bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flap Reconstruction for Treatment of Pediatric Linear Scleroderma
Authors: Yan Maria , Stans Anthony A. , Moran Steven L. 
Published: May 2021

Background
Linear scleroderma is a rare connective tissue disease characterized by thickening of the skin due to excess collagen deposit. It is the most frequent type of localized scleroderma in the pediatric population (40%–70%), and it usually affects the extremities and head. Linear scleroderma can cause growth disturbances, extremity length discrepancy, and debilitating joint contractures. The aim of this study was to describe the surgical outcomes of microsurgical flap reconstruction of linear scleroderma in the pediatric population.

Methods
A retrospective review of all children with linear scleroderma was performed at our institution. Patients less than 18 years of age with clinical diagnosis of linear scleroderma and who underwent microsurgical flap reconstruction for correction of their scleroderma were included. Fat grafting procedures were excluded. Patient demographics and surgical outcomes were collected.

Results
A total 7 patients underwent microsurgical flap reconstruction for treatment of their linear scleroderma producing debilitating soft tissue contractures and preventing ambulation or elbow extension. Six patients had scleroderma involving the lower extremity and 1 involving the upper extremity. Three anterolateral thigh and 4 latissimus dorsi flaps were performed. The median age at surgery was 7 years (Q1–Q3, 5–11), and the median body mass index was 21.3 kg/m2 (Q1–Q3, 16.5–22.1). The median follow-up was 121.1 months (Q1–Q3, 43.2–187.4). All flaps survived, and no donor site complications were reported. Perioperative complications included wound infection that required debridement (n = 1), immediate postoperative bleeding requiring surgical intervention (n = 1), intraoperative venous congestion (n = 1), and scleroderma recurrence outside the flap (n = 2). When comparing anterolateral thigh and latissimus dorsi flaps, there was no statistically significant difference in the development of surgical complications, number of surgical revisions per patient [median, 4 (Q1–Q3, 4–7) vs 2.5 (Q1–Q3, 1.3, 3), P = 0.0916], or unplanned surgical interventions [median, 0 (Q1–Q3, 0–1) vs 1 (Q1–Q3, 0–1), P = 0.7228]. The reconstruction was successful in improving range of motion in 6 patients, 5 of which reached full weight-bearing. However, all patients had residual limb deformity, and 4 had remaining extremity length discrepancy.

Conclusions
Microsurgical flaps are a good option for functional improvement of severe pediatric linear scleroderma affecting the extremities. However, residual limb deformity is common, and patients are often required to undergo additional surgical revisions.
Lop Ear to Conchal Microtia
Authors: Lese Ioana , Aldabbas Mohammed , Mazeed Ahmed S. , Bulstrode Neil W. 
Published: May 2021

Background
The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience.

Materials and Methods
All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded.

Results
Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears.

Conclusion
We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.
Prominent Ear Correction Using Full-Thickness Cartilage Strip
Authors: Elmelegy Nader Gomaa 
Published: May 2021

Background
Prominent ears are one of the most well-known facial disfigurements influencing youngsters. Approximately 5% of the population suffers from some degree of ear prominence. More than 200 techniques have been used for the surgical correction of prominent ears, referring that no single “best” method exists and that techniques and modifications will continue to appear.

Objectives
In this work, we are going to evaluate the results of using a full-thickness cartilage strip, an incomplete cutting technique for the correction of various degrees of the prominent ear.

Patients and Methods
This prospective controlled clinical trial was carried out on a sum of 63 patients, who presented with prominent ear deformity, in the period between March 2014 and January 2020 at the plastic and reconstructive surgery department, Tanta University Hospitals, and private clinic.

Results
Sixty-three patients were operated upon, 46 were males and 17 were females, their age ranged between 4 and 23 years, and their mean age was 9.7 years. Clinical results showed excellent results in 37 patients (58.7%), good results in 18 patients (28. 6%), fair results in 8 patients (12.7%), and no poor results. Patient satisfaction showed excellent results in 32 patients (50.8%), good results in 22 patients (34.9%), fair results in 9 patients (14.3%), and no poor results.

Conclusions
Prominent ear correction using full-thickness cartilage strip, an incomplete cutting technique, is a good technique. It can be used in the correction of different varieties of prominent ears. It has a very low incidence of complications. No hypertrophic or keloidal scars have been reported.
Lateral Nasal Artery Perforator Flap for Nasal Reconstruction
Authors: Abe Yoshiro , Ishida Soushi , Mineda Kazuhide , Yamashita Yutaro , Nagasaka Shinji , Yamasaki Hiroyuki , Hashimoto Ichiro 
Published: May 2021

Background
Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities.

Methods
Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test.

Results
Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients.

Conclusions
Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.
Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion
Authors: Tan Nian , Wang Zhiqiang , Ren Huanhuan , Ye Jian 
Published: May 2021

ObjectiveA majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology.Patients and MethodsPatients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded.ResultsThe lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction.ConclusionsIn patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.
Routine Postsurgical Anesthesia Visit to Improve 30-day Morbidity and Mortality
Authors:   The TRACE Study Investigators
Published: May 2021

Objective:
To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients.

Background:
Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration.

Methods:
In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission.

Results:
Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34–1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up.

Conclusions:
The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined.

Trial Registration:
Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249.
Immunogenicity and Reactogenicity After SARS-CoV-2 mRNA Vaccination in Kidney Transplant Recipients Taking Belatacept
Authors: Ou Michael T. , Boyarsky Brian J. , Chiang Teresa P.Y. , Bae Sunjae , Werbel William A. , Avery Robin K. , Tobian Aaron A.R. , Massie Allan B. , Segev Dorry L. , Garonzik-Wang Jacqueline M. 
Published: May 2021

Background.
Belatacept may impair humoral immunity, impacting the effectiveness of SARS-CoV-2 mRNA vaccines in transplant recipients. We investigated immunogenicity after SARS-CoV-2 mRNA vaccines in kidney transplant recipients who are and are not taking belatacept.

Methods.
Participants were recruited between December 9, 2020, and April 1, 2021. Blood samples were collected after dose 1 and dose 2 (D1, D2) and analyzed using either an anti-SARS-CoV-2 enzyme immunoassay against the S1 domain of the SARS-CoV-2 spike protein or immunoassay against the receptor-binding domain of the SARS-CoV-2 spike protein. Stabilized inverse probability of treatment weights was used to compare immunogenicity, and a weighted logistics regression was used to calculate fold change of positive response.

Results.
Among the 609 participants studied, 24 (4%) were taking belatacept. After dose 1, 0/24 (0%) belatacept patients had detectable antibodies, compared with 77 of 568 (14%) among the equivalent nonbelatacept population (P = 0.06). After dose 2, 1/19 (5%) belatacept patients had detectable antibodies, compared with 190/381 (50%) among the equivalent nonbelatacept population (P < 0.001). Belatacept use was associated with 16.7-fold lower odds of having a positive post-D2 titer result (P < 0.01).

Conclusions.
Additional measures need to be explored to protect kidney transplant recipients taking belatacept. Best safety practices should be continued despite vaccination among this population.
Topics in the mathematical design of materials
Authors: Chen Xian , Fonseca Irene , Ravnik Miha , Slastikov Valeriy , Zannoni Claudio , Zarnescu Arghir 
Published: May 2021

We present a perspective on several current research directions relevant to the mathematical design of new materials. We discuss: (i) design problems for phase-transforming and shape-morphing materials, (ii) epitaxy as an approach of central importance in the design of advanced semiconductor materials, (iii) selected design problems in soft matter, (iv) mathematical problems in magnetic materials, (v) some open problems in liquid crystals and soft materials and (vi) mathematical problems on liquid crystal colloids. The presentation combines topics from soft and hard condensed matter, with specific focus on those design themes where mathematical approaches could possibly lead to exciting progress.
This article is part of the theme issue ‘Topics in mathematical design of complex materials’.
Quantitative analysis of compatible microstructure by electron backscatter diffraction
Authors: Chapman Michael , De Graef Marc , James Richard D. , Chen Xian 
Published: May 2021

We propose a scheme for assigning the martensite variant using electron backscatter diffraction in a martensite material that undergoes a solid–solid phase transformation. Based on the solutions of the crystallographic equations of martensite, we provide an algorithm to assign martensite variants to a particular microscopic region, and to check the elastic compatibility of the microstructure corresponding to low hysteresis and high reversibility in shape memory alloys.This article is part of the theme issue ‘Topics in mathematical design of complex materials’.
Leveraging Northern European population history; novel low frequency variants for polycystic ovary syndrome
Authors: Tyrmi Jaakko S. , Arffman Riikka K. , Pujol-Gualdo Natàlia , Kurra Venla , Morin-Papunen Laure , Sliz Eeva , FinnGen  ,   Estonian Biobank Research Team, Piltonen Terhi T. , Laisk Triin , Kettunen Johannes , Laivuori Hannele 
Published: May 2021

AbstractBackgroundPolycystic ovary syndrome (PCOS) is a common, complex disorder, which should be recognized as a prominent health concern also outside the context of fertility. Although PCOS affects up to 18% of women worldwide, its etiology remains poorly understood. It is likely that a combination of genetic and environmental factors contributes to the risk of PCOS development. Whilst previous genome-wide association studies have mapped several loci associated with PCOS, analysis of populations with unique population history and genetic makeup has the potential to uncover new low frequency variants with larger effects. In this study, we leverage genetic information of two neighboring and well-characterized populations in Europe – Finnish and Estonian – to provide a basis for a new understanding of the genetic determinants of PCOS.Methods and FindingsWe conducted a three-stage case-control genome-wide association study (GWAS). In the discovery phase, we performed a GWAS comprising of a total of 797 cases and 140,558 controls from the FinnGen study. For validation, we used an independent dataset from the Estonian Biobank, including 2,812 cases and 89,230 controls. Finally, we conducted a joint meta-analysis of 3,609 cases and 229,788 controls from both cohorts.In total, we identified three novel genome-wide significant variants associating with PCOS. Two of these novel variants, rs145598156 (p=3.6 × 10−8, OR=3.01 [2.02-4.50] MAF=0.005) and rs182075939 (p=1.9 × 10−16, OR= 1.69 [1.49-1.91], MAF=0.04), were found to be enriched in the Finnish and Estonian populations and are tightly linked to a deletion c.1100delC (r2= 0.95) and a missense I157T (r2=0.83) in CHEK2. The third novel association is a common variant near MYO10 (rs9312937, p= 1.7 × 10−8, OR=1.16 (1.10-1.23), MAF=0.44). We also replicated four previous reported associations near the genes ERBB4, DENND1A, FSHB and ZBTB16.ConclusionsWe identified three novel variants for PCOS in a Finnish-Estonian GWAS. Using isolated populations to perform genetic association studies provides a useful resource to identify rare variants contributing to the genetic landscape of complex diseases such as PCOS.
Lockdown babies- Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa
Authors: Farley Elise , Edwards Amanda , Numanoglu Emma , Phillips Tamsin K. 
Published: May 2021

AbstractBackgroundPerceived birth experiences of parents can have a lasting impact on children. We explored the birth and new parenting experiences of South African parents during the Covid-19 lockdown.MethodsWe conducted an online cross-sectional survey with consenting parents of babies born in South Africa during 2020. Factors associated with negative birth emotions and probable depression were estimated using logistic regression.ResultsMost of the 520 respondents were females (n= 496, 95%) who gave birth at private hospitals (n=426, 86%). Mothers reported having overall positive birth emotions (n= 399, 80%). Multivariable analysis showed that having the baby during lockdown (adjusted odds ratio (aOR) 5.02; CI 1.28 – 19.66); being diagnosed with Covid-19 (aOR 3.17; CI 1.07 – 9.42); having negative new parenting emotions (aOR 6.07; CI 3.27 – 11.29); a preterm baby (aOR 3.02; CI 1.36 – 6.70) and lockdown related barring of preferred in hospital support (aOR 2.45; CI 1.35 – 4.43) were associated with mothers reporting predominately negative emotions about the birth. Having their chosen delivery method reduced the odds of negative birth emotions (aOR 0.4; CI 0.22 – 0.72). Multivariable analysis showed that having predominantly negative new parenting emotions (aOR 10.75; CI 5.41-21.37), breastfeeding struggles (aOR 2.16; CI 1.36 – 3.46); lockdown preventing health care access (aOR 2.06; CI 1.20 – 3.54) and creating financial strain (aOR 2.58; CI 1.08 – 6.18) were associated with probable minor depressionConclusionsLockdown exacerbated many birth and parenting challenges including mental health and health care access. However, overall experiences were positive and there was a strong sense of resilience amongst parents.
T Cell Positive B Cell Negative Flow Cytometry Crossmatch (FCXM): Frequency, HLA-Locus Specificity, and Mechanisms Among 3073 Clinical FCXM Tests
Authors: Putheti Prabhakar , Sharma Vijay K , Friedlander Rex , Menon Arvind , Dadhania Darshana , Muthukumar Thangamani , Suthanthiran Manikkam 
Published: May 2021

ABSTRACTBackgroundA T cell positive and B cell negative (T+B-) flow cytometry crossmatch (FCXM) result remains a conundrum since HLA-class I antigens are expressed on both T and B cells. We investigated the frequency, HLA specificity of the antibodies and mechanisms for the T+B- FCXM result.MethodsWe analyzed 3073 clinical FCXM tests performed in an American Society of Histocompatibility and Immunogenetics accredited histocompatibility laboratory. The sera associated with the T+B- FCXM were also tested for donor HLA IgG antibodies using LABScreen™ single antigen assays.ResultsAmong the 3073 FCXM tests, 1963 were T-B-, 811 were T-B+, 274 were T+B+, and 25 were T+B-. IgG antibodies directed at donor HLA-A, B, or Cw locus determined antigens (DSA) were identified in all 25 sera and the summed mean fluorescence intensity (MFI) of DSA ranged from 212 to 53,187. Correlational analyses identified a significant association between the summed MFI of class I DSA, and the median channel fluorescence (MCF) of T cells treated with the recipient serum (Spearman rank correlation, rs=0.34, P=0.05) but not with the MCF of B cells (rs=0.23, P=0.24). We identified that differential binding of anti-HLA antibodies to T cells and B cells and the B cell channel shift threshold used to classify a B cell FCXM are potential contributors to a T+B- FCXM result.ConclusionsOur analysis of 3073 FCXM, in addition to demonstrating that HLA antibodies directed at HLA-A, B or Cw locus are associated with a T+B- result, identified mechanisms for the surprising T+B- FCXM result.