bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilizing Age of Menarche to Optimize Pediatric Rhinoplasty
Authors: Khetpal Sumun , Dinis Jacob , Peck Connor , Parsaei Yassmin , Lopez Joseph , Steinbacher Derek M. 
Published: September 2021

Background/Purpose:
Pediatric septorhinoplasty has sparked controversial debate amongst craniofacial surgeons, particularly due to its potential growth disturbances of the face and nose. The purpose of this study is (1) to conduct a systematic literature review that explores unique considerations and limitations associated with performing rhinoplasty in the pediatric population; (2) to discuss objective indicators for determining craniofacial skeleton maturation; (3) to perform a case series to further understand whether the age of menarche serves as a good proxy for estimating the time of facial growth maturation, and by extension, whether a post-menarchal patient is a suitable candidate for rhinoplasty.

Methods:
Systematic literature review was performed in order to assess unique considerations and limitations of pediatric rhinoplasty. Retrospective chart review and anthropometric (9 linear, 3 angular, 6 indices) measurements were performed for ten pediatric female patients who underwent open septo-rhinoplasty. Follow-up times ranged from 66 to 103 weeks. Patients were separated into 2 cohorts according to age at the time of menarche. Cohort 1 consisted of patients who had undergone menses for longer than 2 years at the time of rhinoplasty, whereas Cohort 2 comprised of patients who either had menses within 2 years of rhinoplasty or did not have menses at the time of rhinoplasty. Data included demographic factors, procedural variables, revision surgeries, and complications. Measurements were conducted using VECTRA software (Canfield Scientific, Parsippany, NJ). Differences in measurements between the 2 postoperative timepoints were compared.

Results:
Literature review yielded 17 articles, which had conflicting opinions regarding pediatric rhinoplasty and ultimately, highlighting the need for a more objective tool for guiding the decision to perform rhinoplasty.
Patients in Cohort 1 had minimal deviations in measurements over time, within the exception of an increase in nasal tip projection and a decrease in nasolabial angle and facial width. Patients in Cohort 2 had decreases in facial height, upper facial height, nasal tip angle, and nasofrontal angle. Nasolabial angle decreased for both cohorts. Of the ten patients, 1 in Cohort 2 underwent revision rhinoplasty.

Conclusions:
Our case series suggests that anthropometric measurements remain relatively more stable for patients who have undergone menses for more than 2 years, compared to those who have not. Although this study has limitations, further investigation is warranted in order to determine whether age of menarche may serve as a useful tool for craniofacial surgeons in guiding the decision to perform rhinoplasty.
Major Complications and Associated Risk Factors for Osseous Genioplasty With Bimaxillary Orthognathic Surgery: An American College of Surgeons-National Surgical Quality Improvement Program Analysis
Authors: Jazayeri Hossein E. , Parsaei Yassmin , Peck Connor J. , Henry Andrew , Lopez Joseph , Steinbacher Derek M. 
Published: September 2021

Purpose:
Patients with significant dentofacial deformities undergoing aesthetic and functional orthognathic surgery may often require genioplasty to advance the position of the pogonion relative to B point. No study to date has evaluated nationally registered data pertaining to addition of osseous genioplasty to bimaxillary orthognathic surgery and its associated clinical outcomes.

Methods:
Data was extracted from the National Surgical Quality Improvement Program from 2010 to 2018 using current procedural terminology codes pertaining to Le Fort I osteotomy (LF), bilateral sagittal split osteotomy (BSSO), and osseous genioplasty (G) and divided into 2 cohorts: bimaxillary orthognathic surgery with and without osseous genioplasty. Thirty-day postoperative outcomes inherently recorded within National Surgical Quality Improvement Program were identified and recorded. Chi-squared analysis and unpaired 2-tail t tests were performed between the cohorts and their respective outcomes to determine significant relationships with significance set as P < 0.05.

Results:
There were 373 patients double- or triple-jaw patients identified from the years 2010 to 2018. The most common recorded indication for LF/BSSO was maxillary hypoplasia (27.3%) and mandibular hypoplasia (6.8%). The most common indications for LF/BSSO/G were maxillary hypoplasia (16.1%) and maxillary asymmetry (16.1%). In comparison to LF/BBSO only, LF/BSSO/GP was not associated with any differences in the rate of surgical (0.0% versus 0.31%, P = 0.72) or medical complications (0.0% versus 0.63%, P = 0.60), in addition to unplanned readmissions (0.0% versus 1.56% versus P = 0.41) or reoperations (0.0% versus 1.25%, P = 0.46). However, osseous genioplasty addition was associated with increased overall operating time (271.77 versus 231.75 minutes, P = 0.04).

Conclusions:
Osseous genioplasty does not alter short-term, 30-day complication rate when performed with bimaxillary orthognathic surgery. As reoperation rates remained relatively unchanged, it can be inferred that immediate adverse events or patient dissatisfaction were not apparent within 30 days. Although mean operating time is slightly longer, cardiopulmonary resuscitation without medical comorbidity was achieved at the conclusion of the procedure.
Reconstruction of Extensive Periorbital Defects With Pericranial Flap
Authors: Gümüş Nazim , Gümüş Zehra Betül 
Published: September 2021

Abstract
Wide excision of recurrent malignant tumors of periorbital region leaves deep and large composite defects, requiring a reconstruction to restore both the form and function of the eyelids. In this study, a pericranial flap was utilized in the reconstruction of large, complex defects of periorbital region.
This study included 5 patients who underwent wide excision of recurrent large medial canthus and supraorbital rim malignant tumors. All defects involved the medial parts of eyelids including medial canthal ligaments, nasal walls, periosteum, and medial orbital walls. Defects were reconstructed via a pericranial flap, which was facilitated by the natural concavity and the acute angled nature of the medial canthus.
The pericranial flap is not only a versatile alternative to the local or regional flaps in the reconstruction of periorbital defects, but also has the advantages of availability of abundant amount of flap tissue.
Lingual Arteriovenous Malformation With Bleeding Treated With Polidocanol Foam Sclerotherapy Using Intestinal Forceps to Control Blood Flow
Authors: Sasaki Yuki , Sasaki Satoru , Ishikawa Kosuke 
Published: September 2021

Abstract
Arteriovenous malformation (AVM) sometimes causes hemorrhage that can be fatal. We report a case of AVM of the tongue with bleeding that was treated by semi-emergent sclerotherapy with polidocanol. A 33-year-old woman presented with Schobinger stage III AVM of the tongue. Sclerotherapy with 3% polidocanol foam was performed under general anesthesia using curved intestinal forceps to clamp the root of the tongue for control of blood flow. Postoperatively, there was no further bleeding from the lesion. Three subsequent sclerotherapy sessions with polidocanol were performed, and there was a marked reduction in the size of the lesion. The lesion has remained well controlled in the year since the last sclerotherapy session.
Ex vivo normothermic preservation of amputated limbs with a hemoglobin-based oxygen carrier perfusate
Authors: Figueroa Brian A. , Said Sayf A. , Ordenana Carlos , Rezaei Majid , Orfahli Lynn M. , Dubé Gregory P. , Papay Francis , Brunengraber Henri , Dasarathy Srinivasan , Rampazzo Antonio , Gharb Bahar Bassiri 
Published: September 2021

BACKGROUND
Ex vivo normothermic limb perfusion (EVNLP) preserves amputated limbs under near-physiologic conditions. Perfusates containing red blood cells (RBCs) have shown to improve outcomes during ex vivo normothermic organ perfusion, when compared with acellular perfusates. To avoid limitations associated with the use of blood-based products, we evaluated the feasibility of EVNLP using a polymerized hemoglobin-based oxygen carrier-201 (HBOC-201).

METHODS
Twenty-four porcine forelimbs were procured from Yorkshire pigs. Six forelimbs underwent EVNLP with an HBOC-201-based perfusate, six with an RBC-based perfusate, and 12 served as static cold storage (SCS) controls. Ex vivo normothermic limb perfusion was terminated in the presence of systolic arterial pressure of 115 mm Hg or greater, fullness of compartments, or drop of tissue oxygen saturation by 20%. Limb contractility, weight change, compartment pressure, tissue oxygen saturation, oxygen uptake rates (OURs) were assessed. Perfusate fluid-dynamics, gases, electrolytes, metabolites, methemoglobin, creatine kinase, and myoglobin concentration were measured. Uniformity of skin perfusion was assessed with indocyanine green angiography and infrared thermography.

RESULTS
Warm ischemia time before EVNLP was 35.50 ± 8.62 minutes (HBOC-201), 30.17 ± 8.03 minutes (RBC) and 37.82 ± 10.45 (SCS) (p = 0.09). Ex vivo normothermic limb perfusion duration was 22.5 ± 1.7 hours (HBOC-201) and 28.2 ± 7.3 hours (RBC) (p = 0.04). Vascular flow (325 ± 25 mL·min−1 vs. 444.7 ± 50.6 mL·min−1; p = 0.39), OUR (2.0 ± 1.45 mL O2·min−1·g−1 vs. 1.3 ± 0.92 mL O2·min−1·g−1 of tissue; p = 0.80), lactate (14.66 ± 4.26 mmol·L−1 vs. 13.11 ± 6.68 mmol·L−1; p = 0.32), perfusate pH (7.53 ± 0.25 HBOC-201; 7.50 ± 0.23 RBC; p = 0.82), flexor (28.3 ± 22.0 vs. 27.5 ± 10.6; p = 0.99), and extensor (31.5 ± 22.9 vs. 28.8 ± 14.5; p = 0.82) compartment pressures, and weight changes (23.1 ± 3.0% vs. 13.2 ± 22.7; p = 0.07) were not significantly different between HBOC-201 and RBC groups, respectively. In HBOC-201 perfused limbs, methemoglobin levels increased, reaching 47.8 ± 12.1% at endpoint. Methemoglobin saturation did not affect OUR (ρ = −0.15, r2 = 0.022; p = 0.45). A significantly greater number of necrotic myocytes was found in the SCS group at endpoint (SCS, 127 ± 17 cells; HBOC-201, 72 ± 30 cells; RBC-based, 56 ± 40 cells; vs. p = 0.003).

CONCLUSION
HBOC-201- and RBC-based perfusates similarly support isolated limb physiology, metabolism, and function.
Plasma metagenomic sequencing to detect and quantify bacterial DNA in ICU patients suspected of sepsis: A proof-of-principle study
Authors: Kisat Mehreen T. , Odenheimer-Bergman Ahuva , Markus Havell , Joseph Bellal , Srivatsan Sridhar N. , Contente-Cuomo Tania , Khalpey Zain , Keim Paul , O’Keeffe Terence , Askari Reza , Salim Ali , Rhee Peter , Murtaza Muhammed 
Published: September 2021

BACKGROUND
Timely recognition of sepsis and identification of pathogens can improve outcomes in critical care patients but microbial cultures have low accuracy and long turnaround times. In this proof-of-principle study, we describe metagenomic sequencing and analysis of nonhuman DNA in plasma. We hypothesized that quantitative analysis of bacterial DNA (bDNA) levels in plasma can enable detection and monitoring of pathogens.

METHODS
We enrolled 30 patients suspected of sepsis in the surgical trauma intensive care unit and collected plasma samples at the time of diagnostic workup for sepsis (baseline), and 7 days and 14 days later. We performed metagenomic sequencing of plasma DNA and used computational classification of sequencing reads to detect and quantify total and pathogen-specific bDNA fraction. To improve assay sensitivity, we developed an enrichment method for bDNA based on size selection for shorter fragment lengths. Differences in bDNA fractions between samples were evaluated using t test and linear mixed-effects model, following log transformation.

RESULTS
We analyzed 72 plasma samples from 30 patients. Twenty-seven samples (37.5%) were collected at the time of infection. Median total bDNA fraction was 1.6 times higher in these samples compared with samples with no infection (0.011% and 0.0068%, respectively, p < 0.001). In 17 patients who had active infection at enrollment and at least one follow-up sample collected, total bDNA fractions were higher at baseline compared with the next sample (p < 0.001). Following enrichment, bDNA fractions increased in paired samples by a mean of 16.9-fold. Of 17 samples collected at the time when bacterial pathogens were identified, we detected pathogen-specific DNA in 13 plasma samples (76.5%).

CONCLUSION
Bacterial DNA levels in plasma are elevated in critically ill patients with active infection. Pathogen-specific DNA is detectable in plasma, particularly after enrichment using selection for shorter fragments. Serial changes in bDNA levels may be informative of treatment response.

LEVEL OF EVIDENCE
Epidemiologic/Prognostic, Level V.
A Primer on EEG Spectrograms
Authors: Ng Marcus C. , Jing Jin , Westover M. Brandon 
Published: September 2021

Summary:
As continuous brain monitoring becomes a routine part of clinical care, continuous EEG has allowed better detection and characterization of nonconvulsive seizures, and patterns along the ictal–interictal continuum in critically ill patients. However, this increased workload has led many to turn to quantitative EEG whose central tool is the “spectrogram.” Although in relatively wide use, many clinicians lack a detailed understanding of how spectrograms relate to the underlying “raw” EEG signal. This article provides an approachable set of first principles to help clinicians understand how spectrograms encode information about the raw EEG and how to interpret spectrograms to efficiently infer underlying EEG patterns.
Causal Associations of Self-Reported Walking Pace with Telomere Length in 405,981 middle-aged adults: a UK Biobank study
Authors: Dempsey Paddy C. , Musicha Crispin , Rowlands Alex V. , Davies Melanie , Khunti Kamlesh , Razieh Cameron , Timmins Iain , Zaccardi Francesco , Codd Veryan , Nelson Christopher P. , Yates Tom , Samani Nilesh J 
Published: September 2021

ABSTRACTObjectivesWalking pace is a strong marker of functional and health status. We investigated whether walking pace is also associated with leucocyte telomere length (LTL), which is causally associated with several diseases and has been proposed as a marker of biological age.MethodsWe used baseline data from UK Biobank participants recruited from March-2006 to July-2010. Walking pace was self-reported as slow, steady/average, or brisk. Accelerometer-assessed measures of total physical activity and intensity were included to support interpretation of walking pace data. LTL was measured by qPCR assay. Bi-directional Mendelian randomization (MR) analyses were undertaken to inform likely causal directions.ResultsThe analysed cohort comprised 405,981 adults (54% women) with mean age of 56.5 years (SD, 8.1) and body mass index 27.2 kg/m2 (SD, 4.7). Steady/average and brisk walkers had significantly longer LTL compared with slow walkers, with a Z-standardised LTL difference of 0.066 (0.053-0.078) and 0.101 (0.088-0.113), respectively. Associations remained but were attenuated following full covariate adjustment: 0.038 (0.025-0.051) and 0.058 (0.045-0.072), respectively. Accelerometer data (n=86,002) demonstrated a non-linear association between LTL and habitual movement intensity, but not total activity. MR analysis supported a causal association of walking pace on LTL, with an increase in Z-standardised LTL of 0.192 (0.077, 0.306) for each difference in walking pace category. No evidence of a causal association was observed for LTL on walking pace.ConclusionFaster walking pace may be causally associated with longer LTL, which could explain some of the beneficial effects of brisk walking on health status.
Patient-Centered Approach Might Effectively Tackle The Definition Of Progression In Chronic Neurological Diseases: Results From The EmBioProMS Trial In Progressive Multiple Sclerosis
Authors: Abdelhak Ahmed , Krumbholz Markus , Senel Makbule , Havla Joachim , Zettl Uwe K. , Kleiter Ingo , Skripuletz Thomas , Stahmann Alexander , Huss Andre , Antweiler Kai , Gingele Stefan , Kowarik Markus C. , Hoshi Muna-Miriam , Hengstebeck Sandra , Friede Tim , Ludolph Albert C. , Kümpfel Tania , Ziemann Ulf , Tumani Hayrettin 
Published: September 2021

AbstractBackgroundProper identification of disability accumulation in the routine clinical care of progressive multiple sclerosis (PMS) patients is usually a challenging task. Patient-reported outcome measurements (PROMs) can provide a practical, cost-efficient, and remotely accessible tool to assess disease progression.MethodsEmBioProMS is a prospective, multicentric cohort, conducted in 7 specialized MS centers in Germany. PROMs were evaluated at inclusion and compared between patients with retrospective evidence of disease progression in the last two years and those with stable disease. Patients with either primary or secondary progressive MS according to the McDonald criteria 2017 were included in the analysis, while patients with incomplete PROMs scores, MS relapses, other neurological or systemic inflammatory diseases were excluded. The disease progression was assessed using a combined outcome parameter, including EDSS score, timed 25-foot walk test, and nine-hole-peg test.Results185 patients were included in the final analysis (SPMS, n=77; PPMS, n=108). The median age and disease duration were 55 years and 13 years, respectively. Disease progression was diagnosed in 114 of 185 patients (61.6%). BDI-II, MSIS-29, and FSMC scores were worse in patients with evidence of disease progression in the last two years. Patients with any of the included PROMs above the 90th percentile had an odds ratio of 3.8 (95% confidence interval: 1.4–10.6, P=0.01) for having progression in the last two years in a binomial regression model adjusted for age, sex, disease duration, treatment status, center effect, and Expanded Disability Status Scale (EDSS). Similar results were observed in patients with PROM scores in the 80th and 70th percentile (OR: 2.9 and 3.7, P=0.015 and 0.003, respectively).ConclusionPROMs can be a simple and effective way to detect disability worsening in a chronic neurological disease like PMS and, therefore, substantially contribute to better classification and prognostication of the disease course through objective and structural patient-doctor communication.Trial RegistrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien - DRKS), DRKS00020132
Psychosis in Alzheimer’s Disease is Associated with Excitatory Neuron Vulnerability and Post-Transcriptional Mechanisms Altering Synaptic Protein Levels
Authors: DeChellis-Marks MR , Wei Y , Ding Y , Wolfe CM , Krivinko JM , MacDonald ML , Lopez OL , Sweet RA , Kofler J 
Published: September 2021

AbstractAlzheimer’s disease with psychosis (AD+P) is a phenotypic variant of the disease which is associated with a much more rapid deterioration compared to Alzheimer’s disease without psychosis (AD-P). The neurobiological basis of AD+P is poorly understood. AD is thought to be a disease of the synapse, and our previous studies suggest that those with AD+P have a differentially affected synaptic proteome relative to those with AD-P. We previously demonstrated that multiple neuropathologies only account for approximately 18% of the variance in the occurrence of psychosis in AD. In this study, we utilized RNA-sequencing of dorsolateral prefrontal cortex (DLPFC) in a cohort of 80 AD cases to evaluate novel transcriptomic signatures that may confer risk of psychosis in AD. We found that AD+P was associated with a 9% reduction in excitatory neuron proportion compared to AD-P [Mean (SD) AD+P 0.295 (0.061); AD-P 0.324 (0.052), p = 0.026]. Network analysis identified altered expression of gene modules from protein ubiquitination, unfolded protein response, eukaryotic initiation factor 2 (EIF2) signaling and endoplasmic reticulum stress pathways in AD+P. Including cell type proportions and differentially expressed modules with neuropathology measures explained 67.5% of the variance in psychosis occurrence in our AD cohort.
Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort
Authors: Schirle Lori , Jeffery Alvin , Yaqoob Ali , Sanchez-Roige Sandra , Samuels David 
Published: September 2021

ASTRACTBackgroundAlthough electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. There is a need to expand this work to characterize the spectrum of problematic opioid use.MethodsUsing a large academic medical center database, we developed 2 datadriven methods of OUD detection: (1) a Comorbidity Score developed from a Phenome-Wide Association Study of phenotypes associated with OUD and (2) a Textbased Score using natural language processing to identify OUD-related concepts in clinical notes. We evaluated the performance of both scores against a manual review with correlation coefficients, Wilcoxon rank sum tests, and area-under the receiver operating characteristic curves. Records with the highest Comorbidity and Text-based scores were re-evaluated by manual review to explore discrepancies.ResultsBoth the Comorbidity and Text-based OUD risk scores were significantly elevated in the patients judged as High Evidence for OUD in the manual review compared to those with No Evidence (p = 1.3E-5 and 1.3E-6, respectively). The risk scores were positively correlated with each other (rho = 0.52, p < 0.001). AUCs for the Comorbidity and Text-based scores were high (0.79 and 0.76, respectively). Follow-up manual review of discrepant findings revealed strengths of data-driven methods over manual review, and opportunities for improvement in risk assessment.ConclusionRisk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use. This pilot project establishes a foundation for more robust work in the future.