bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Live Surgery Meetings: Our Experience with the “Live Makeover Aesthetic Surgery Symposium”
Authors: Skouras George , Skouras Athanasios , Skoura Elena 
Published: January 2021

Background:
Live Surgery Meetings have been established as a vey effective means to demonstrate certain surgical techniques and intraoperative decision-making. However, many authors still question the ethics of this approach. We present our experience as organizers of the Live Makeover Aesthetic Surgery Symposium, an annual international live surgery meeting taking place in Athens, Greece.

Methods:
Throughout the course of our meetings, 2 surveys were performed, 1 after Live Makeover Aesthetic Surgery Symposium 3, comparing the educational value between live surgery and pre-recorded videos, and the second after LMASS 6, re-evaluating the educational value of live surgery, as well as the ethics of this educational method and the patient safety. In addition, we studied the results of the patients operated on in all of our meetings, and their level of satisfaction.

Results:
Based on the results of the first survey, the superior educational value of live surgery was obvious. The second survey confirmed those valuable educational benefits. In addition, the concerns on both surgical outcomes and patient safety were minimal. The patients showed a very high level of satisfaction through their answers. The complications encountered were only 2 of the 49 live surgical demonstrations and were not directly related to the live demonstration.

Conclusions:
Based on our study, live surgery is an effective, safe educational tool. However, strict guidelines have to be followed to ensure high educational value and patient safety. Based on our 9-year experience with our live surgery meeting, we provide detailed guidelines for optimal outcomes.
Classification of Transgender Man’s Breast for Optimizing Chest Masculinizing Gender-affirming Surgery
Authors: Wolf Yoram , Kwartin Samuel 
Published: January 2021

Background:
The purpose of mastectomy for the female-to-male transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique; these have generally been based on the degree of breast ptosis and the quality and elasticity of the skin. We present a series of subcutaneous mastectomies operated on by 1 surgeon during the last 2 decades. Based on our experience, we suggest a classification system for selecting surgical technique.

Methods:
Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003–2019. The data included background and surgery information. Pictures from the clinic’s archive of the patients before, during, and after surgery were collected and analyzed.

Results:
In total, 220 mastectomies were performed on 110 patients aged 13.5–50 years (mean 22.5 ±6.1). The excision averaged 443 g per breast (range: 85–2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple–areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple–areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple–areola complex graft in 56 (50.9%). Complications included 2 hypertrophic scars, 6 hematomas requiring revision surgery, 3 wound dehiscences, and 3 cases of partial nipple necrosis.

Conclusions:
Analysis of the data led to a proposed classification for female-to-male transgender mastectomy (Wolf’s classification), based on skin excess and the distance between the original and the planned position of the nipple–areola complex.
Mediterranean diet and antihypertensive drug use: a randomized controlled trial
Authors: Ribó-Coll Margarita , Lassale Camille , Sacanella Emilio , Ros Emilio , Toledo Estefanía , Sorlí José V. , Babio Nancy , Lapetra José , Gómez-Gracia Enrique , Alonso-Gómez Ángel M. , Fiol Miquel , Serra-Majem Lluis , Pinto Xavier , Castañer Olga , Díez-Espino Javier , González José I. , Becerra-Tomás Nerea , Cofán Montserrat , Díaz-López Andrés , Estruch Ramón , Hernáez Álvaro 
Published: January 2021

Objective:
To examine in older individuals at high cardiovascular risk whether following a Mediterranean diet decreased the necessity of antihypertensive drugs and modulated their associated cardiovascular risk.

Methods:
In the PREvención con DIeta MEDiterránea study, we assessed whether volunteers randomly allocated to an intervention with a Mediterranean diet enriched with extra-virgin olive oil or nuts (relative to a low-fat control diet) disclosed differences in the risk of: initiating antihypertensive medication in nonusers at baseline (n = 2188); and escalating therapy in participants using one, two, or three drugs at baseline (n = 2361, n = 1579, and n = 554, respectively). We also assessed whether allocation to Mediterranean diet modified the association between antihypertensive drug use and incident cardiovascular events.

Results:
Participants allocated to Mediterranean diet interventions were associated with lower risk of initiating antihypertensive therapy [5-year incidence rates: 47.1% in the control diet, 43.0% in MedDiets; hazard ratio = 0.84, 95% CI (0.74--0.97), in a model adjusted for age, sex, and recruitment site]. Volunteers using two drugs at baseline in the Mediterranean diet intervention enriched with extra-virgin olive oil decreased their risk of therapy escalation [5-year incidence rates: 22.9% in the control diet, 20.1% in the MedDiet; hazard ratio = 0.77, 95% CI (0.60--0.99)]. Allocation to Mediterranean diet interventions attenuated the association between antihypertensive therapy at baseline and incidence of major adverse cardiovascular events (P interaction = 0.003).

Conclusion:
In an older population at high cardiovascular risk, following a Mediterranean diet reduced the risk of initiating or escalating antihypertensive medication and attenuated cardiovascular risk in antihypertensive drug users.
22q11 MICRODELETION (DIGEORGE) SYNDROME WITH MICROVASCULAR MACULOPATHY
Authors: Chaudhry Sarah G. , Fung Adrian T. 
Published: January 2021

Purpose:
To describe a novel retinal finding of 22q11 microdeletion syndrome.

Methods:
Retrospective chart review of a single patient.

Results:
A 32-year-old man with genetically confirmed 22q11.2 microdeletion syndrome was found to have bilateral tortuous retinal vessels and right microvascular microangiopathy with microaneurysms, hard exudate, and cystoid macular oedema. Other underlying causes for this including diabetic and hypertensive retinopathy were excluded. No treatment was required because he was asymptomatic, and the visual acuity remained 20/30 in that eye with over one year of follow-up.

Conclusion:
22q11 microdeletion syndrome can be associated with microvascular microangiopathy.
The dual role of HMGB1 in pancreatic cancer
Authors: Kang Rui , Tang Daolin 
Published: January 2021

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of exocrine pancreatic cancer with a 9% 5-year survival rate. High mobility group box 1 (HMGB1) is a nuclear protein that can act as a DNA chaperone in the sustainment of chromosome structure and function. When released into the extracellular space, HMGB1 becomes the most well characterized damage-associated molecular pattern (DAMP) to trigger immune responses. Recent evidence indicates that intracellular HMGB1 is a novel tumor suppressor in PDAC, which is connected to its role in the prevention of oxidative stress, genomic instability, and histone release. However, since extracellular HMGB1 is a DAMP and proinflammatory cytokine, cancer cells can also exploit it to survive through the receptor for advanced glycation endproducts (RAGE) in the pancreatic tumor microenvironment. Interestingly, targeting the HMGB1-RAGE pathway has become a new anti-cancer therapy strategy for PDAC.
A Chinese consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency after pancreatic surgery (2018)
Authors: Zhang Taiping , Cao Zhe , Chen Rufu , Du Yiqi , Hong Defei , Jiang Kuirong , Jin Gang , Li Fei , Li Weiqin , Li Zhaoshen , Liang Tingbo , Liao Quan , Lou Wenhui , Miao Yi , Qian Jiaming , Qin Renyi , Sun Bei , Tang Zhaohui , Wang Chunyou , Wang Weilin , Wu Wenming , Yang Yinmo , Zhao Gang , Zhao Yupei 
Published: January 2021

Abstract
A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) after pancreatic surgery was developed based on the latest references, combined with China's actual situation. More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions. This consensus discusses the definition, epidemiology, diagnosis, treatment, and follow-up of PEI after pancreatic surgery. The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.
Management of inadequate weight loss or weight regain in post-bariatric surgical patients
Authors: Sahebzamani Frances M. 
Published: January 2021

ABSTRACT
Nurse practitioners play a key role in the front-line treatment of obesity in primary care practice settings. National guidelines for the management of obesity are provided by a majority of national organizations, yet little guidance is provided for the management of post-bariatric surgical patients who experience inadequate weight loss or early weight regain. As the number of surgical procedures increases, guidelines and interventions for managing this complex outcome are needed.
The influence of the gut microbiome on obesity
Authors: Blanco Christy 
Published: January 2021

ABSTRACT
Obesity is a disease with multiple environmental and genetic factors, which when combined contribute to the maintenance of an elevated body weight, thereby reducing long-term success of weight loss. The human gut microbiome is becoming a new potential contributor to obesity. Specifically, gut bacteria and their metabolites are known to affect dysbiosis, metabolism, endotoxemia, and inflammation. Many environmental and lifestyle factors can alter the gut microbiota affecting obesity. Potential therapies to alter the gut microbiota include supplementation with probiotic organisms and the use of fecal microbiota transplantation. This review will examine the growing evidence supporting the mechanisms with which the human gut microbiota may influence obesity, various influences on the microbiota, and potential therapies.
Recognizing obesity as a disease
Authors: Christensen Sandra 
Published: January 2021

ABSTRACT
Obesity is a chronic, progressive, relapsing disease that impairs health and quality of life and shortens lifespan. Genetic and environmental factors contribute to its development and persistence. If left untreated, it worsens and leads to serious health consequences for those affected, as well as their offspring and future generations. Obesity complications drive many of the conditions that are seen routinely in clinical practice. By treating obesity first, many of these conditions improve or resolve. Given the seriousness of the disease, it is imperative that clinicians in primary and specialty care settings diagnose and treat or refer so that patients can receive appropriate treatment. Evidence-based treatment that is individualized and patient centered improves health and quality of life.
Cytologic and Histologic Aspects of High-Grade Transformation of Salivary Gland Carcinoma
Authors: Nakaguro Masato , Faquin William C. , Sadow Peter M. 
Published: January 2021

Abstract
High-grade transformation (HGT) is a process whereby low- to intermediate-grade carcinomas transform into high-grade, poorly differentiated, or undifferentiated carcinomas. In salivary gland tumor pathology, several terminologies, including dedifferentiation or hybrid tumor, have been adopted to describe tumors that do not fit into one distinct tumor type. As HGT confers a poor prognosis despite initial tumor type, the finding of HGT must be recognized for optimal patient management. Preoperative fine-needle aspiration biopsy is typically positive for malignancy, but the recognition of both low- and high-grade components is not always possible and, if only the latter present, may obscure the tumor subtype from which the HGT derives. Most HGTs occur in association with acinic cell carcinoma and adenoid cystic carcinoma, but have also been seen with epithelial-myoepithelial carcinoma, secretory carcinoma, and mucoepidermoid carcinoma.
Ancillary Testing of Salivary Gland Fine-Needle Aspiration Biopsy Material
Authors: Wong Kristine S. , Krane Jeffrey F. 
Published: January 2021

Abstract
Salivary gland tumors are often challenging to diagnose, particularly in cytologic material. Advances in our understanding of the molecular alterations in different salivary neoplasms have improved the ancillary testing tools available to resolve diagnostic uncertainty and refine clinical management options. Using a morphologically based approach focused on common basaloid and oncocytic/clear cell tumors, this review discusses the current role of immunohistochemical and fluorescence in situ hybridization–based testing as tools for diagnosing salivary gland tumors in fine-needle aspiration biopsy specimens.
Circumferential Lipobrachioplasty Is a Safe Procedure
Authors: Ahmad Mahfouz S. I. 
Published: January 2021

Background:
Excess fat and skin in the upper arms have become troublesome with aging and especially after the advancement in methods of weight reduction. Arm contouring procedures can be divided into three groups: those dealing with skin redundancy, those dealing with the lipodystrophy, and a combination of both. This study tries to find an answer to the debate about the safety of simultaneous circumferential liposuction and brachioplasty.

Methods:
Sixty-two patients (49 women and 13 men) were operated on by simultaneous circumferential suction-assisted lipectomy followed by brachioplasty. Preoperative and postoperative arm circumferences and outcomes (including complications and patient satisfaction) were evaluated starting at least 6 months after the procedure.

Results:
Only two patients (3.2 percent) developed small areas of wound dehiscence that healed after repeated dressing and an extended period of compression garment use. One patient (1.6 percent) complained of hypertrophic scarring, which was managed by local compression and silicone sheets. The average reduction in mid arm circumference was 9 cm (range, 5 to 14 cm). Approximately 95.2 percent of the patients in the study are highly satisfied, and 4.8 percent reported a mild degree of satisfaction.

Conclusions:
Simultaneous circumferential arm liposuction followed by brachioplasty addresses both the lipodystrophy and arm ptosis in a single hospital admission. This combination does not increase the complication rate. The results are highly satisfactory to the patients. According to the results of this study, circumferential arm lipobrachioplasty is considered to be a safe, efficient, reliable, and feasible procedure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Extending the Reach of Craniofacial Free Flaps Using the Descending Branch of the Lateral Circumflex Femoral Vessels
Authors: Frommer Sarah A. , Teal Lindsey N. , Myers René P. , Kelley Patrick K. , Henry Steven L. 
Published: January 2021

Summary:
Craniofacial free tissue transfer is sometimes complicated by insufficient pedicle length and/or paucity of recipient vessels. A saphenous vein graft can be used to reach the high-flow, large-caliber vessels of the neck, but because of the vein’s taper and thick wall, there is often a mismatch. Following the principle of like-for-like, the authors prefer the descending branch of the lateral circumflex femoral vessels to achieve a more anatomical pedicle extension for free tissue transfer in complex craniofacial reconstruction. The authors’ experience using the descending branch of the lateral circumflex femoral pedicle extender from 2010 to 2019 was reviewed. Indications, patient characteristics, reconstruction site, flap type, pedicle length, recipient vessels, and vascular complications were noted. The authors reviewed two strategies for implementation of the pedicle extender: in some cases, the flap was first transferred and allowed to perfuse on the descending branch of the lateral circumflex femoral vessels in the thigh, and then transferred to the recipient vessels (double-ischemia transfer); and in other cases, the flap and pedicle extender were transferred such that the flap underwent a single period of ischemia (single-ischemia transfer). The descending branch of the lateral circumflex femoral pedicle extender was used in 17 craniofacial cases. Indications included tumor, trauma, osteoradionecrosis, and congenital. Double-ischemia transfer was used in eight cases and single-ischemia transfer in nine. The longest pedicle extender in the series was 15 cm. Arterial thrombosis occurred in one case. This case series demonstrates that the descending branch of the lateral circumflex femoral pedicle extender is a viable option for complex craniofacial free tissue transfer cases. It provides ample length and excellent vessel match, following the like-for-like principle.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Three-Dimensional Analysis and Surgical Planning for Open Correction of Trigonocephaly
Authors: Maniskas Seija , Chandler Ludmila , Bruckman Karl , Pourtaheri Navid , DiLuna Michael , Steinbacher Derek M. 
Published: January 2021

Summary:
Metopic craniosynostosis results in trigonocephaly, characterized by a triangular forehead with metopic ridge, bitemporal pinching, and narrow-set eyes with recessed lateral orbital rims. Surgical management is controversial but may include open expansion and vault remodeling, to enhance neurocognitive and aesthetic outcomes. This article and video vignette depict the diagnosis and treatment of metopic craniosynostosis, demonstrating the senior author’s open approach, three-dimensional virtual surgical planning, and technical steps.
Reverse Lymph Node Mapping Using Indocyanine Green Lymphography: A Step Forward in Minimizing Donor-Site Morbidity in Vascularized Lymph Node Transfer
Authors: Pons Gemma , Abdelfattah Usama , Sarria Jose , Duch Joan , Masia Jaume 
Published: January 2021

Background:
Reverse lymphatic mapping before harvesting a lymph node flap is crucial to avoid donor-site lymphedema; however, the technique is complex and unavailable in many centers. The authors introduce radioisotope-free reverse lymphatic mapping using indocyanine green and Patent Blue dye.

Methods:
The authors conducted a prospective study in patients undergoing free vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. The day before surgery, 0.2 ml of technetium-99 was injected into the first and second web spaces of the ipsilateral foot. The following day, once the patient was anesthetized, indocyanine green was injected into the same web spaces of the same foot and Patent Blue dye was injected just proximal to the upper margin of the skin paddle of the lymph node flap. The main lymph nodes draining the limb were localized using indocyanine green lymphography and gamma probe.

Results:
Thirty-nine patients underwent vascularized groin lymph node transfer with or without deep inferior epigastric artery perforator flap breast reconstruction. Navigation of the main lower extremity draining inguinal lymph nodes using the gamma probe and indocyanine green lymphography was identical in all patients. The blue-stained lymphatics in the skin paddle drained to the superficial proximal inguinal lymph node and were targeted for transfer. No donor-site lymphedema was reported, and lymphatic drainage of the lower extremity was preserved in all cases.

Conclusions:
Reverse lymphatic mapping using indocyanine green lymphography provides identical results to those using technetium-99 isotope scanning. However, indocyanine green is preferable in terms of safety and reproducibility and also avoids the complexity and hazards of radioisotope mapping.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Therapeutic cardiac arrest as an adjunct to resuscitative endovascular balloon occlusion of the aorta: Bridging the gap from fatal hemorrhage to definitive surgical control in swine
Authors: Stigall Kyle S. , Neidert Leslie E. , Morgan Clifford G. , Hemond Peter J. , Brown Dallas R. , Salas Mary , Hathaway Emily N. , Tiller Michael M. , Cardin Sylvain , Glaser Jacob J. 
Published: January 2021

BACKGROUND
Uncontrolled hemorrhage is the leading cause of potentially survivable combat casualty mortality, with 86.5% of cases resulting from noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive technique used to stabilize patients with noncompressible torso hemorrhage; however, its application can take an average of 8 minutes to place. One therapeutic capable of bridging this gap is adenosine-lidocaine-magnesium (ALM), which at high doses induces a reversible cardioplegia. We hypothesize by using ALM as an adjunct to REBOA, the ALM-induced cardiac arrest will temporarily halt exsanguination and reduce blood loss, allowing for REBOA placement and control of bleeding.

METHODS
Male Yorkshire swine (60–80 kg) were randomly assigned to REBOA only or ALM-REBOA (n = 8/group). At baseline, uncontrolled hemorrhage was induced via a 1.5-cm right femoral arteriotomy, and hemorrhaged blood was quantified. One minute after injury (S1), ALM was administered, and 7 minutes later (T0), zone 1 REBOA inflation occurred. If cardiac arrest ensued, cardiac function either recovered spontaneously or advanced life support was initiated. At T30, surgical hemostasis was obtained, and REBOA was deflated. Animals were resuscitated until they were humanely euthanized at T90.

RESULTS
During field care phase, heart rate and end-tidal CO2 of the ALM-REBOA group were significantly lower than the REBOA only group. While mean arterial pressure significantly decreased from baseline, no significant differences between groups were observed throughout the field care phase. There was no significant difference in survival between the two groups (ALM-REBOA = 89% vs. REBOA only = 100%). Total blood loss was significantly decreased in the ALM-REBOA group (REBOA only = 24.32 ± 1.89 mL/kg vs. ALM-REBOA = 17.75 ± 2.04 mL/kg, p = 0.0499).

CONCLUSION
Adenosine-lidocaine-magnesium is a novel therapeutic, which, when used with REBOA, can significantly decrease the amount of blood loss at initial presentation, without compromising survival. This study provides proof of concept for ALM and its ability to bridge the gap between patient presentation and REBOA placement.