bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dr. Ian Thomas Jackson (1934–2020): A “Messiah” of the Deformed
Authors: Agarwal Rajiv , Agarwal Devisha 
Published: January 2021

Summary:
Ian Thomas Jackson was born and bred in Scotland and eventually settled in the United States. He rose to dizzying heights in his career due to his role in shaping the specialty of craniofacial surgery, not only in the United States but in the rest of the world. Jackson was first missed in Scotland, which lost this talented surgeon to America very early in his career; now this is everyone's loss, as we will all miss him forever. He was a skilled surgeon, great friend, and wonderful human being who touched the lives of innumerable patients with difficult deformities around the world. He never let any constraints affect his philanthropy and ushered a boy in Peru who had been abandoned by his parents through 80 operations, with a later adoption into the Jackson family, which is remarkable and unmatched by anyone even today. Jackson left indelible marks on the history and development of plastic surgery around the world and especially India, where he was introduced by Prof. Ramesh Chandra of Lucknow. The trailblazing and successful craniofacial surgeries conducted by Dr. Jackson in North India in the 1980s eventually opened the doors to the intriguing world of craniofacial surgery for the Indian plastic surgeon diaspora. He is in true sense a “messiah” of the deformed.
Breast Reconstruction Practices and Barriers in West Africa: A Survey of Surgeons
Authors: Ranganathan Kavitha , Ogunleye Adeyemi A. , Aliu Oluseyi , Agbenorku Pius , Momoh Adeyiza O. 
Published: January 2021

Background:
Access to breast reconstruction is limited in low-income countries. Identifying current barriers that plague both providers and patients can inform future interventions focused on improving access to care. The goal of this study was to delineate perceptions of breast reconstruction among providers in West Africa and define current barriers to care.

Methods:
Surveys were administered to surgeons attending the annual meeting of the West African College of Surgeons in 2018. Surgeons were surveyed regarding their practices and perceptions of breast reconstruction. Information on barriers to breast reconstruction focused on patient- and surgeon-related factors was also obtained. A univariate analysis was performed to assess association of demographic and practice information with perceptions of reconstruction barriers.

Results:
Thirty-eight surgeons completed the questionnaires; 10 of the respondents were plastic surgeons (27%). The survey response rate was 40%. Factors that a majority of surgeons believed to limit access to reconstruction included limited experience (72.9%), resources (76.3%), and a lack of referrals for reconstruction (75%). In total, 76.5% of surgeons had performed <10 breast reconstruction cases in the past year. Two patient factors highlighted by most surgeons (>80%) were a lack of knowledge and concerns about cost.

Conclusions:
Perspectives from surgeons in the West African College of Surgeons suggest that barriers in access, patient awareness, surgeon technical expertise, and cost limit the delivery of breast reconstructive services to women in the region. Implementation of interventions focused on these specific metrics may serve as valuable first steps in the movement to increase access to breast reconstruction.
Successful Intralesional Laser Therapy for Sclerotherapy-resistant Huge Venous Malformation
Authors: Wada Yoshitaka , Miyazaki Hidetaka , Kusuhara Hirohisa , Uemura Kazuhisa , Asamura Shinichi 
Published: January 2021

Summary:
Venous malformations (VMs) are compressible, blue-purple tumors that are present at birth, and are treated with either surgery or sclerotherapy, or a combination of both. Patients often experience recurrent hemorrhage, swelling, pain, or difficulty in daily life. Treatment of massive VMs can, therefore, be challenging. We applied intralesional laser photocoagulation (ILP) to a 19-year-old female patient with a huge VM who had shown resistance to sclerotherapy. It spanned from the dorsal area to the lateral chest. ILP is delivered directly into thick, deep lesions through a bare fiber delivery system. The effect on deep components is optimized without directly contacting the cutaneous or mucosal surfaces to minimize epithelial damage. We applied ILP to the lesion at 30 W in continuous mode (10 seconds) under ultrasound monitoring using an Nd:YAG laser of 1064-nm wavelength. In total, there have been 4 sessions of the same treatment; the lesion was treated with a combined 120 kJ of energy. Satisfactory regression of the huge VM was achieved by this ILP treatment. No significant complications (major bleeding, severe pain, post-perforation skin ulcer, and scar contraction) occurred during the treatment. ILP has been indicated for only sclerotherapy-resistant cases until now, but we suggest that it is a potentially safe and minimally-invasive resolution of VM without scarring or loss of normal shape, sensory feel, or function. ILP appears to be a safe and minimally-invasive resolution of VM. We propose that this technique could become a first-choice treatment modality for VM.
Hand Surgery Transfers to Level 1 Center: Variables Affecting Transfer Method and Diagnostic Accuracy
Authors: Putnam Jill , Pedreira Rachel , Fox Paige 
Published: January 2021

Background:
We hypothesize that some costly patient transfers to a level 1 trauma center for hand specialist management may be unnecessary. This analysis evaluates transfer cost effectiveness and whether time of consult, transfer distance, diagnosis at time of transfer, and provider level influence diagnostic accuracy and transport method.

Methods:
Two hundred and sixty-five patients transferred to a suburban level 1 trauma center for hand surgeon evaluation between 2014 and 2019 were evaluated for patient and injury characteristics, time of consult, transfer distance, provider level, transport method, treatment cost, and diagnostic accuracy.

Results:
The average patient age was 36.2 years, and 80.3% were men. 21% of transfers had inaccurate pre-transfer diagnoses, and certain pre-transfer diagnoses correlated with an increased likelihood of inaccuracy, including flexor tenosynovitis and vascular injury. Patients with a language barrier had a greater likelihood of being transferred with an inaccurate diagnosis (P < 0.05). Compared with ground transport, air ambulance was associated with a higher cost of treatment ($225,679 versus $133,887, P < 0.00001). Of all transfers, 14 (5%) were discharged from the emergency department (ED) without a procedure, 9 (3%) were admitted for observation, 73 (27%) had an ED procedure before discharge, and 166 (62%) received operative management.

Conclusions:
Over 30% of transfers to a level 1 trauma center likely could have been managed at the transferring facility at a decreased cost. Certain diagnoses are associated with increased risk for diagnostic error and unnecessarily urgent transport. Providers can use this information to consider transfer patterns and to educate transferring providers.
Beyond the Core Suture: A New Approach to Tendon Repair
Authors: Zeng Weifeng , Albano Nicholas J. , Sanchez Ruston J. , Mccabe Ronald , Vanderby Ray , Poore Samuel O. , Dingle Aaron M. 
Published: January 2021

Background:
Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) repair site without the use of core sutures. The hypothesis being that the reclaimed FDS tendon autograft will redistribute tensile forces away from the FDP repair site, increasing overall strength and resistance to gapping in Zone II flexor tendon injuries compared with the current clinical techniques.

Methods:
Two novel FDP repair methods utilizing portions of FDS have been described: (1) asymmetric repair (AR), and (2) circumferential repair. Ultimate tensile strength and cyclical testing were used to compare novel techniques to current clinical standard repairs: 2-strand (2-St), 4-strand (4-St), and 6-strand (6-St) methods. All repairs were performed in cadaveric sheep tendons (n = 10/group), by a single surgeon.

Results:
AR and circumferential repair techniques demonstrated comparable ultimate tensile strength to 6-St repairs, with all 3 of these techniques able to tolerate significantly stronger loads than the 2-St and 4-St repairs (P < 0.0001). Cyclical testing demonstrated that AR and circumferential repair were able to withstand a significantly higher total cumulative force (P < 0.001 and P = 0.0064, respectively) than the 6-St, while only AR tolerated a significantly greater force to 2-mm gap formation (P = 0.042) than the 6-St repair.

Conclusion:
Incorporating FDS as an autologous graft for FDP repair provides at least a comparable ultimate tensile strength and a significantly greater cumulative force to failure and 2-mm gap formation than a traditional 6-St repair.
Pediatric Mandible Reconstruction: Controversies and Considerations
Authors: Shahzad Farooq 
Published: January 2021

Summary
Mandibular reconstruction in pediatric patients has some unique considerations. The method of reconstruction has to factor in the growth potential of the neo-mandible, the native mandible, and the donor site. The condyle is considered the main growth center of the mandible. Current literature indicates that fibula, iliac crest, and scapula osseous flaps do not have the ability to grow. Costochondral grafts exhibit growth because of the costal cartilage component, although the growth is unpredictable. Preservation of the mandibular periosteum can result in spontaneous bone regeneration. Fibula bone harvest in a child mandates close follow-up till skeletal maturity, to monitor for ankle instability and valgus deformity. Dental rehabilitation maintains occlusal relationships, which promotes normal maxillary development. Elective hardware removal should be considered to facilitate future dental implant placement and possible revision procedures. After completion of growth, if occlusion or symmetry is not satisfactory, secondary procedures can be performed, including distraction osteogenesis, orthognathic-type bone sliding operations, and segmental ostectomy.
Deep Layer Radiofrequency Thermo-coagulative Technology for Cervicofacial Contouring: Sonographic and Clinical Results
Authors: Cohen Sarit , Dominsky Omri , Artzi Ofir , Dayan Erez , Eckstein Joseph 
Published: January 2021

Background:
Radiofrequency energy thermally induces collagen contraction and remodeling. The resultant dermal tightening is well established. However, facial aging encompasses also deeper layers of collagen-containing tissues. We present a deep layer radiofrequency-based thermo-coagulative technique for cervicofacial contouring and evaluate its efficacy.

Methods:
This prospective single center study was conducted from June 2017 to June 2018 and included 10 women. Echogenicity and thickness of layers 1–5 of the lower face, lateral neck, and submental regions were sonographically measured at baseline and at 6 weeks postoperatively. Echogenicity analysis was based on the number of high echogenic pixels counted and processed using Matlab-based image application (The Mathworks, Natick, Mass.). Clinical outcome at 12 months postoperatively was evaluated by 2 independent evaluators using a validated 5-point lower face improvement scale and the Merz jawline scale (0–4). Patient satisfaction and adverse effects were recorded.

Results:
Mean age was 60.2 years (range, 52–76). A statistically significant increase in echogenicity (P ≤ 0.02) and a decrease in thickness (P = 0.01) was noted. Echogenicity increased at 149%, 78%, and 60%, for the lateral neck, lower face, and submental region, respectively. The corresponding decrease in thickness per site was 16%, 6%, and 19%. The average physicians’ improvement in lower face contour was 3.8, and the Merz jawline scale was improved from 2.85 at baseline to 1.05 at 12 months postoperatively. Patient satisfaction was high. Side effects were minimal.

Conclusions:
Deep layer radiofrequency-based technology thermally induces profound soft tissue tightening and neocollagenesis. It is a safe and effective technique for cervicofacial contouring in selected patients.
Brachial Plexus Desmoid Tumor: Care for Functional Preservation
Authors: Liechty Andrew E. , Liu Yusha , Kao Dennis S. 
Published: January 2021

Summary:Desmoid tumors are a rare, locally invasive, non-metastasizing tumor of mesenchymal origin. Most of such tumors occur sporadically, but some arise as part of germline adenomatous polyposis coli mutations. They tend to aggregate in the abdomen, thorax, extremities, and the head and neck region. They are challenging to treat, with a high rate of recurrence even if achieving negative margins. We present the case of an 18-year-old woman with a desmoid tumor involving her brachial plexus. A non-oncological resection was performed, with a focus on functional preservation. Residual disease is being treated with β-catenin inhibitor and monitored with serial MRI.
Resuming Elective Surgery during Covid-19: Can Inpatient Hospitals Collaborate with Ambulatory Surgery Centers?
Authors: Squitieri Lee , Ko Clifford Y. , Brook Robert H. , Chung Kevin C. 
Published: January 2021

Background:
Little is known about the volume and scope of surgical procedures performed in ambulatory surgery centers (ASCs) and the resources that ASCs may provide to assist local health systems. The purpose of this study was to evaluate elective surgical procedures in the inpatient and outpatient ASC setting using currently available administrative claims data.

Methods:
We used the 2019 Medicare Point of Service (POS) file to evaluate the geographic distribution of Medicare-certified ASCs in the U.S. To evaluate the volume and scope of elective procedures in the inpatient and outpatient ASC setting, we used the 2016 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the 2018 California HHS Open Data Portal ambulatory surgery database. HCUP software programs were used to clinically categorize procedures and determine Elixhauser comorbidity profiles for each patient.

Results:
Among the 8,540 Medicare certified ASCs in 2019, the majority are freestanding (99.5%) and privately owned (92.9%). In the inpatient setting, 13.3% of elective operating room procedures occur in patients without any Elixhauser comorbidities and require < 2 days of hospital stay. However, the types of elective procedures performed in the inpatient setting are different from the types of procedures routinely performed in ASCs.

Conclusions:
Current administrative data lack robust facility, provider, and procedure level information to inform surge capacity protocols for elective surgery. Plastic surgeons are uniquely positioned to work with other specialties and local health systems to guide future development of surge capacity protocols that maintain and improve patient care.
Monotherapy vs combination treatments of different complexity: a meta-analysis of blood pressure lowering randomized outcome trials
Authors: Thomopoulos Costas , Bazoukis George , Grassi Guido , Tsioufis Costas , Mancia Giuseppe 
Published: January 2021

Background:
Use of drug combinations is recommended by hypertension guidelines for most patients because of the greater blood pressure (BP)-lowering effect compared with monotherapy. However, no evidence is available on outcome benefits of treatment strategies based on drug combinations vs. simpler treatment regimens, using data from randomized clinical trials (RCTs). We evaluated drug combination therapies of different complexity.

Methods:
Electronic databases were searched for BP-lowering RCTs that compared combination treatment or monotherapy vs. placebo, no-treatment or less-complex treatment. Combination treatment was considered as follows: background treatment continued during follow-up on top of the trial drug(s) of interest and drug(s) were added to the initial drug(s) of interest in the majority of the patients. Monotherapy was considered whenever pre-randomization treatment was withdrawn or absent and a single drug was administered at randomization. Complexity of treatment indicates the higher averaged number of daily medications used in the eligible RCTs.

Results:
We selected 93 trials (290 304 patients; follow-up, 3.9 years). The on-treatment mean number of drugs was 2.10 and 0.99 in the more and less actively treated patients, respectively. Compared with placebo, no-treatment or less-complex treatment, combination treatments of any complexity (mean number of drugs, 1.40 vs. 0.41, 2.32 vs. 0.48, 2.56 vs. 1.62 and 3.14 vs. 2.19) were associated with reduction of all or most fatal and nonfatal outcomes. There was also an increased rate of side effects leading to treatment discontinuation, although in absolute numbers the benefit usually prevailed.

Conclusion:
These data provide randomized-based trial evidence that antihypertensive combination treatment up to three or more drugs is protective. The net benefit, however, may be attenuated when side effects are considered.
Oropharyngeal Carriage of Kingella kingae and Transient Synovitis of the Hip in Young Children: A Case-control Study
Authors: Gravel Jocelyn , Manzano Sergio , Nault Marie-Lyne , Vallières Émilie , Rallu Fabien , Renaud Christian 
Published: January 2021

Background:
Transient synovitis of the hip affects mostly preschool children, and its etiology is unknown. Kingella kingae has been identified recently as a common etiologic agent of osteoarticular infections (OAI) in young children and could potentially be associated to transient synovitis of the hip. The main objective of this study was to evaluate the association between transient synovitis of the hip and oropharyngeal carriage of K. kingae among preschool children.

Methods:
This was a prospective case-control study conducted at a tertiary care pediatric emergency department. Cases were children between 6 and 71 months of ages with a diagnosis of transient synovitis of the hip. For each transient synovitis case, an age-matched control was recruited among children presenting for a trauma. A second control group included children with any OAI. The independent variable was the presence of oropharyngeal K. kingae identified by a specific polymerase chain reaction assay. The primary analysis was the association between oropharyngeal K. kingae carriage and final diagnosis.

Results:
A total of 73 children were included in the study. Among them, 25 had a transient synovitis, 16 an OAI, and 22 controls. Baseline demographics were similar between the groups. There was no difference in oropharyngeal carriage of K. kingae for children with transient synovitis (5/25; 0.20) in comparison to controls (3/22; 0.14), while it was higher for children with OAI (10/16; 0.63).

Conclusions:
There is no association between oropharyngeal K. kingae and transient synovitis of the hip among preschool children.
Genotype distribution, clinical characteristics, and racial differences observed in chronic hepatitis C patients in Pingtung, Taiwan
Authors: Jang Tyng-Yuan , Liang Po-Cheng , Liu Ta-Wei , Wei Yu-Ju , Yeh Ming-Lun , Hsu Cheng-Ting , Hsu Po-Yao , Lin Yi-Hung , Hsieh Meng-Hsuan , Huang Ching-I , Huang Chung-Feng , Lin Zu-Yau , Chen Shinn-Cherng , Huang Jee-Fu , Dai Chia-Yen , Yu Ming-Lung , Chuang Wan-Long 
Published: January 2021

Background:
The World Health Organization (WHO) set out to eliminate hepatitis C virus (HCV) infection by 2030, a goal Taiwan might achieve before 2025. Using effective direct antiviral agents (DAAs) against chronic hepatitis C (CHC) in Taiwan, the treatment of CHC has been initiated in rural areas. Here, we aimed to elucidate the clinical and virological characteristics of HCV infection, and the treatment efficacy of DAAs in patients from Pingtung county in southern Taiwan.

Methods:
A total of 152 chronic hepatitis patients treated with DAAs were consecutively enrolled. Baseline characteristics and therapeutic efficacy were evaluated.

Results:
HCV genotype 2 was the most common viral genotype (39.5%), followed by 1b (36.8%), 6 (10.5%), and 1a (9.2%). The sustained virological response (SVR) rate was 98.7%. Hakka patients accounted for 22.4% of the study cohort, of which 14.7% had HCV genotype 6. There were no differences in clinical characteristics between Hakka and non-Hakka patients. Patients with HCV genotype 6 were younger in age (OR/CI: 0.95/0.91-1.00, p = 0.04) and composed of more people who inject drugs (PWID) (OR/CI: 17.6/3.6-85.5, p <0.001), when compared with other patients.

Conclusion:
We demonstrated that DAA therapy can achieve a 98.7% SVR rate among CHC patients in Pingtung county of southern Taiwan, with a relative higher prevalence of genotype 6. The most important factor attributed to genotype 6 infection was PWID.
RISE: Exploring Volunteer Retention and Sustainability of a Second Victim Support Program
Authors: Connors Cheryl A. , Dukhanin Vadim , Norvell Matt , Wu Albert W. 
Published: January 2021

EXECUTIVE SUMMARY
The Resilience In Stressful Events (RISE) program that supports healthcare professionals traumatized by stressful clinical events has had a stable, volunteer-based membership since its inception in 2011 at Johns Hopkins Hospital. For this study, we explored RISE members’ perceptions of the program that contribute to their retention and the program’s sustainability. We distributed a survey with quantitative and qualitative elements to assess perceptions in seven domains of interest. The response rate was 100%. Pearson chi-squared tests established statistical associations among quantitative variables. Qualitative data were explored using content analysis. Of 27 respondents, 19 had been members for 3 or more years. The training completion percentage was 100%, and the annual turnover percentage was 12%. Members found their duties to be meaningful (100%), personally satisfying (96%), and positively impactful (93%). A total of 89% reported confidence in their competency to perform RISE duties, 84% in their autonomy, and 56% in their personal resilience; 28% reported some burnout from RISE duties. Cronbach’s α for these domain scores ranged from 0.65 to 0.97. Content analysis also revealed positive perceptions of RISE volunteering and personal empowerment. Members indicated a personal affinity with RISE and gains in energy and enjoyment from their membership. Contributing factors to volunteer retention may include members’ perceptions that RISE builds valued skills and supports their affinity for others.
Examining the Acceptability of a Resilience Building Intervention Among Adults Aging With HIV
Authors: Fazeli Pariya L. , Hopkins Cierra N. , Wells Andrea , Lambert Crystal Chapman , Turan Bulent , Kempf Mirjam-Colette , Vance David E. 
Published: January 2021

Abstract
Few interventions have targeted resilience resources in people living with HIV (PLWH). We tested the acceptability of an existing resilience intervention in middle-age and older PLWH. Fourteen PLWH attended one 3-hr group session, which included videos, quizzes, and written activities. Participants provided quantitative and qualitative feedback. The mean acceptability rating was 8.71 (1.27) on a 10-point scale. A majority of participants reported that the intervention was an appropriate length; that it improved their resilience, mood, and ability to manage HIV; and that they would likely continue using the tools. Average content retention accuracy was 75% (12.66). Qualitative feedback suggested addressing HIV-specific stressors, including disclosure concerns, stigma, health concerns, and treatment adherence. The resilience intervention was deemed highly acceptable among older PLWH. Uptake may increase by addressing HIV-specific stressors and improving comprehensibility. Future research should further refine and test the efficacy of a modified version of the intervention.