bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Surgical Anatomy and the Deep Plane Thread Lift of the Buccal Fat Pad
Authors: Tsai Yun-Ta , Zhang Yajie , Wu Yumeng , Yang Hung-Hsu , Chen Lili , Huang Patrick Po-Han , Wang Chao-Huei 
Published: March 2021

Background:
Management of facial rejuvenation by the thread lift procedure has evolved over the past few years. The role of deep plane thread lift for buccal fat pad reposition was advocated. However, there are concerns about the risks and the feasibility of the deep plane thread lift. This study was designed to determine whether the deep plane thread lift could achieve effective aesthetic results and to investigate the possible risks of critical tissue injury through cadaveric studies.

Methods:
Twelve fresh frozen cephalic specimens of 8 male and 4 female Asian body donors (mean age, 63.3 ± 8.0 years) were investigated. The deep plane thread lifts for reposition of the buccal fat pads were performed for all the left hemifaces. Cadaveric dissections were performed to investigate the moving distance of the buccal fat pad and to examine the surrounding tissue of the passage of the deep plane thread lift.

Results:
The average moving distance of the buccal fat pads after the deep plane thread lift was 3.73 cm. The difference in moving distance of buccal fat pads between bilateral sides was statistically significant (P < 0.001). No injuries of the critical vessels or nerves were found after cadaveric dissection. The passage of the deep plane thread lift was evaluated.

Conclusion:
The deep plane thread lift for reposition of the buccal fat pad is a safe, effective, and practical method.
Bilateral Eyebrow Sclerosis: A New Clinical Entity
Authors: Ueno Kazuki , Kunimoto Kayo , Iwahashi Yoshifumi , Murata Shin-ichi , Yamamoto Yuki , Jinnin Masatoshi , Asamura Shinichi 
Published: March 2021

Summary:
We report a man with sparse eyebrows and recurrent bilateral subcutaneous nodules beneath the eyebrows. Their histopathologic features were sclerosis of a subcutaneous lesion. The proliferation of muscle was not obvious and inflammatory cell infiltration was inconspicuous, but some dilated capillaries were noted. Collagen was regularly interlaced, thickened, and hyalinized with dispersed fibroblasts. Various skin tumors can occur on adult faces, but this presentation, to our knowledge, was unique and could not be characterized as a known condition. Plastic surgeons, dermatologists, and pathologists may encounter similar conditions, so it should be considered as a new clinical entity called bilateral eyebrow sclerosis. This may be of comfort to patients with similar conditions. Moreover, we propose enlarged resection to include the skin surface and underlying muscles as an effective treatment for recovery of the eyebrows and prevention of recurrence.
Calibration Tool to Standardize Magnification during Smartphone-based Microsurgical Skills Training
Authors: Rahman Sadeea A. , Henderson Peter W. 
Published: March 2021

Summary:
Acquiring microsurgical skills outside the operating room has traditionally required not only a substantial amount of time and practice, but also a significant amount of equipment, such as an operating microscope. Difficulty in accessing such equipment hinders opportunities to acquire skills, particularly in environments with limited resources. Furthermore, the current era of restricted work hours has led to an increased demand for surgical skills training outside of the clinical setting. The near-ubiquity of the standard smartphone and its ability to magnify, illuminate, and record videos give it the potential to serve as an excellent tool to conduct training in microsurgical skills—particularly in the context of self-directed, home-based training. However, the variety of smartphones available and their inherent variability in technical and optical specifications have made it difficult to create a standardized, reproducible, and interchangeable system for smartphone-based microsurgical training. Therefore, we have developed a simple and effective calibration tool that ensures accurate magnification levels so that smartphone-based microsurgical training can be performed reliably with any device and in virtually any surroundings.
Mini-midface Lift Using Polydioxanone Cog Threads
Authors: Myung Yujin , Jung Chinkoo 
Published: March 2021

Background:
Deepening of the nasolabial fold with reduced malar highlight caused by sagging of the midface is one of the most important characteristics of facial aging. This report describes the use of 18-G polydioxanone (PDO) cog threads to improve midface soft tissue sagging and achieve satisfactory results through a minimally invasive procedure.

Methods:
In total, 64 patients (all women; age, 33–60 years) underwent a midface thread lift from January 2017 to January 2018. After a stab incision was made through an 18-G needle over the lateral orbital rim, three 18-G precannulated PDO cog threads were inserted, targeting the deep medial fat pad and inner layer of the superficial muscular aponeurotic system. The threads were anchored to the periosteum of the lateral orbit, suspending the soft tissue to a more superior direction. Surgical results were evaluated subjectively (patient satisfaction ratings) and objectively (blinded physician ratings based on changes in the vertical position of the malar highlight).

Results:
No major complications (postoperative hematoma, infection, or temporary sensory/motor decreases) were observed. The mean procedural time was 15 minutes, and all patients underwent local anesthesia. Patient satisfaction was the highest at 1 month postoperatively (mean, 4.7/5.0), decreasing at 1 year postoperatively (2.8/5.0). The scores on the objective assessment followed the same trend (4.5/5.0 at 1 month; 3.1/5.0 at 1 year).

Conclusion:
Using PDO cog threads for midface lifting is simpler, quicker, and less invasive than using conventional surgical methods, and this method simultaneously achieves satisfactory results for at least 6 months.
Fibroblast Heterogeneity in and Its Implications for Plastic and Reconstructive Surgery: A Basic Science Review
Authors: desJardins-Park Heather E. , Chinta Malini S. , Foster Deshka S. , Borrelli Mimi R. , Shen Abra H. , Wan Derrick C. , Longaker Michael T. 
Published: March 2021

Summary:
Fibroblasts’ integral role in tissue development, maintenance, and disease represents a fast-growing field of basic science research. Although fibroblasts were long thought to be a homogeneous cell population, recent research has illuminated the unforeseen complexity of these cells, giving rise to the rapidly expanding research field of “fibroblast heterogeneity.” Fibroblasts play a critical role in states of tissue fibrosis such as skin scarring, which affects hundreds of millions of patients annually and causes severe aesthetic, developmental, and functional morbidity. Beyond scarring, major organ fibrosis is an enormous public health concern responsible for nearly half of all deaths in the United States. Because fibrosis is a conserved response to tissue damage in all organs, the study of fibroblasts throughout the body may help us to understand their role in the conditions most relevant to plastic and reconstructive surgery—for instance, skin scarring (eg, from burns, traumatic lacerations, or surgical incisions), “pathological” scarring (hypertrophic scars, keloids), and capsular contracture. Here, we present a basic science review of fibroblast heterogeneity in wound healing, cancer, organ fibrosis, and human dermal architecture. The field of fibroblast heterogeneity is young, and many of the insights discussed have yet to be translated clinically. However, plastic surgeons stand in a unique position to bridge these discoveries into clinical realities. We hope this information can spur readers to consider both what questions in plastic surgery can be studied from the lens of fibroblast heterogeneity, and how these preclinical insights can be translated to improving care of our patients.
Pleuroperitoneal (Denver) Shunt for Recurrent Nonmalignant Breast Seroma in a Metastatic Breast Cancer Patient
Authors: Pflibsen Lacey R. , Velazco Cristine S. , Rhee Daniel H. , Bryant Lyndsey A. , Chapital Alyssa B. , Rebecca Alanna M. 
Published: March 2021

Summary:
Pleuroperitoneal (Denver) shunts have been used primarily for palliation of refractory malignant and chylous peritoneal and pleural collections.
1–5
We used a pleuroperitoneal (Denver) shunt for a recurrent, nonmalignant breast seroma in the palliation of metastatic breast cancer as a novel use of this shunt.
Efficacy of a Coriolus versicolor–Based Vaginal Gel in Women With Human Papillomavirus–Dependent Cervical Lesions: The PALOMA Study
Authors: Serrano Luis , López Andrés Carlos , González Silvia P. , Palacios Santiago , Dexeus Damián , Centeno-Mediavilla Cristina , Coronado Pluvio , de la Fuente Jesús , López José Antonio , Vanrell Cristina , Cortés Javier 
Published: March 2021

Objective
The aim of the study was to evaluate the efficacy of Papilocare, a Coriolus versicolor–based vaginal gel, in repairing human papillomavirus (HPV)-related low-grade cervical lesions.

Methods
The study is a multicenter, open-label, randomized, parallel-group, watchful waiting approach-controlled trial involving 91 HPV-positive women with low-grade Pap smear alterations and consistent colposcopy.

Results
The percentage of patients with normal Pap smear and concordant colposcopy 3 and 6 months after receiving treatment (78.0% and 84.9%) was significantly higher than without treatment (54.8% and 64.5%), especially in high-risk HPV patients (79.5% and 87.8% vs 52.0% and 56.0%). At 6-month visit, overall HPV clearance was achieved by a greater number of patients receiving treatment (59.6%) compared with those without treatment (41.9%), especially high-risk HPV ones (62.5% vs 40.0%). The cervical re-epithelization score was significantly higher with treatment (mean = 4.5) than without (mean = 4.1). Compared with baseline, perceived stress decreased in the treatment group (from 21.1 to 19.0) and increased in the control group (from 17.7 to 20.7). A total of 7 possible or probable treatment-related adverse events were reported, most of them (n = 6) being mild or moderate in severity.

Conclusions
Treatment with Papilocare has demonstrated a better clinical benefit than the conventional watchful waiting approach in clinical practice for total and high-risk HPV patients in terms of its efficacy to treat HPV-related cervical lesions and to clear all HPV strains after a single 6-month period. It has demonstrated an adequate safety and tolerability and confers additional benefits such as higher re-epithelization, stress reduction, and high treatment adherence.
Efficacy of orthopaedic-inspired osteoporosis management: a secondary fracture prevention program after a fracture of the hip in a prospective randomized study
Authors: Zinger Gershon , Sylvetsky Noa , Levy Yedin , Steinberg Kobi , Bregman Alexander , Yudkevich Genady , Peyser Amos 
Published: March 2021

Abstract

Aims:
Patients who present with fragility fractures are consistently under-evaluated and under-treated for underlying osteoporosis. This point-of-care represents a lost opportunity to prevent future fractures. This 2-arm study evaluated the success by an orthopaedic department in osteoporosis evaluation and initiating treatment.

Methods:
Patients over the age of 50 years with a fragility fracture of the hip were candidates for inclusion. Exclusion criteria included end-of-life care and moderate or severe dementia. Patients were prospectively randomized into 1 of 2 groups. The Letter group received a letter at the time of discharge encouraging their primary care physician to start medication for osteoporosis (Letter group). The intervention group had 4 interventions including printed information, a DEXA scan, a specific treatment recommendation, and monthly phone calls for 4 months (Intervention group). The primary outcome measure was whether the patient was on recommended treatment at 4 months from the fracture.

Results:
There were 200 patients in the study, 100 in the Letter, and 100 in the Intervention group. Sixteen patients were removed from the study since they either died (9) within 4 months of their fracture, were transferred for end-of-life care (7), and 4 dropped out. This left 180 patients for analysis. The Letter group had only 6 patients (6.2%) on recommended treatment compared with the Intervention group with 64 patients (77.1%). This was statistically significant (P < 0.0001).

Conclusion:
Osteoporosis is a worldwide epidemic. Internationally, only about 20% of patients after a hip fracture are treated for their underlying weak bone. The most effective systems use a fracture liaison service (FLS) model. We present a 4-part intervention program that uses an FLS coordinator within the orthopaedic department. We encourage orthopaedic programs to adopt this or other models with the goal of taking the first step toward responsibility for bone health.
An FLS program within an orthopaedic department can successfully initiate treatment for underlying osteoporosis.
Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania
Authors: von Kaeppler Ericka P. , Donnelley Claire A. , Roberts Heather J. , Eliezer Edmund N. , Haonga Billy T. , Morshed Saam , Shearer David W. 
Published: March 2021

Objectives:
To compare clinical and radiographic outcomes following antegrade versus retrograde intramedullary nailing of infraisthmic femoral shaft fractures.

Design:
Secondary analysis of prospective cohort study.

Setting:
Tertiary hospital in Tanzania.

Participants:
Adult patients with infraisthmic diaphyseal femur fractures.

Intervention:
Antegrade or retrograde SIGN intramedullary nail.

Outcomes:
Health-related quality of life (HRQOL), radiographic healing, knee range of motion, pain, and alignment (defined as less than or equal to 5 degrees of angular deformity in both coronal and sagittal planes) assessed at 6, 12, 24, and 52 weeks postoperatively.

Results:
Of 160 included patients, 141 (88.1%) had 1-year follow-up and were included in analyses: 42 (29.8%) antegrade, 99 (70.2%) retrograde. Antegrade-nailed patients had more loss of coronal alignment (P = .026), but less knee pain at 6 months (P = .017) and increased knee flexion at 6 weeks (P = .021). There were no significant differences in reoperations, HRQOL, hip pain, knee extension, radiographic healing, or sagittal alignment.

Conclusions:
Antegrade nailing of infraisthmic femur fractures had higher incidence of alignment loss, but no detectable differences in HRQOL, pain, radiographic healing, or reoperation. Retrograde nailing was associated with increased knee pain and decreased knee range of motion at early time points, but this dissipated by 1 year. To our knowledge, this is the first study to prospectively compare outcomes over 1 year in patients treated with antegrade versus retrograde SIGN intramedullary nailing of infraisthmic femur fractures.
Level of Evidence: III
Considerations for Payment Bundling in Cleft Care
Authors: Ahsanuddin Sofia , Sayegh Farah , Lu Jocelyn , Sanati-Mehrizy Paymon , Taub Peter J. 
Published: March 2021

Summary:
Since the introduction of the Bundled Payments for Care Improvement initiative, progress has been made in piloting bundled payment models to improve care coordination and curtail health care expenditures. In light of improvements in patient outcomes and the concomitant reduction in health care spending for certain high-volume and high-cost procedures, such as total joint arthroplasty and breast reconstruction, the authors discuss theoretical considerations for bundling payments for the care of patients with orofacial clefts. The reasons for and against adopting such a payment model to consolidate cleft care, as well as the challenges to implementation, are discussed. The authors purport that bundled payments can centralize components of cleft care and offer financial incentives to reduce costs and improve the value of care provided, but that risk adjustment based on the longitudinal nature of care, disease severity, etiologic heterogeneity, variations in outcomes reporting, and varying definitions of the episode of care remain significant barriers to implementation.
Recommended Maximum Laryngeal Prominence Size in Adult Females: A Cross-Sectional Study Proposing a Laryngeal Prominence Size Standard for Chondrolaryngoplasty in Male-to-Female Transgender Individuals
Authors: van Rossem Anna P. , Meijer Brigitte A. , Rinkel Rico N. P. M. 
Published: March 2021

Background:
Although the World Professional Association for Transgender Health has provided international, multidisciplinary, evidence-based standards of care for various aspects of transgender health care, there is a lack of evidence-based guidelines for facial feminization surgery, including chondro laryngoplasty. The aim of this study was to define the recommended maximum laryngeal prominence size in adult females to propose an evidence-based laryngeal prominence size standard for chondrolaryngoplasty in male-to-female transgender individuals.

Methods:
This cross-sectional study was conducted in a tertiary care hospital. The study sample consisted of cisgender patients aged 18 to 60 years old with no history of surgery or radiotherapy in the head and neck area who visited the Otolaryngology/Head and Neck Surgery outpatient clinic. Laryngeal prominence size data were collected using three-dimensional scanning of the head and neck area.

Results:
Seventy-nine participants, 43 males and 36 females, were included in data analysis. Laryngeal prominence size was larger in male participants (median, 0.16 mm; range, 0 to 9.40 mm) than in female participants (median, 0.00 mm; range, 0 to 1.24 mm) (p < 0.001). The proportion of participants with a laryngeal prominence size larger than 0 mm was greater in male participants (55.81 percent) than in female participants (22.22 percent) (p = 0.002).

Conclusions:
To the authors’ knowledge, this is the first study to assess laryngeal prominence size in the general population. Their results suggest that 2 mm would be the recommended maximum laryngeal prominence size in females. Therefore, a laryngeal prominence size standard of 2 mm could be considered for chondrolaryngoplasty in male-to-female transgender individuals.
Liver Transplantation for Cholangiocarcinoma: Charting a Path With Lessons Learned From Center Experience
Authors: Ziogas Ioannis A. , Rauf Muhammad A. , Matsuoka Lea K. , Izzy Manhal , Rega Scott A. , Feurer Irene D. , Alexopoulos Sophoclis P. 
Published: March 2021

Background.
While liver transplantation (LT) with neoadjuvant chemoradiation is increasingly utilized for the management of unresectable cholangiocarcinoma (CCA), data on post-LT survival are limited.

Methods.
We identified 844 patients who underwent LT (2002–2019) for nonincidental (CCA listing) or incidental (CCA on explant, not at listing) CCA in the Scientific Registry of Transplant Recipients. Kaplan–Meier and multivariable proportional hazards regression methods evaluated the effects of patient characteristics, donor type, transplant era (before/after 2010), and center volume (center-level CCALTs/active year) on the risk of graft failure and patient mortality.

Results.
One center performed >12 CCALTs/y, and the rest performed ≤4. Five-year graft survival was 50.6%. Multivariable models demonstrated laboratory model of end-stage liver disease ≥40 versus <15 and center volumes of 1, >1 to ≤2, and >2 to ≤4 CCALTs/y compared to >12 were associated with increased risk of graft failure and mortality (all P ≤ 0.002). Extra vessel use was associated with center volume. Among all recipients, extra vessel use occurred in 55.4% of CCALTs performed at the highest volume center and in 14.0% of cases at centers having ≤4 CCAs/y (P < 0.05).

Conclusions.
Center volume-related differences in outcomes and extra vessel use highlight the importance of establishing a unified, effective treatment protocol and the potential utility of regionalization of LT for CCA.
Intragraft Hyaluronan Increases in Association With Acute Lung Transplant Rejection
Authors: Hostetler Haley P. , Neely Megan L. , Kelly Francine L. , Belperio John A. , Budev Marie , Reynolds John M. , Shah Pali D. , Singer Lianne G. , Snyder Laurie D. , Palmer Scott M. , Todd Jamie L. 
Published: March 2021

Background.
Acute perivascular rejection (AR) is common in lung recipients and increases the risk for chronic lung allograft dysfunction (CLAD). Hyaluronan (HA), an extracellular matrix constituent, accumulates in experimental AR and can act as an innate immune agonist, breaking tolerance and potentiating alloimmunity. We previously demonstrated HA accumulates in CLAD after human-lung transplantation. We sought to determine if HA accumulates in the bronchoalveolar lavage fluid (BALF) concurrent with AR in lung recipients.

Methods.
The cohort consisted of 126 first adult lung recipients at 5 transplant centers with a total of 373 BALF samples collected within the first posttransplant year. All samples were paired with a lung biopsy from the same bronchoscopy. BALF HA (ng/mL) was quantified by ELISA and log-transformed for analysis. Linear-mixed effect models, adjusted for potential confounders, were used to estimate the association between BALF HA concentration and the presence of AR on biopsy. The association between early posttransplant BALF HA levels and the development of CLAD was explored utilizing tertiles of maximum BALF HA level observed within the first 6 months of transplant.

Results.
In analyses adjusted for potential confounders, BALF HA concentration was significantly increased in association with AR (change in means on log-scale 0.31; 95% CI, 0.01-0.60; P = 0.044). When considered on the original scale (ng/mL), BALF HA concentrations were 1.36 times (36%) higher, on average, among samples with, versus without, AR. The cumulative incidence of CLAD was numerically higher in individuals in the highest tertiles of BALF HA level within the first 6 months after transplant, as compared with those in the lowest tertile; however, this difference was not statistically significant (P = 0.32).

Conclusions.
These results demonstrate accumulation of HA in clinical AR and suggest a mechanism by which innate and adaptive immune activation might interact in the development of AR and CLAD.
Preferred sound groups of vocal iconicity reflect evolutionary mechanisms of sound stability and first language acquisition: evidence from Eurasia
Authors: Dellert Johannes , Erben Johansson Niklas , Frid Johan , Carling Gerd 
Published: March 2021

In speech, the connection between sounds and word meanings is mostly arbitrary. However, among basic concepts of the vocabulary, several words can be shown to exhibit some degree of form–meaning resemblance, a feature labelled vocal iconicity. Vocal iconicity plays a role in first language acquisition and was likely prominent also in pre-historic language. However, an unsolved question is how vocal iconicity survives sound evolution, which is assumed to be inevitable and ‘blind’ to the meaning of words. We analyse the evolution of sound groups on 1016 basic vocabulary concepts in 107 Eurasian languages, building on automated homologue clustering and sound sequence alignment to infer relative stability of sound groups over time. We correlate this result with the occurrence of sound groups in iconic vocabulary, measured on a cross-linguistic dataset of 344 concepts across single-language samples from 245 families. We find that the sound stability of the Eurasian set correlates with iconic occurrence in the global set. Further, we find that sound stability and iconic occurrence of consonants are connected to acquisition order in the first language, indicating that children acquiring language play a role in maintaining vocal iconicity over time.This article is part of the theme issue ‘Reconstructing prehistoric languages'.