictive of overall aesthetic result. Skin patch and scar were least predictive of overall aesthetic appearance.

Conclusions:
Aesthetic outcomes rated by crowds were reliable and correlated closely with those by expert surgeons. Crowdsourcing can be a rapid, reliable, and valid way to assess aesthetic outcomes in the breast reconstruction patient.
Splitting the Difference: Using Synthetic and Biologic Mesh to Decrease Cost in Prepectoral Immediate Implant Breast Reconstruction
Authors: Karp Nolan S. , Salibian Ara A. 
Published: February 2021

Summary:
Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Robin Sequence: 5-Year Speech Outcomes—A Case-Control Study
Authors: Schwaiger Michael , Cook Hannah , Jordan Zoe , Edmondson Sarah-Jayne , Mischak Irene , Wallner Jürgen , Atherton Duncan , Haers Piet , Timoney Norma , Ferguson Louisa 
Published: February 2021

Background:
Pierre Robin sequence (Robin sequence) is defined as the triad of micrognathia, glossoptosis, and airway obstruction. It is frequently associated with palatal clefting. In recent years, increased interest in speech outcomes of cleft patients diagnosed with Robin sequence has been shown.

Methods:
Speech outcomes of cleft patients with Robin sequence were assessed at age 5 in comparison with a cleft palate–only cohort. Speech parameters were evaluated according to the Cleft Audit Protocol for Speech-Augmented and analyzed using the National Audit Standards for Speech (United Kingdom). All patients were treated in the same institution during the same period (2005 to 2012). Subjects who needed nasopharyngeal airway support and those whose airway was managed by positioning only were eligible.

Results:
Fifty-one cleft patients diagnosed with Robin sequence were included in this study. Outcomes were compared to those of 128 nonsyndromic cleft palate–only patients.
Patients with Robin sequence were shown to present with a significantly higher rate of cleft speech characteristics in comparison to the reference cohort (p = 0.001). Furthermore, it was shown that Robin sequence is associated with a significantly higher rate of secondary speech surgery for velopharyngeal dysfunction before the age of 5 (p = 0.016). Robin sequence patients with a nasopharyngeal airway presented with a higher rate of cleft speech characteristics compared to Robin sequence patients managed with positioning only.

Conclusion:
Cleft patients with Robin sequence are more likely to need further surgery to correct velopharyngeal dysfunction before the age of 5 and are more prone to present with cleft speech characteristics at the age of 5.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Four-Step Spreader Flap: The Pull-Twist-Turn Technique
Authors: Rohrich Rod J. , Durand Paul D. 
Published: February 2021

Summary:
The spreader (or autospreader) flap offers an alternative to the traditional spreader graft in reconstructing the dorsal midvault and preserving internal valve function. This is of particular importance after an aggressive dorsal hump reduction, which has the potential to result in an inverted-V deformity, dorsal narrowing, or saddle-nose deformity. In this article, the authors describe a four-step spreader flap technique that offers a simple, reproducible method of shaping the dorsal midvault while preserving internal valve function.
The Effect of Depressor Anguli Oris Muscle Block on Facial Symmetry in Synkinetic Facial Paralysis Patients and Its Role in Preoperative Assessment
Authors: Krag Andreas E. , Glick Samuel , Hembd Austin , Rozen Shai M. 
Published: February 2021

Background:
Depressor anguli oris muscle hypertonicity in synkinetic facial paralysis patients may have an overpowering antagonistic effect on facial symmetry. Depressor anguli oris muscle block is a crucial diagnostic test before any treatment planning. Presented is the largest patient cohort analysis to date on static and dynamic facial symmetry changes after depressor anguli oris muscle block.

Methods:
Unilateral synkinetic patients with depressor anguli oris muscle hypertonicity were included. Resting symmetry and smile modiolus angle, excursion, and exposure of teeth were measured on both synkinetic and healthy hemifaces before and after depressor anguli oris muscle block using Emotrics and FaceGram photographic analyses.

Results:
Thirty-six patients were included. Before depressor anguli oris block, resting modiolus height was elevated on the synkinetic side (p = 0.047). During open-mouth smile, reduced modiolus angle (p < 0.0001), modiolus excursion (p < 0.0001), and exposure of teeth (p < 0.0001) were observed on the synkinetic hemiface. After depressor anguli oris block, resting modiolus height became symmetric (p = 0.64). During open-mouth smile, modiolus angle and exposure of teeth significantly increased (both p < 0.0001); excursion did not improve on the synkinetic side (p = 0.13) but unexpectedly improved in open-mouth smile on the healthy side (p = 0.0068).

Conclusions:
Depressor anguli oris muscle block improved resting symmetry and modiolus angle and exposure of teeth during smile, demonstrating the inhibitory mimetic role of a hypertonic depressor anguli oris muscle in synkinesis. It is a critical diagnostic and communication tool in the assessment and treatment planning of depressor anguli oris muscle hypertonicity, suggesting the potential effects of future depressor anguli oris myectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Free Flap Reconstruction of Posterior Trunk Soft-Tissue Defects: Single-Institution Experience and Systematic Literature Review
Authors: Akdeniz-Dogan Zeynep , Roubaud Margaret S. , Kapur Sahil K. , Liu Jessie , Yu Peirong , Selber Jesse C. , Mericli Alexander F. 
Published: February 2021

Background:
The posterior trunk is a technically demanding location for microvascular free tissue transfer. In this study, the authors report their own institutional experience with soft-tissue free flap reconstruction of the posterior trunk and provide a systematic review of the literature regarding this uncommon clinical scenario.

Methods:
A systematic review was performed using the PubMed database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A single-institution retrospective review was also performed including all patients who received a soft-tissue free flap for a posterior trunk defect between 1990 and 2019.

Results:
The database search yielded 15 articles, representing 61 patients; the most commonly used flap was the latissimus dorsi (45.9 percent) and the most commonly reported defect location was the lumbosacrum (42.3 percent). Retrospective review of the authors’ database identified 26 patients, with the latissimus dorsi being the most common flap and the sacrum the most common defect site. The authors’ institutional case series showed a 30.7 percent major complication rate and 7.7 percent total flap loss rate; 38.4 percent of flaps required vein grafting.

Conclusions:
In this study, the authors provided a systematic literature review and described their own long-term institutional experience with these rare and difficult reconstructions. Although the overall complication rate is high, these reconstructions are frequently necessary, and an algorithmic approach can improve outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Linear Modeling to Reduce Bias in Plastic Surgery Residency Selection
Authors: Elmaraghi Shady , Rao Venkat K. , Christie Brian M. 
Published: February 2021

Background:
Consistently selecting successful, productive applicants from an annual candidate pool is the goal of all resident selection practices. Efforts to routinely identify high-quality applicants involve scrutiny of multiple factors and formulation of an ordinal rank list. Linear modeling offers a quantified approach to applicant selection that is strongly supported by decades of psychological research.

Methods:
For the 2019 residency application process, the University of Wisconsin Plastic Surgery Residency Program used linear modeling in their evaluation and ranking process. A linear model was developed using United States Medical Licensing Examination Step 1 and Step 2 scores, letters of recommendation, publications, and extracurricular activities as inputs.

Results:
The applicant’s total score was calculated from a maximum total score of 100. The mean and median scores were 49 and 48, respectively, and applicants were ranked according to total score. A separate rank list was maintained using our program’s standard methodology for applicant ranking, which involves global intuitive scoring during the interview process. The Spearman rank correlation coefficient between the two lists was 0.532, and differences between the rank lists were used as a fulcrum for discussion before making the final rank list.

Conclusions:
This article presents the first known instance of the use of linear modeling to improve consistency, increase fairness, and decrease bias in the plastic surgery residency selection process. Transparent sharing of methodology may be useful to other programs seeking to optimize their own ranking methodology. Furthermore, it indicates to applicants that they are being evaluated based on fair, quantifiable criteria.
The eternal dilemma of antitoxin antibiotics for skin and soft tissue infection
Authors: Burillo Almudena , Bouza Emilio 
Published: February 2021

Purpose of review
In standard clinical practice, combined antibiotic treatment is used to treat severe skin and soft tissue infections (SSTIs), whereby one of the drugs is usually a protein synthesis inhibitor antibiotic. However, evidence for this practice is only based on data from ‘in vitro’ studies, animal models and case reports. There are no randomized controlled trials. In the light of several new drugs marketed for the treatment of these infections, there is a need to revise the state of the art.

Recent findings
New reviews and systematic appraisals of the literature exist on the use of protein synthesis inhibitor antibiotics to treat severe SSTI. Several ‘in vitro’ studies have assessed the efficacy of some of the new drugs.

Summary
Combination therapy, including an adjuvant protein synthesis inhibitor antibiotic for toxin suppression, should be used both in patients with severe SSTI and in those with moderate infection and risk factors for methicillin-resistant positive- or Panton–Valentine leukocidin positive-Staphylococcus aureus infection.
Interventions for Informal Caregivers of Stroke Survivors: Is There Racial and Ethnic Representation in Stroke Caregiver Studies?
Authors: Lopez Janet , Stacciarini Jeanne-Marie , Scarton Lisa , Uphold Constance R. 
Published: February 2021

Abstract

Purpose
The specific aims of this scoping review of the literature are to (1) map the current scope of literature regarding nonpharmacological interventions for informal stroke caregivers and (2) explore the degree to which racial/ethnic minority groups were represented in nonpharmacological interventions for stroke caregivers in the United States.

Design and Methods
Arksey and O’Malley’s methodological framework was used to conduct this scoping review. The framework entails formulating research questions, developing criteria for selecting relevant studies, charting the data, and synthesizing results.

Findings
The scoping review yielded 11 studies that varied in intervention design, methods of implementation, and outcome measurements. The review indicated that racial and ethnic minorities were less likely to be represented in nonpharmacological intervention studies for stroke caregivers.

Conclusion
Currently, there is sparse research that focuses on interventions with family caregivers of varying racial/ethnic groups in the United States.
Overexpression of the MSK1 Kinase in Patients With Chronic Lung Allograft Dysfunction and Its Confirmed Role in a Murine Model
Authors: Nemska Simona , Daubeuf François , Obrecht Adeline , Israel-Biet Dominique , Stern Marc , Kessler Romain , Roux Antoine , Tavakoli Reza , Villa Pascal , Tissot Adrien , Danger Richard , Reber Laurent , Durand Eugénie , Foureau Aurore , Brouard Sophie , Magnan Antoine , Frossard Nelly ,   the COLT consortium
Published: February 2021

Background.
Chronic lung allograft dysfunction (CLAD) and its obstructive form, the obliterative bronchiolitis (OB), are the main long-term complications related to high mortality rate postlung transplantation. CLAD treatment lacks a significant success in survival. Here, we investigated a new strategy through inhibition of the proinflammatory mitogen- and stress-activated kinase 1 (MSK1) kinase.

Methods.
MSK1 expression was assessed in a mouse OB model after heterotopic tracheal allotransplantation. Pharmacological inhibition of MSK1 (H89, fasudil, PHA767491) was evaluated in the murine model and in a translational model using human lung primary fibroblasts in proinflammatory conditions. MSK1 expression was graded over time in biopsies from a cohort of CLAD patients.

Results.
MSK1 mRNA progressively increased during OB (6.4-fold at D21 posttransplantation). Inhibition of MSK1 allowed to counteract the damage to the epithelium (56% restoration for H89), and abolished the recruitment of MHCII+ (94%) and T cells (100%) at the early inflammatory phase of OB. In addition, it markedly decreased the late fibroproliferative obstruction in allografts (48%). MSK1 inhibitors decreased production of IL-6 (whose transcription is under the control of MSK1) released from human lung fibroblasts (96%). Finally, we confirmed occurrence of a 2.9-fold increased MSK1 mRNA expression in lung biopsies in patients at 6 months before CLAD diagnosis as compared to recipients with stable lung function.

Conclusions.
These findings suggest the overall interest of the MSK1 kinase either as a marker or as a potential therapeutic target in lung dysfunction posttransplantation.