bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implications of COVID-19 on School Services for Children with Disabilities: Opportunities for Interagency Collaboration
Authors: Harris Bryn , McClain Maryellen Brunson , O'Leary Sonja , Shahidullah Jeffrey D. 
Published: February 2021

ABSTRACT:
The transition to virtual and hybrid schooling given the COVID-19 pandemic in the United States has upended the education system and may be widening gaps in service disparities, particularly for children with disabilities. Schools often function as “de facto” service systems for most children with disabilities, particularly those from racially and ethnically minoritized, economically vulnerable, and bilingual populations. The impact of school closures on children with disabilities poses significant ramifications for the medical, behavioral health, and educational systems in which they are served, necessitating the need for pediatric clinicians to collaborate with schools in purposeful ways. This commentary (1) presents an overview of the current guidance for providing school-based services to children with disabilities during the COVID context with many schools operating in virtual or hybrid formats, (2) reviews potential service inequities exacerbated by school closures and lack of on-site services, and (3) offers recommendations for collaborating with school staff and community agencies in support of children and families with disabilities.
Nonsurgical Methods for Penile Augmentation: A Systematic Review
Authors: Salloum Antoine , Bazzi Nagham , Haber Roger 
Published: February 2021

BACKGROUND
There is no standardized approach for nonsurgical techniques for penile augmentation despite the increase of demand for this intervention.

OBJECTIVE
To compare the efficacy and safety between different injection techniques.

MATERIALS AND METHODS
On October 8, 2019, a literature search was performed on PubMed, Embase, Ovid, and Cochrane database. All articles describing penile augmentation were included.

RESULTS
Thirteen studies were included in this article with a total of 1,311 patients. Five studies were prospective cohort. The most commonly described technique was hyaluronic acid fillers with a total of 4 articles and 205 patients. The mean injected volume ranged from 20 to 40 mL. In all included studies, a minority of patients had side effects, but some had disabling complications.

CONCLUSION
There are no defined clinical guidelines for penile augmentation techniques implemented yet. Hyaluronic acid seems to be safe, efficient, and with a high satisfaction score. Further randomized control trials are warranted.

EBM (LEVEL OF EVIDENCE-BASED MEDICINE)
2a.
Prior Botulinum Toxin Treatment Does Not Impact Efficacy or Safety in Clinical Trials: Analysis of DaxibotulinumtoxinA for Injection in the SAKURA Program
Authors: Cohen Joel L. , Green Lawrence J. , Beer Kenneth R. , Liu Yan , Gallagher Conor J. 
Published: February 2021

BACKGROUND
Pivotal studies of approved botulinum toxin type A (BoNTA) formulations for treatment of glabellar lines have mostly included treatment-naive participants, and the impact of prior BoNTA treatment on efficacy and safety is not well documented.

OBJECTIVE
To evaluate whether prior BoNTA treatment affects efficacy, duration of response, and tolerability for treatment of glabellar lines.

METHODS
Adults with moderate or severe glabellar lines treated with DaxibotulinumtoxinA for Injection (DAXI) or placebo from the randomized, double-blind SAKURA 1/2 trials and the open-label SAKURA 3 safety study were analyzed by prior BoNTA treatment status. Efficacy was evaluated using investigator and participant assessments.

RESULTS
In this analysis, 609 participants (52.2% BoNTA-experienced) from the SAKURA 1/2 trials and 2,380 (38.0% BoNTA-experienced) from the SAKURA 3 study were evaluated. Proportion of participants with none or mild glabellar lines and duration of response were similar between the BoNTA-naive and BoNTA-experienced cohorts in both the DAXI and placebo groups. The incidence of adverse events was also comparable regardless of prior BoNTA treatment status.

CONCLUSION
Efficacy and tolerability were similar with DAXI and placebo regardless of prior BoNTA treatment. Assuming an appropriate washout is observed, future BoNTA trials should enroll both treatment-experienced and treatment-naive participants to reflect clinical practice.
Utility of Debulk Specimens During Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma
Authors: McIlwee Bridget E. , Abidi Nadia Y. , Ravi Manisha , Carr David R. 
Published: February 2021

BACKGROUND
Limited literature exists regarding whether intraoperative analysis of frozen debulk specimens during Mohs micrographic surgery (MMS) improves identification of high-risk features (HRF) of cutaneous squamous cell carcinoma (CSCC).

OBJECTIVE
Primary: identification of new HRF on debulk specimens. Secondary: CSCC upstaged after considering debulk data.

MATERIALS AND METHODS
A single-center, retrospective cohort study of patients with biopsy-proven CSCC treated by MMS with intraoperative frozen debulk analysis. Restricted (poor differentiation, new perineural invasion ≥0.1 mm, and Breslow depth >6 mm) and nonrestricted (any worsened tumor differentiation, any new perineural invasion, and Breslow depth >2 mm) analyses were performed.

RESULTS
In restricted analysis, 3.94% of cases had 1 new HRF on debulk analysis. In nonrestricted analysis, 32.9% of cases had ≥1 new HRF; 7.6% increased by 2 HRF. Approximately 2.0% of cases were upstaged by American Joint Committee on Cancer system, eighth edition criteria, 1.4% by Brigham and Women's Hospital. Tumor size ≥2 cm, male sex, and moderate differentiation on biopsy were significantly associated with new HRF identified on debulk analysis.

CONCLUSION
Intraoperative frozen debulk analysis can reveal HRF of CSCC not seen on biopsy or MMS stages, particularly among tumors ≥2 cm. American Joint Committee on Cancer system, eighth edition T2 tumors were most likely to be upstaged. Identification of new HRF on debulk analysis can improve CSCC staging and may impact patient treatment and follow-up.
New Concept for Severely Burned Ear Reconstruction: Grafting of the Frame Using Banked Ear Cartilage Combined with Costal Cartilage
Authors: Yotsuyanagi Takatoshi , Yamashita Ken , Sugai Asuka , Kato Shinji , Gonda Ayako , Kitada Ayaka , Onuma Masahiro , Kudo Mami 
Published: February 2021

Background:
Damage and loss of ear cartilage can easily occur in a burned ear accompanied by severe extensive burns due to exposure of the cartilage or chondritis. Deformity can also occur due to later development of scar contracture despite minimal damage to the ear cartilage when the injury occurred. We have developed a new technique for treatment of a deep burn in the whole ear.

Methods:
In the new technique, the ear is amputated, and soft tissues are denuded. The cartilage is banked in a subcutaneous pocket in the chest and later regrafted in combination with costal cartilage.

Results:
Although techniques for regrafting banked ear cartilage have been reported, the reconstructed ear cannot acquire a good shape because of absorption of the cartilage or lack of intensity to sustain the outline of the ear. Meanwhile, when we tried to reconstruct an ear by only using costal cartilage, we found it difficult to fabricate a frame because most patients are adults in whom the costal cartilage is too rigid and fragile to be shaved or combined. In our technique, the frame has both the advantages of sufficient intensity in costal cartilage and a smooth curved surface together with elasticity in the ear cartilage. Ears reconstructed by our technique have a natural appearance.

Conclusion:
Our technique can be used for cases in which treatment for another large area of the body surface needs to be performed first to save the patient’s life.
Interdisciplinary Care for Amputees Network: A Novel Approach to the Management of Amputee Patient Populations
Authors: Sobti Nikhil , Park Andy , Crandell David , Smith Felicia A. , Valerio Ian , Lozano-Calderon Santiago A. , Eberlin Kyle R. , Heng Marilyn 
Published: February 2021

Summary:
Extremity amputation remains a common intervention for limb-threatening conditions. With advancement in surgical technique to address deleterious postoperative sequelae of limb removal, there is a salient need to develop and operationalize interdisciplinary care frameworks to provide more comprehensive care to an otherwise challenging patient population. Herein, we describe our interdisciplinary approach to the management of amputee patient populations at our institution, referred to as the Interdisciplinary Care for Amputees Network (ICAN). This novel framework focuses on 3 fundamental areas: combined preoperative patient evaluation, orthoplastic surgical intervention, and multi-specialty postoperative functional and psychosocial rehabilitation. Importantly, the successful implementation of a combined orthoplastic clinic requires establishing a working relationship among providers to leverage increased provider familiarity. This, coupled with sufficient clinic space, dedicated operating room time, and standardized patient workflow, serves to improve care and meet patient goals of pain minimization, return to desired functional status, and improvement in quality of life.
Subjective Cognitive Functioning in Silicone Breast Implant Patients: A Cohort Study
Authors: Colaris Maartje J. L. , Cohen Tervaert Jan Willem , Ponds Rudolf W. H. M. , Wilmink Johan , van der Hulst Rene R. W. J. 
Published: February 2021

Background:
Cognitive impairment is frequently reported by silicone breast implant (SBI) patients. The aim of our study is to investigate whether subjective cognitive failure indeed is more frequent in a cohort of SBI patients compared with healthy controls (HCs). Furthermore, the severity of this cognitive failure and a possible relation to other symptoms as well as the duration of SBI exposure was examined. In addition, we assessed the effect of ruptures and reinterventions on cognitive failure severity.

Methods:
A cohort study was performed, including 376 women and consisting of 3 different groups of patients; 143 SBI patients (group 1), 94 age- and sex-matched HC patients (group 2), and 139 women with SBI and health issues who registered themselves at a Dutch foundation for women with illness due to SBI (group 3). All patients filled in the Cognitive Failure Questionnaire (CFQ). The American College of Rheumatology Fibromyalgia Diagnostic Criteria (2010) were used to score other symptoms.

Results:
Completed CFQ data from 222 patients were available for analysis: n = 79 for group 1, n = 62 for group 2, and n = 81 for group 3. SBI patients from group 3 had a significantly higher prevalence of subjective cognitive dysfunction (CFQ score ≥ 43) compared with SBI patients from group 1 and HC (60.5% versus 13.9% and 12.9%; P = 0.000). Linear regression showed a statistically significant relation between subjective cognitive functioning scores and other symptoms (P = 0.000). Implant duration as well as rupture rate and reinterventions were not found to significantly influence CFQ scores.

Conclusion:
An increased risk of cognitive failure in consecutive SBI patients when compared with HCs could not be found.
A Standardized Hand Fracture Fixation Training Framework using Novel 3D Printed Ex Vivo Hand Models: Our Experience as a Unit
Authors: Papavasiliou Theodora , Chatzimichail Stelios , Chan Jeffrey C. Y. , Bain Charles J. , Uppal Lauren 
Published: February 2021

Background:
Surgery for hand trauma accounts for a significant proportion of the plastic surgery training curriculum. The aim of this study was to create a standardized simulation training module for hand fracture fixation with Kirschner wire (K-wire) techniques for residents to create a standardized hand training framework that universally hones their skill and prepares them for their first encounter in a clinical setting.

Methods:
A step-ladder approach training with 6 levels of difficulty on 3-dimensional (3D) printed ex vivo hand biomimetics was employed on a cohort of 20 plastic surgery residents (n = 20). Assessment of skills using a score system (global rating scale) was performed in the beginning and at the end of the module by hand experts of our unit.

Results:
The overall average scores of the cohort before and after assessment were 23.75/40 (59.4%) and 34.7/40 (86.8%), respectively. Significant (P < 0.01) difference of improvement of skills was noted on all trainees. All trainees confirmed that the simulated models provided in this module were akin to the patient scenario and noted that it helped them improve their skills with regard to K-wire fixation techniques, including improvement of their understanding of the 3D bone topography.

Conclusions:
We demonstrate a standardized simulation training framework that employs 3D printed ex vivo hand biomimetics proved to improve the skills of residents and that paves the way to more universal, standardized and validated training across hand surgery. This is, to our knowledge, the first standardized method of simulated training on such hand surgical cases.
Expanding the Horizon: Single-port Robotic Vascularized Omentum Lymphatic Transplant
Authors: Teven Chad M. , Yi Johnny , Hammond Jacob B. , Aime Victoria L. , Pallace Nathan M. , Pearson David G. , Casey William J. , Rebecca Alanna M. 
Published: February 2021

Summary:
Vascularized omentum lymphatic transplant is frequently used for the treatment of lymphedema due to demonstrated efficacy, a reduced complication profile, and, in particular, negligible risk of donor site lymphedema. Historically harvested by open laparotomy, more recent techniques involve laparoscopic omental harvest. Although effective and reproducible, laparoscopy may be limited by reduced visualization, minimal tactile feedback, multiple port sites, and imprecise instrumentation. Therefore, we employed the da Vinci Single-Port (SP) surgical robot system for vascularized omentum lymphatic transplant. A 52-year-old man with a 3-year history of progressive left lower extremity swelling and lymphoscintigraphy and magnetic resonance lymphangiogram consistent with lymphedema of unknown etiology underwent vascularized omentum lymphatic transplant to the left groin. A 2.5-cm infraumbilical incision was used for placement of the primary trocar, through which the camera and operating instruments were passed. Following robotic harvest, the omental lymph node flap was transferred to the left groin for microsurgical anastomosis. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6 weeks, there were no complications. Here, we show for the first time the safety and feasibility of robotic omental lymph node flap harvest for extremity lymphedema using the da Vinci Single-Port robotic system. The benefits of this technology include a minimally-invasive approach that allows for flap dissection and removal through a single 2.5-cm incision. Further investigation is necessary to characterize the indications and limitations of this technique in plastic surgery.
Open Dislocation Injury of the Metacarpophalangeal Joints III–V: Case Report
Authors: Beylich Tino , Schmidt Ingo 
Published: February 2021

SummaryA 79-year-old man sustained left open metacarpophalangeal joints III–V dislocation injury in the dorsal direction associated with avulsions of the volar fibrocartilaginous plates. Surgical revision became necessary. Three months after the injury, the patient was very satisfied with his intermedium outcome; however, complete restoration of hand function was not observed at this time. To our knowledge, this is the first case presentation in the literature that describes such an injury involving the metacarpophalangeal joints III–V.
Thermal Imaging in a Clinically Non-assessable Free Flap Reconstruction of the Face
Authors: Frohwitter Gesche , Nobis Christopher-Philipp , Weber Manuel , Oetter Nicolai , Rau Andrea , Kesting Marco R. , Lutz Rainer 
Published: February 2021

Summary:
Free flap monitoring and early detection of malperfusion are a central aspect in reconstructive surgery. Warm ischemia, measured as the time a certain tissue is able to survive without any additional medical or thermal treatment, ranges from hours in muscle and nerval tissue up to days in bony tissue. Hence, meticulous flap monitoring is essential to discover early signs of malperfusion and decide upon timely re-intervention. Besides clinical examination techniques and Doppler sonography, a multitude of mostly experimental procedures are available to evaluate free flap perfusion. Particularly in older patients, the assessment of the skin island in microvascular grafts is a demanding task because the natural loss of elasticity, the reduction of subcutaneous tissue, and the decrease in water content limit the visibility of capillary filling and favor hematomas. We report a case of a 90-year-old woman with an extensive cutaneous squamous cell carcinoma of the right zygomatic and lateral orbital region without any locoregional or distant metastasis. Due to the resilient health status, we decided for a surgical approach with consecutive microvascular radial forearm flap reconstruction. On account of the difficult assessment of elderly skin after microvascular transplantation, we decided on additional flap monitoring by thermal heat imaging during the operation and aftercare. This case report discusses the successful application of thermal heat imaging in a clinical non-assessable free flap and discusses the application of dynamic infrared thermography as a monitoring tool in microvascular free flap surgery.
Benefits of Cardiac Rehabilitation on Functional Status and Mood Disorders in Elderly and Very Elderly Patients
Authors: Cañas Felipe , Giraldo German C. , Murillo Angela , Perafán Pablo E. , Quintero Orlando 
Published: February 2021

Purpose:
Patients ≥80 yr are not frequently referred for cardiac rehabilitation (CR). This study aimed to describe the benefit of CR in the very elderly population in comparison with patients ≤65 and 66-79 yr in terms of gain in functional status and improvement of mood disorders.

Methods:
We conducted a prospective, cohort, single-center study. Physical performance was evaluated with a 6-min walk test (6MWT). Anxiety, depression, and overall psychological distress were evaluated with Hospital Anxiety and Depression Scale (HADS) scores. Primary outcomes were the percent improvement in the predicted distance and the reduction in the prevalence of anxiety, depression, and overall psychological distress.

Results:
There were 45 (9%) patients ≥80 yr among 499 participants. There were no significant differences in the percent improvement of the predicted distance in the 6MWT among age groups, being +15 (7, 25)%, +15 (7, 25)%, and +10 (4, 26)% for ≤65, 66-79, and ≥80-yr groups, respectively (P = .11). The elderly group had a higher prevalence of depression, anxiety, and overall psychological distress (72%, 51%, and 38%, respectively). After CR, there was a significant improvement in HADS scores in all groups. The prevalence of depression was reduced by 38%, anxiety by 60%, and overall psychological distress by 58%.

Conclusion:
Patients ≥80 yr have decreased physical performance and a higher prevalence of mood disorders than their younger counterparts. Nevertheless, they improved significantly in all outcomes measured.
Corneal Stromal Regeneration Therapy for Advanced Keratoconus: Long-term Outcomes at 3 Years
Authors: El Zarif Mona , Alió Jorge L. , Alió del Barrio Jorge L. , Abdul Jawad Karim , Palazón-Bru Antonio , Abdul Jawad Ziad , De Miguel María P. , Makdissy Nehman 
Published: February 2021

Purpose:
To report the 3-year clinical outcomes of corneal stromal cell therapy consisting of the intrastromal implantation with autologous adipose-derived adult stem cells (ADASCs), and decellularized or ADASC-recellularized human donor corneal laminas in advanced keratoconus.

Methods:
Fourteen patients were enrolled in 3 experimental groups. Group 1 (G-1) patients underwent implantation of ADASCs alone (3 × 106 cells/1 mL) (n = 5). Group 2 (G-2) patients received a 120-μm decellularized corneal stroma lamina (n = 5). Group 3 (G-3) patients received a 120-μm lamina recellularized with ADASCs (1 × 106 cells/1 mL) (n = 4). ADASCs were obtained by elective liposuction. Implantation was performed into a femtosecond pocket under topical anesthesia.

Results:
At 3 years, a significant improvement of 1 to 2 logMAR lines in uncorrected distance visual acuity was observed in all groups. A statistically significant decrease in corrected distance visual acuity was obtained in G-2 and G-3 (P < 0.001) when compared with that of G-1. Rigid contact lens distance visual acuity showed a statistically significant worsening in G-2 (P < 0.001) compared with that of G-1. A statistically significant increase in central corneal thickness was observed in G-2 (P = 0.012) and G-3 (P < 0.001); in the Scheimpflug corneal topography, the thinnest point was observed in G-2 (P = 0.007) and G-3 (P = 0.001) when compared with that of G-1.

Conclusions:
Intrastromal implantation of ADASCs and decellularized or ADASC-recellularized human corneal stroma laminas did not have complications at 3 years. The technique showed a moderate improvement in (uncorrected distance visual acuity) and (corrected distance visual acuity) in advanced keratoconus.
Corneal Donor Characteristics and Descemet Membrane Endothelial Keratoplasty Success: A Scoping Review
Authors: Luke Weinel , Tamme Golding-holbrook , Yee Chen Jern , Richard Mills 
Published: February 2021

Purpose:
The purpose of this study was to review published data on donor characteristics and the influence on preoperative Descemet membrane endothelial keratoplasty (DMEK) preparation and intraoperative graft manipulation.

Methods:
A systematic review of PubMed, EMBASE, OVID MEDLINE, and EBSCOhost was conducted up to April 2020. Studies were screened and predefined data criteria extracted. Eleven studies were found to meet the inclusion criteria.

Results:
Research regarding donor characteristics and the relationship to DMEK graft preparation and intraoperative graft manipulation was found to be limited because of the overall low-quality data. However, there was a trend of evidence supporting donor diabetes increasing the risk of graft tearing and consequent preparation failure and younger donors producing tighter scrolls complicating intraoperative graft unfolding.

Conclusions:
Further research into the area is warranted to better understand how donor characteristics impact preoperative DMEK graft preparation and intraoperative graft manipulation.